What’s the scoop on Medi-Cal hearing aid coverage?

Written by Kim Cantrell, CFILC’s Director of Programs

With so many cuts to Medi-Cal and other social service programs, it makes sense that many of us are confused when it comes to Medi-Cal coverage. Lately the AT Network has received many questions from people throughout California who want to know if Medi-Cal still covers hearing aids and hearing exams, and if so, under what circumstances. Medi-Cal reduced benefits coverage in 2009, which makes now a good time to review Medi-Cal’s scope of audiology benefits, including hearing aids and hearing exams.

Medi-Cal currently covers hearing aids for people with at least a 25 dB hearing loss in the better ear and moderate to severe loss in the other ear when prescribed by a qualified physician. Since July 1, 2009, Medi-Cal no longer covers the hearing exam needed prior to being prescribed hearing aids.

However, there are exceptions. According to the Medi-Cal website, people in the following situations still receive hearing exam coverage:

a. Pregnant women will receive the optional benefit if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.

b. Children or young adults who are 20 years old and younger and receive full scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) and Sub Acute Facility.

So unless you are under 21-years-old or live in a nursing home, chances are you have to pay for a hearing exam out of pocket if Medi-Cal is your only insurance coverage. I find this process frustrating because people who can’t afford the hearing exam are forced to go without needed hearing aids.

Once you get your hearing aids, Medi-Cal no longer covers testing them unless you are one of the populations listed under A, B and C above. You are also on your own for replacement batteries unless you are EPSDT-eligible. The good news is that Medi-Cal continues to cover hearing aid repair and replacement parts.

Have you had any experiences with Medi-Cal’s new audiology coverage limitations? Have you or someone you know who has Medi-Cal been unable to receive a needed hearing exam?