Hearing Aids Denied by Insurance? How to Appeal

Hearing aids cost $1,000–$7,000+ per pair, and most health insurance plans — including traditional Medicare — don't cover them. But coverage is expanding, and for those who do have coverage, denials can be fought. Here's a complete guide.

The Hearing Aid Coverage Landscape in 2026

Traditional Medicare (Parts A and B): Does NOT cover hearing aids or routine hearing exams. This is a major coverage gap.

Medicare Advantage (Part C): Many Medicare Advantage plans include hearing aid benefits as an extra benefit. Coverage varies widely by plan — check your specific MA plan's hearing aid benefit.

ACA Marketplace Plans: Most do not cover hearing aids for adults. Some state benchmarks include pediatric hearing aid coverage.

Employer/Commercial Plans: Hearing aid coverage is not required for adults under ACA, but many plans include a limited hearing aid benefit (e.g., $500–$2,500 every 3 years per ear).

State Mandates: As of 2026, many states mandate hearing aid coverage for children; fewer states mandate adult coverage. States with significant adult hearing aid mandates include: Arkansas, Connecticut, New Hampshire, New Mexico, Oklahoma, Rhode Island, and others (check current state regulations).

OTC Hearing Aids (FDA Rule 2022): The FDA created a category of over-the-counter hearing aids for adults with mild-to-moderate hearing loss. OTC hearing aids (Sony, Jabra, Jabra Enhance, Eargo, Lexie, etc.) cost $200–$1,500 and are sold without a prescription. They are generally not covered by insurance but significantly increase access.

If You Have Hearing Aid Coverage — And It Was Denied

Common Denial Reasons

Degree of hearing loss threshold not met: Plans often require a specific audiometric threshold (e.g., hearing loss of ≥30 dB in the better ear, or pure tone average ≥25 or ≥40 dB in the speech frequencies) before covering hearing aids.

Benefit frequency exceeded: Plans cover hearing aids every 3–5 years; requests within that period are denied.

Specific device not covered: Plan covers basic hearing aids but not the specific model prescribed (e.g., Bluetooth-enabled, rechargeable, behind-the-ear vs. in-the-ear preference).

Not age-eligible: Some plans only cover children under 18 (per state mandates) and deny for adults.

Prior audiologist evaluation not included: Plans require a licensed audiologist evaluation with audiogram results before approving.

Building Your Hearing Aid Appeal

Step 1: Get audiogram documentation Your appeal must include:

• Recent audiogram (ideally within 6 months) performed by a licensed audiologist
• Pure tone averages (PTA) in speech frequencies (500, 1000, 2000, 4000 Hz)
• Word recognition scores (speech discrimination score)
• Type of hearing loss: conductive, sensorineural, or mixed

Step 2: Document functional impact

• HHIE (Hearing Handicap Inventory for the Elderly) or HHIA (adults) scores
• Describe specific functional limitations: difficulty with work communication, phone calls, social situations, safety awareness
• Impact on employment, relationships, and daily functioning

Step 3: Medical necessity for specific device features If the prescribed device has specific features (directional microphones, Bluetooth, rechargeable, tinnitus masking):

• Document the clinical indication for each feature
• Bluetooth: for integration with assistive listening devices at work or school
• Rechargeable: dexterity limitations (arthritis, stroke) preventing battery changes
• Tinnitus masking: documented tinnitus requiring therapeutic noise suppression

Step 4: Audiologist's letter Include a detailed recommendation letter from the audiologist stating:

• Diagnosis (hearing loss type and degree)
• Why hearing aids are medically necessary
• Why the specific prescribed device is appropriate (vs. a less expensive alternative)

Children's Hearing Aid Appeals

For children under 18:

• Most states mandate hearing aid coverage for children — cite your state's mandate
• EPSDT (Medicaid): All Medicaid-enrolled children under 21 must receive medically necessary hearing aids under EPSDT
• If Medicaid denied hearing aids for a child: file an EPSDT appeal stating that hearing aids are medically necessary for educational and developmental purposes
• ACA marketplace plans must cover pediatric hearing aids in states where it's an EHB (Essential Health Benefit)

Medicare Advantage Hearing Aid Coverage

If your MA plan has a hearing benefit:

Check your Evidence of Coverage (EOC): The EOC specifies the hearing aid benefit in detail — covered amounts, eligible providers, covered device types, frequency limits.

Common MA hearing aid coverage:

• Annual benefit allowance: $500–$2,500 per year (varies enormously by plan)
• Requires audiologist visit for evaluation
• May require purchase through specific plan-approved providers

If denied by MA plan:

• File appeal within the MA plan's timeframe
• Expedited appeal if health-related urgency exists
• Escalate to the Independent Review Entity (IRE) if internal appeal fails

Veterans: VA Hearing Aid Coverage

Veterans with hearing loss related to military service (noise exposure, traumatic brain injury) can receive hearing aids at no cost through the VA:

• Service-connected hearing loss: Full coverage
• Non-service-connected: Available based on priority group and VA eligibility

If denied VA hearing aids:

• File a VA Notice of Disagreement (NOD)
• Request Board of Veterans' Appeals review
• DAV, VFW, or VSO representatives can assist with appeals

OTC Hearing Aid Alternative

While pursuing your appeal:

• Consider OTC hearing aids as a bridge option for mild-to-moderate hearing loss
• FDA-regulated OTC devices are available without prescription
• Cost: $200–$1,500 vs. $3,000–$7,000 for prescription devices
• Not a substitute for severe or profound hearing loss, which requires prescription devices

Sample Appeal Language

"I am appealing the denial of hearing aids. The attached audiogram documents [PTA of X dB, word recognition score of Y%] in [left/right/both] ear(s), demonstrating [moderate/severe] sensorineural hearing loss. My audiologist, [Name], has determined that hearing aids are medically necessary to restore functional hearing for communication, safety, and occupational purposes.

[For children:] Per [State] hearing aid mandate and ACA Essential Health Benefits requirements for pediatric hearing, this child is entitled to hearing aid coverage. Per EPSDT requirements (42 U.S.C. § 1396d(r)), medically necessary hearing aids must be covered for Medicaid enrollees under 21.

I respectfully request reversal of this denial."

Fight Back With ClaimBack

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Related Reading

• What Is Medical Necessity and How to Prove It
• Medicare Claim Denied? How to Appeal
• Common Reasons Insurance Claims Are Denied