Insurance and coverage
Will insurance pay for this?
It's the first question almost every patient or family asks, and it's rarely answered plainly. This page explains what Medicare and HearQuest's contracted commercial plans actually cover, sourced directly from Medicare.gov. It is general education, not a coverage determination for your specific plan.
Reviewed by Dr. Reginald Arevalo, AuD, CCC-A, FAAA · Last reviewed August 29, 2026· Coverage rules change and vary by plan. Confirm details with your specific plan, or with HearQuest, before scheduling.
What Original Medicare covers
Medicare Part B covers diagnostic hearing and balance exams when your doctor or other health care provider orders them to find out if you need medical treatment. The exam has to be diagnostic, evaluating a specific concern, not a routine or preventive hearing check.
After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for the exam. Original Medicare does not cover hearing aids or exams for fitting hearing aids, a gap covered in more detail below. (Source: Medicare.gov, Hearing & balance exams.)
You can see an audiologist once a year without a referral
Most people don't know this, and it removes a real barrier to getting an evaluation: Medicare lets you visit an audiologist once every 12 months without an order from your health care provider. This applies to non-acute hearing conditions, the gradual hearing loss that develops over years, and to diagnostic services related to surgically implanted hearing devices.
You don't need to see your primary care doctor first to get that annual visit covered. Other diagnostic hearing and balance exams outside that yearly visit still need to be ordered by a provider. (Source: Medicare.gov, Hearing & balance exams.)
Why hearing aids are the gap
Original Medicare's coverage stops at the diagnostic exam. It does not cover hearing aids themselves, or exams performed specifically to fit them, which is why people are often surprised after an otherwise-covered evaluation. This isn't a HearQuest policy; it's how Original Medicare is structured nationally. (Source: Medicare.gov, Hearing aid coverage.) Some Medicare Advantage plans close part of this gap, which is the next section.
Medicare Advantage: what to ask your plan
If you have a Medicare Advantage plan instead of Original Medicare, hearing coverage varies by plan, and many Medicare Advantage plans add hearing benefits that Original Medicare lacks. Because benefits differ by plan and can change year to year, the useful step is asking your plan directly rather than assuming a specific figure applies to you:
- Does my plan include a hearing benefit at all?
- If so, what is the allowance, and how often can I use it?
- Does my plan require a specific hearing-aid supplier or network?
- Does my plan cover an in-home visit, or only an in-office one?
Commercial plans: what to ask your plan
HearQuest is contracted, in-network with Aetna, Blue Shield of California, and UnitedHealthcare. Hearing benefits under these plans vary by employer group and by the specific plan you're enrolled in, the same way Medicare Advantage benefits vary by plan. Being in-network with a carrier doesn't mean every product and network under that carrier covers this the same way. Ask your plan:
- Does my specific plan include a hearing benefit, separate from the general medical benefit?
- What does my plan cover: diagnostic exams, hearing aids, both, or neither?
- Is there a network requirement or a specific supplier I need to use?
- Does my plan cover a mobile or in-home visit?
HearQuest verifies your specific plan's hearing benefits before your visit rather than assuming coverage from the carrier name alone.
The reassurance this page exists to give
How HearQuest handles billing.
The short version for Medicare: HearQuest submits your claim, you pay only the standard cost-sharing Medicare sets, and there is no surprise bill afterward.
Medicare
HearQuest is a Medicare participating provider and accepts assignment. We submit the claim directly to Medicare, you pay the Part B deductible and 20% coinsurance, and there is no balance billing afterward. (Source: Medicare.gov, accepting assignment.)
Aetna, Blue Shield of California, UnitedHealthcare
HearQuest is contracted, in-network with each of these carriers. Being in-network with a carrier doesn't mean every plan under it covers this the same way, so we verify your specific plan's hearing benefits before your visit.
Cash-pay
Cash-pay applies when a plan doesn't cover the service, most commonly hearing aids under Original Medicare, and to patients who don't have hearing benefits with us. Published starting cash-pay prices for hearing aids are on the hearing-aid care page.
Common questions
Insurance and coverage, explained.
Does Medicare cover hearing aids?
No. Original Medicare does not cover hearing aids or exams for fitting hearing aids. It does cover diagnostic hearing and balance exams when they meet Medicare's requirements. Some Medicare Advantage plans add hearing-aid benefits that Original Medicare lacks; ask your specific plan.
Do I need a referral to see an audiologist with Medicare?
Not always. Medicare lets you visit an audiologist once every 12 months without an order from your health care provider, for non-acute hearing conditions or diagnostic services related to surgically implanted hearing devices. Other diagnostic hearing and balance exams still need to be ordered by your doctor or provider.
Will I get a bill after my Medicare visit?
HearQuest is a Medicare participating provider and accepts assignment, which means we submit your claim directly to Medicare, charge only the Part B deductible and 20% coinsurance Medicare sets, and do not balance-bill you afterward.
Is HearQuest in-network with my insurance?
HearQuest is contracted, in-network with Aetna, Blue Shield of California, and UnitedHealthcare. Being in-network with the carrier doesn't guarantee every plan under it covers this service the same way, so we verify your specific plan's hearing benefits before your visit.
What if my plan doesn't cover the service I need?
That's a cash-pay visit. The most common example is hearing aids under Original Medicare, which are never covered regardless of plan. Published starting cash-pay prices for hearing aids are on the hearing-aid care page.
Can you tell me exactly what my plan will pay?
Not on this page. Coverage depends on your specific plan and can change year to year, so HearQuest verifies your individual benefits before scheduling rather than quoting a general figure that might not apply to you.
Does this page cover Medi-Cal or VA benefits?
No. Those aren't addressed here. Call or text (310) 569-8058 to ask about your specific situation.
Coverage explained, not promised.
This page explains how coverage generally works. It is not a determination of what your specific plan will pay, and it does not replace verifying benefits with your plan or with HearQuest before scheduling. Website information is general and does not replace individualized medical or benefits advice.
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