This act clarifies that Medicare must cover surgically implanted active middle ear devices by defining them as prosthetics, exempting them from standard hearing aid exclusions.
Amy Klobuchar
Senator
MN
The Hearing Device Coverage Clarification Act ensures that surgically implanted active middle ear implants are explicitly covered by Medicare. This is achieved by mandating that CMS classify these devices as "prosthetics." This clarification prevents the implants from being excluded under the existing Medicare rule that generally denies coverage for routine hearing aids.
Medicare Mandated to Cover Advanced Hearing Implants Within 60 Days, Bypassing 'Routine' Hearing Aid Exclusion
The new Hearing Device Coverage Clarification Act cuts straight to the chase: it mandates that Medicare must cover specific, surgically implanted hearing technology. Within 60 days of the law taking effect, the head of the Centers for Medicare & Medicaid Services (CMS) has to issue a formal ruling stating that active middle ear implants are officially classified as “prosthetics.” This isn't just bureaucratic paperwork; it’s the key to unlocking coverage for Medicare beneficiaries who need these advanced devices.
The Prosthetic Loophole
Why does calling it a “prosthetic” matter so much? Because Medicare has a long-standing rule—found in section 1862(a)(7) of the Social Security Act—that explicitly excludes coverage for routine hearing aids. This is why if you need a standard hearing aid, you're usually paying out of pocket. This bill uses the existing definition of a prosthetic (found in 42 CFR 414.202) to draw a clear line between a replaceable hearing aid and an advanced, surgically installed medical device. By classifying the active middle ear implant as a prosthetic, the bill ensures it can’t be denied coverage under that routine hearing aid exclusion.
What This Means for Everyday Access
For Medicare recipients, this is a big deal. Active middle ear implants are not cheap; they can cost tens of thousands of dollars, making them financially out of reach for many seniors. This bill removes that massive financial barrier for people who have specific types of hearing loss that require this advanced surgical solution. Think of a retiree who relies on Medicare and needs this specific technology to stay connected with family, remain in the workforce, or simply function safely in daily life. This clarification makes that technology accessible.
The Cost of Clarity
While this is a clear win for patient access, it’s worth noting that expanding coverage means expanding costs for the Medicare system. The bill doesn't introduce new funding; it simply mandates that Medicare must pay for these devices and the associated surgical procedures, which will increase expenditures for the program. However, the clarity provided here is valuable. It gives providers certainty that they will be reimbursed for these medically necessary implants, which should smooth the path for patients seeking care.