New HEAR Act Mandates Medicare Coverage for Hearing Aids and Rehab, Starting as Late as 2028

The proposed Help Extend Auditory Relief Act of 2025 (HEAR Act) is straightforward: it aims to finally bring hearing aids and related rehabilitation services under Medicare coverage. This is a big deal because, right now, Medicare generally excludes coverage for hearing aids. The bill amends the Social Security Act to include both aural rehabilitation services and hearing aids as covered durable medical equipment (DME), effectively removing the current exclusion.

The End of the Hearing Aid Exclusion

For anyone with Medicare who has struggled with the high cost of hearing aids—which often run thousands of dollars out-of-pocket—this bill is a game-changer. The HEAR Act defines covered “hearing rehabilitation” broadly. It includes the hearing aid itself (which must be an FDA-approved wearable device, explicitly excluding over-the-counter options), plus all the necessary services that go with it. Think comprehensive audiologic assessments, initial fittings, adjustments, instruction on use, and rehabilitation counseling like speech reading and auditory training. Essentially, it covers the full process, not just the hardware.

Who Gets Covered and When

There are a few key rules for eligibility. First, you must have hearing loss that is treatable with a hearing aid. Second, you can only receive a new covered device (one monaural or two binaural aids) every three years. The bill specifically notes that if your hearing has deteriorated since your last aid such that a different type is needed, you’d be eligible for replacement, but the three-year clock is the standard. This three-year limit is worth noting, especially for people whose hearing loss progresses quickly; they might find themselves waiting for coverage even if their current aid is no longer sufficient. Also, the bill gives the Secretary of Health and Human Services some wiggle room on the start date. While the Act takes effect immediately upon enactment, the actual coverage for items and services won’t start until January 1 of the first year after enactment, or as late as January 1 of the third year after enactment. So, while the bill is promising, the benefits might not hit until 2028, depending on when the bill passes and how fast the bureaucracy moves.

The Fine Print: What’s Not Included and Who Pays

By explicitly covering only FDA-approved wearable hearing aids and excluding over-the-counter (OTC) hearing aids, the bill ensures that beneficiaries receive devices fitted and managed by professionals, which is generally a good thing for quality of care. However, it means that the lower-cost, consumer-driven OTC market won't be subsidized by Medicare. This might limit choices for people who prefer a simpler, cheaper option, but it focuses the benefit on clinically managed care. Furthermore, covering these expensive items and services will significantly increase Medicare expenditures. While this is great news for seniors who need the devices, it means higher costs for taxpayers funding the program. This is the trade-off: better health access for millions, but a larger bill for the federal government to pick up.