Newsroom · Sioux Falls

Does Medicare Cover Hearing Aids? The Real Sioux Falls Answer for 2026

Original Medicare has excluded hearing aids since 1965. Here's what actually pays for them in 2026, and what genuinely doesn't.

Big Sioux Benefits Data Desk

Published August 22, 2026 · 11 min read · Sourced from CMS.gov

If you're on Medicare in Sioux Falls, Original Medicare will not pay one dollar toward a hearing aid — but some Medicare Advantage plans sold in Minnehaha County will, and a real over-the-counter option now exists too. The confusion isn't really about whether Medicare covers hearing aids. It's about which piece of "Medicare" you're talking about, and that distinction is worth ten minutes of your attention before you spend money on a device.

This comes up constantly in conversations we have — both with people newly on Medicare who assumed hearing aids worked like eyeglasses (partially reimbursed, at least), and with adult children calling on behalf of a parent who just got quoted a price at an audiology clinic and wants to know why "Medicare" didn't cover any of it. The honest answer is that Original Medicare was never designed to, the private Medicare Advantage market fills part of that gap unevenly, and a genuinely new federal rule from 2022 opened a third path that a lot of people still don't know exists. All three of those threads are worth untangling separately.

Every figure below is sourced to a named source this session — Medicare.gov, CMS's 2026 cost fact sheet, the FDA and GAO's account of the 2022 over-the-counter hearing aid rule, KFF's 2026 Medicare Advantage benefit analysis, and NIDCD's published hearing-loss statistics — plus the same Minnehaha County plan data (CMS PY2026 landscape and 2026 star ratings) that runs every plan comparison on this site. No invented numbers, no "typically."

The one-line answer

Original Medicare — Part A (hospital) and Part B (medical) — does not cover hearing aids or the exam to fit one, full stop, per Medicare.gov's own hearing aid coverage page. What Part B does cover is a diagnostic hearing and balance exam, but only when a doctor orders it to find out whether you need medical treatment — a different service with a different purpose. Medicare Advantage plans, sold by private insurers under contract with CMS, are allowed to add extra benefits Original Medicare skips, and hearing aid allowances are one of the most common. That's the entire structure. Everything below is detail on top of it.

Why the exclusion exists — the mechanism, not just the rule

This isn't a modern cost-cutting decision. When Congress created Medicare in 1965, the law that defines what Part A and Part B can pay for specifically excluded hearing aids, along with routine dental and routine vision care — the three benefit categories people now casually call "the Medicare gaps." Congress has amended Medicare many times since, including adding the entire Part D drug benefit in 2003 and the Part D out-of-pocket cap that took effect for 2025, but it has never repealed the hearing aid exclusion. Bills to do that — versions of a Medicare Hearing Aid Coverage Act — have been introduced in recent sessions of Congress but have not passed. That matters for how you should read anything you see marketed as a "new Medicare hearing benefit": if it isn't coming from an act of Congress, it's coming from a private plan's benefit design, which is optional and can change.

It helps to see the exclusion in context. The original 1965 statute drew a line between what Congress considered "medically necessary" hospital and physician care — the core of Parts A and B — and a handful of categories it treated as elective, cosmetic, or routine maintenance: hearing aids, eyeglasses, routine dental work, and (for decades) most preventive screenings. Congress has revisited that line many times since. Preventive care got pulled inside Medicare's coverage through a series of laws starting in the 1980s and expanding sharply after the Affordable Care Act in 2010, which is why an Annual Wellness Visit and dozens of screenings are now free. Prescription drugs got their own new benefit, Part D, in 2003. Hearing aids, along with routine dental and routine vision, never got that treatment. They sit exactly where they sat in 1965 — a private expense, unless a supplemental source of coverage steps in.

That history matters for one practical reason: it tells you where to look for change. A Medicare Advantage plan can add a hearing benefit tomorrow, because CMS lets private plans compete on extra benefits within the rules of their annual bid. Original Medicare cannot do the same thing on its own — closing this gap for the roughly two-thirds of the country's Medicare population who stay on Original Medicare would take an act of Congress, not a CMS regulation. That's exactly why the various Medicare Hearing Aid Coverage Act proposals introduced in recent sessions of Congress keep stalling; they require the kind of broad, durable legislative agreement that has proven hard to reach on this particular benefit, even though lawmakers on both sides have sponsored versions of it.

