Considering a cochlear implant for yourself or a loved one? As an audiologist, I have seen firsthand the transformative power of cochlear implants.
For those with severe to profound hearing loss, they can literally open up a world of sound that was previously inaccessible. However, many of my clients are initially concerned about the potential cost of the procedure and follow-up care.
In this article, I will provide comprehensive information on the costs associated with cochlear implants, including insurance coverage and pricing without insurance. By the end of this article, you will have a better understanding of the financial implications of undergoing this life-changing treatment and will be more empowered to make an informed decision.
Who is a candidate for cochlear implants?
Cochlear implants are a viable option for those with severe to profound hearing loss that cannot be helped by hearing aids. This includes individuals who have severe hearing loss and have difficulty understanding speech even with the use of hearing aids.
Typically, cochlear implant candidates have:
• Limited benefit from hearing aids
• Moderate to profound sensorineural hearing loss
• No medical contraindications
• A strong motivation to become a full-time CI user
• Realistic expectations about the outcomes of the procedure
👉 Read more about what to know about cochlear implants here.
How does the process work?
The cochlear implant process has several stages.
First, a patient undergoes a preoperative evaluation, including a comprehensive hearing test, medical evaluation, and counseling on the procedure, post-operative rehabilitation period, and potential benefits and risks. If the patient is a suitable candidate and decides to proceed, the doctor recommends a cochlear implant and requests predetermination or recertification of benefits from your health plan (ie. insurance, Medicare or Medicaid).
Next, your health plan will contact you and your doctor to determine whether the surgery and device are covered. After this written notification, the procedure can move forward, and the surgery is scheduled. At that point, any applicable coinsurance or co-pays apply.
Will insurance cover the cost?
Unlike hearing aids, cochlear implants are generally substantially covered by insurance. However, specific coverage will vary depending on your health insurance.
While your insurance is the best source to determine your specific coverage, let's look at what is typical for common types of insurance.
For patients who meet candidacy criteria for a cochlear implant, Original Medicare covers 80% of the cochlear implant costs. A supplemental Medicare program sometimes covers the remaining 20%.
Patients may also have coverage through Medicare Advantage if they selected this over Original Medicare. Sometimes, Medicare with supplemental coverage or Medicare Advantage may fully cover the costs. Remember, you'll want to look specifically at which type of Medicare and supplemental coverage you have to understand better how much out-of-pocket cost you can expect.
Medicaid covers cochlear implants for eligible children in all fifty states from birth to age 21. However, Medicaid does not cover cochlear implants for adults in every state. About 60% of states currently offer adult Medicaid coverage for cochlear implants. You should check what is covered in your state.
The VA is another option that can help cover cochlear implantation. If you have hearing loss as a result of military service, you may be eligible for services through the VA system. Read more about hearing healthcare benefits for veterans here.
Coverage from private insurance plans varies, but many offer cochlear implant coverage. Check with your health insurance about your covered benefits.
To learn more about health insurance coverage, look at this helpful document from Cochlear Americas.
How much would it cost without insurance coverage?
The sticker price of cochlear implants can be daunting, with an estimated cost of $60,000 to $100,000 per ear, including implantation surgery and post-operative rehabilitation.
It's a jaw-dropping number, but this procedure involves:
- Pre-op Assessment
- Meningococcal vaccination
- MR of the brain pre and post contrast
- Hospital visit
- General anesthesia
- Cath Surflo IV SROX225
- Facial nerve monitoring
- Cochlear device implantation, with or without mastoidectomy
- Electrode array insertion
- Premium processor Cochlear Implant & Sound Processor
- Cochlear Implant surgery
- Local skin flaps (large, complicated)
- Diagnostic Radiology
- Post-operative recovery
Keep in mind, this does not include ongoing maintenance costs, such as replacement batteries, external processors, and other parts that may need replacement over time.
Fortunately, most insurance companies offer coverage for cochlear implants, significantly reducing the cost burden for patients. But, there are several options available for individuals without insurance coverage.
Some manufacturers offer payment plans or financial assistance programs based on the patient's income level.
Additionally, some non-profit organizations help fund cochlear implant procedures for those who cannot afford them. For example, the Colorado Neurological Institute has an assistance fund for cochlear implants.
What about follow-up appointments, batteries, and parts?
After the surgery, the implant is activated, and the patient undergoes intensive speech and auditory rehabilitation to learn how to use and interpret the new sounds.
The entire process can take several months to a year and requires regular follow-up visits.
Again, these costs will vary depending on your insurance, but you may need to pay a copay for these office visits. Most patients will have appointments with their audiologist for programming at four-week post-op for activation and follow-ups at two weeks, one month, three months, six months, and one year, with additional appointments as needed.
Regular follow-up appointments are necessary to ensure that the implant functions correctly and that the patient adapts well to the new sounds. These appointments include adjustments to the implant settings and troubleshooting any issues that may arise.
Batteries for the external processor need regular replacement, and parts may need to be replaced over time due to wear and tear. Considering any of these costs and discussing them with your insurance provider or manufacturer before the procedure is essential.
Consider batteries, microphone covers, and whether your insurance covers the loss and damage of your CI processor.
Additionally, many insurance companies cover a CI upgrade every three to five years, with some variation based on your plan.
Here are a few questions you can ask your insurance provider:
- Are audiology services covered for my follow-up visits? What is my co-pay?
- How many replacement batteries are covered each year?
- Is there coverage for the loss and damage of my processor?
- When am I eligible for an upgrade? What is my estimated cost?
Medicare covers disposable batteries (180 batteries every three months). Many patients now use rechargeable batteries, and Medicare also covers several new batteries yearly.
While the costs associated with cochlear implants can sound intimidating, it is essential to consider the potential benefits to your quality of life and your out-of-pocket costs. By understanding the costs and options available, you can decide whether cochlear implants are the right choice for you.
As always, it is advisable to consult with your audiologist or physician to determine if you are a suitable candidate and to discuss the procedure's risks and rewards. By taking on an informed and proactive approach, you can make your journey towards better hearing more empowered and fulfilling.