Two terms are worth pinning down before you go further, because plans and providers use them loosely:

What Part B actually pays for

Setting the hearing aid question aside, Original Medicare's hearing coverage is narrower but real. Here's what it looks like in practice for 2026:

Source: Medicare.gov — Hearing & balance exams and Medicare.gov — Hearing aid coverage; 2026 deductible from CMS's 2026 Medicare Parts A & B Premiums and Deductibles fact sheet (Nov. 14, 2025).

In a hospital outpatient setting, you'll also owe a facility copayment on top of the coinsurance, per Medicare.gov. If your doctor recommends a test Medicare doesn't cover, or orders it more often than Medicare allows, you can end up with a bill you didn't expect — ask directly what a recommended test is for and whether Medicare covers it before you agree to it.

The 2022 rule that actually changed something: over-the-counter hearing aids

The one genuine expansion of access in the last several years didn't come from Medicare at all — it came from the FDA. In August 2022, the FDA finalized a rule creating a new regulatory category of over-the-counter (OTC) hearing aids: devices adults 18 and older with perceived mild-to-moderate hearing loss can buy without a medical exam, a prescription, or a professional fitting, sold in stores, pharmacies, and online. The rule took effect October 17, 2022, and OTC hearing aids have been available for purchase since then, per the U.S. Government Accountability Office's own review of the new device category.

What that means practically: if your hearing loss is mild to moderate and you don't have a medical red flag, you now have a lower-friction, lower-commitment path to try a device without first booking an audiologist appointment. It is not a fix for the coverage gap — you still pay for the device yourself unless a Medicare Advantage plan's allowance applies to it, and OTC devices are not appropriate for severe hearing loss, sudden hearing loss, or hearing loss with a medical cause that needs diagnosis first. The GAO's review also notes that affordability, consumer awareness, and provider habits remain real barriers even with the OTC option on the market — the rule opened a new lane, it didn't repave the whole road.

How common is this, really?

Hearing loss isn't a minority concern once you're past 65 — it's closer to the norm, and it gets more common every decade after that. The National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health, tracks this nationally by age band:

Source: NIDCD — Quick Statistics About Hearing, Balance, & Dizziness. Figures describe disabling hearing loss prevalence by age, nationally.

NIDCD also reports that roughly 28.8 million U.S. adults could benefit from using hearing aids — and among adults 70 and older who could benefit, fewer than 1 in 3 (30%) has ever actually used one. Minnehaha County isn't exempt from that national pattern: with 39,532 Medicare beneficiaries in the county, per CMS enrollment data, a meaningful share are sitting in that same 65–74 or 75-plus age band where disabling hearing loss is common and hearing aid use lags far behind need.

Why Medicare covers a "balance exam" at all

Medicare.gov files hearing coverage and balance coverage together for a reason: the inner ear handles both, and a balance or dizziness problem is one of the clearest medical triggers for a Part B-covered diagnostic exam. That connection matters more than it might seem, because falls are a serious, well-documented risk for the exact population reading this article. The CDC reports that more than 1 in 4 older adults falls each year, and older-adult falls send about 3 million people to the emergency department and cause roughly 1 million hospitalizations annually nationwide — falls are also the most common cause of traumatic brain injury in this age group, per the CDC. Difficulty with walking and balance is one of the modifiable risk factors the CDC names directly.

This is the practical case for not skipping a hearing and balance evaluation because you assume "Medicare doesn't cover that anyway." If dizziness, unsteadiness, or a sudden hearing change is part of the picture, a doctor's order for a diagnostic hearing and balance exam is a covered service under Part B — 20% coinsurance after your deductible, not the full self-pay cost of a routine hearing aid fitting. Treating a real medical symptom as if it were just "getting older" can mean missing a covered, treatable issue.

Who actually does the exam — audiologist vs. hearing instrument specialist

Two different kinds of providers show up in this conversation, and knowing which is which helps you ask the right question when you call to schedule something.

• Audiologists hold a clinical doctorate (Au.D.) or equivalent graduate training. They perform diagnostic hearing and balance testing, diagnose the underlying cause of hearing loss, and can also fit and sell hearing aids. A doctor's referral to an audiologist for a medical concern is the visit type Part B covers.
• Hearing instrument specialists are licensed to test hearing specifically for the purpose of fitting and selling hearing aids, but they are not diagnosing medical conditions the way an audiologist is. Many retail hearing aid storefronts are staffed by hearing instrument specialists rather than audiologists.

In Sioux Falls, both Sanford Health and Avera Health operate audiology clinics as part of their broader hospital systems — the same two systems that anchor almost every other Medicare coverage decision in this market, from your primary care network to your specialist referrals. If a balance or medical hearing concern is part of what's going on, starting with your primary care provider for a referral into one of those systems is the path that keeps you inside Part B's covered diagnostic exam, rather than starting at a retail hearing aid storefront where the visit is structured as a sales fitting from the outset.

What Sioux Falls Medicare Advantage plans actually offer

Minnehaha County has 5 standard Medicare Advantage PPOs open to anyone with Medicare, plus Dual-Eligible, Institutional, and Medicare Cost plans for people who qualify for them — 15 drug-carrying plans in total for 2026. We don't have a verified, line-by-line hearing allowance figure for each one to publish here — those numbers live inside each plan's Evidence of Coverage and can change at every Annual Notice of Change, which is exactly why we check them individually with clients rather than publish a number that might already be stale by the time you read it. What we can show you is the same premium, deductible, and CMS star-rating landscape that determines the rest of your plan comparison:

Source: CMS Medicare Advantage / Part D Landscape (PY2026) & CMS Medicare Advantage & Part D Star Ratings (2026), Minnehaha County, PY2026.

Minnehaha County also carries Dual-Eligible Special Needs Plans (D-SNP), Institutional Special Needs Plans (I-SNP) for nursing-home residents, and Medica's Medicare Cost plans — all of which can carry their own hearing benefit design, separate from the standard PPOs above:

Source: CMS Medicare Advantage / Part D Landscape (PY2026), Minnehaha County, PY2026. Full 15-plan detail, including drug deductibles, is in our Sioux Falls plan-by-plan guide.

We do not offer every plan sold in Minnehaha County. When we compare hearing benefits as part of a plan review, we're comparing the plans we offer against each other and against your specific situation — not scanning the entire county market. That's a meaningful distinction, and one reason working with a local independent agency instead of a single carrier's call center can surface options you'd otherwise miss.

How a hearing "allowance" actually works

Plan marketing tends to lead with a dollar figure — "up to $X toward hearing aids" — without explaining the mechanics behind it, and the mechanics are what determine whether that number is generous or nearly meaningless for your situation. An allowance is a maximum, not a rebate check and not a guarantee that your out-of-pocket cost drops to zero. The way to evaluate one:

• It's a ceiling, not a discount rate. If the device you want costs more than the allowance, you owe the difference — the plan doesn't negotiate the price down separately from applying the allowance.
• It usually routes through a specific vendor network. Many Medicare Advantage hearing benefits are administered by a third-party hearing benefit manager with its own list of participating providers and, sometimes, its own device catalog — which can be narrower than "any audiologist who takes Medicare."
• Per-ear vs. per-year vs. per-benefit-period matters more than the headline number. An allowance described "per ear" effectively doubles for a set of two devices; one described "per benefit period" (which can span more than one calendar year on some plans) changes how often you can use it.
• Unused allowance typically does not roll over. If you don't use it, it resets — it doesn't accumulate into a bigger pot next year.

None of this is a criticism of the benefit — an allowance that covers even part of a device is real money a plan without one wouldn't offer at all. It's simply why reading the actual benefit language, not the marketing headline, is the step that keeps you from being surprised at the register.

Medigap doesn't fill this gap

If you're on Original Medicare with a Medigap (Medicare Supplement) policy — Plan G and Plan N are the most common choices for new enrollees in South Dakota — it's natural to assume Medigap picks up whatever Original Medicare skips. It doesn't, for hearing aids specifically. Medigap plans are standardized to cover cost-sharing: the Part A deductible, Part B coinsurance, excess charges, and similar gaps that exist because Original Medicare covers something at less than 100%. Since Original Medicare covers hearing aids at 0%, there's no coinsurance for Medigap to step in on. If the hearing aid allowance matters more to you than Original Medicare's no-network, see-any-provider flexibility, that's a real trade-off worth running through deliberately — not something to discover after you've already locked in your annual choice.

How to check this yourself — the method, start to finish

You don't need us for this part. Here's exactly how to find out what your own plan actually does:

1. Pull your plan's Evidence of Coverage or Summary of Benefits — every Medicare Advantage plan publishes one, updated each year, usually mailed with your Annual Notice of Change every September.
2. Search it for "hearing" — look for a specific dollar allowance (e.g., "up to $X per year toward hearing aids"), not just the word "hearing exam."
3. Confirm the network — many hearing benefits route through a specific third-party hearing benefit manager with its own provider list, separate from your plan's medical network.
4. Ask whether it's per ear, per year, or per benefit period — this changes the real value of the allowance more than the headline number does.
5. If you're on Original Medicare, decide deliberately whether an OTC device, a full out-of-pocket professional fitting, or a switch to a Medicare Advantage plan with a hearing benefit fits your situation — during the Oct. 15–Dec. 7 Annual Enrollment Period or the Jan. 1–Mar. 31 Open Enrollment Period if you're already on Advantage.

Free, unbiased help that isn't us

We'd rather you know this exists even though we don't run it: South Dakota's State Health Insurance Assistance Program, branded locally as SHIINE (Senior Health Information and Insurance Education), offers free, unbiased Medicare counseling with no products to sell and no carrier relationships to protect. If you'd rather have a neutral third party walk through your Evidence of Coverage with you before you talk to any agent, including us, that's exactly what SHIINE is for. The generic CMS Third-Party Marketing disclaimer below points to the same federal resources — Medicare.gov and 1-800-MEDICARE — for the same reason: you're never limited to whoever you called first.

How we help

When hearing coverage comes up in a plan review, we pull the current Evidence of Coverage for the plans we offer, confirm the actual dollar allowance and network for this plan year (not last year's), and lay it next to your other priorities — your doctors, your drug list, your budget — so hearing isn't the only thing you're optimizing for. It's free; carriers pay the agency, not you.

What you get

A plan choice that isn't a guess: you know before you enroll whether your plan has a real hearing allowance, what it's actually worth this year, and whether it's enough to matter compared to buying an OTC device outright or paying for a professional fitting yourself. No surprise bill for a fitting exam you assumed was covered.

What to watch heading into the 2027 Annual Enrollment Period

1. Your plan's hearing allowance can shrink or disappear at renewal — re-check it every September when your Annual Notice of Change arrives, the same way you'd check your drug formulary.
2. Watch for federal legislation — Medicare Hearing Aid Coverage Act proposals resurface most sessions of Congress; none has passed as of this writing, and marketing that implies otherwise deserves a second look.
3. OTC hearing aid technology and pricing keep shifting as more manufacturers enter the category the FDA created in 2022 — worth a fresh look even if you dismissed OTC devices a year or two ago.
4. If you switch Medicare Advantage plans this AEP, confirm the new plan's hearing benefit and network before you switch, not after — allowances are not portable between plans.
5. Bundle the check with your annual review — the same September-October window you use to check your drug formulary and doctor network is the right time to check hearing, dental, and vision allowances too.

How we know all this: Big Sioux Benefits runs every article through a data desk that cross-references Medicare.gov's own coverage pages, CMS's 2026 cost fact sheet, the FDA and GAO's published account of the 2022 over-the-counter hearing aid rule, KFF's 2026 Medicare Advantage benefit analysis, NIDCD's national hearing-loss statistics, and the same CMS PY2026 Minnehaha County plan landscape and star ratings used across this site — built by Strategic AI Architects. This is education, not advice; confirm your own plan's hearing benefit, costs, and eligibility with a licensed agent or Medicare.gov. We take no payment from any carrier to feature a plan, and we do not offer every plan available in Minnehaha County.