Does Medi-Cal Cover Hearing Aids? $1,510 Cap and Age Limits

Yes, Medi-Cal does cover hearing aids. The program pays for the devices, custom ear molds, an initial set of batteries, fitting visits, and repairs, but the rules split sharply by age. Children and young adults under 21 qualify under a broad federal medical-necessity standard, while adults must meet specific hearing-loss thresholds set in California regulations. Every hearing aid purchase requires prior authorization, and most adult services are subject to a $1,510 annual benefit cap.

Coverage for Children and Young Adults Under 21

If the beneficiary is under 21, hearing aids are covered through the Early and Periodic Screening, Diagnostic, and Treatment benefit, known as EPSDT. Under this federal program, Medi-Cal must pay for all medically necessary services to correct or improve conditions found during screenings, including hearing aids, even when those services are not otherwise listed in California’s state plan.¹

Routine hearing screening is part of the required EPSDT exam, and when a test reveals a defect the state must provide the diagnostic workup and treatment that follow.² These services are provided at no cost to the beneficiary.¹ Because EPSDT is broader than the standard adult benefit, children do not have to meet the decibel thresholds that apply to adults; the test is whether a hearing aid is medically necessary to address a condition identified in screening.³

Coverage for Adults 21 and Older

Adults face a stricter standard. California Code of Regulations, Title 22, Section 51319 sets the medical thresholds Medi-Cal uses before it will authorize a hearing aid. Authorization may be granted when tests of the better ear show an average hearing loss of 35 decibels or greater at 500, 1,000, and 2,000 Hertz by pure-tone air conduction.⁴ An alternative threshold applies when the difference between the 1,000 Hz and 2,000 Hz levels is 20 decibels or more; in that case the average need only reach 30 decibels.

Meeting the numbers alone is not enough. The regulation also requires that the hearing aid effectively improve speech communication, or that the device is necessary for sound awareness and personal safety in the beneficiary’s environment.⁴ Testing must take place after any medical cause of hearing loss has been treated, so an untreated ear infection or blockage has to be dealt with first before the audiogram will count.

What the Benefit Pays For

Once a hearing aid is approved, Medi-Cal covers:

Monaural (one-ear) or binaural (two-ear) hearing aids, depending on the medical evaluation.
Custom ear molds needed for a proper fit.
An initial set of batteries supplied with the device.
Up to six follow-up visits with the same provider for fitting, training, and adjustments.⁵
Repairs, though any repair costing more than $25 requires prior authorization.⁴
A trial-period rental of a hearing aid, also with prior authorization.

Ongoing replacement batteries are not covered.⁶ You get the first set with the device, and after that you pay out of pocket. If that cost worries you, ask your provider about rechargeable models. Over-the-counter hearing aids, available without a prescription since 2022, are designed mainly for adults with mild to moderate loss, and Medi-Cal reimbursement rules for them are not clearly established; ask your provider before buying one if you expect coverage.

The $1,510 Annual Cap

Most hearing aid services for adults fall under a $1,510 maximum annual benefit. That amount is typically enough for two analog hearing aids in the same year, including the initial batteries, molds, and six fitting visits. Digital hearing aids cost more, so two digital devices may not fit under the cap in a single year.⁵ Your provider can walk you through which options stay within the limit.

There is one notable exception. Replacement of a hearing aid that was lost, stolen, or irreparably damaged through no fault of the beneficiary does not count against the $1,510 cap.⁷ You will need to document what happened in a signed statement from both you and your physician.

Prior Authorization and Documentation

Every new hearing aid, trial rental, and repair over $25 needs prior authorization through a Treatment Authorization Request, or TAR. Your provider submits the TAR to Medi-Cal on your behalf, along with the supporting documentation and the proposed device specifications.⁷

A TAR for new hearing aids must include:

A signed prescription from an otolaryngologist, or from your attending physician in consultation with an otolaryngologist if no specialist is available in your community.⁷
A signed physical examination by an otolaryngologist ruling out medical conditions that would make a hearing aid unsafe or ineffective.
A signed audiologic report and hearing aid evaluation, done by or under the supervision of the prescribing physician or by a licensed audiologist. This is required regardless of whether the beneficiary speaks English.⁷
A statement of which ear will be fitted.

For a replacement device, the audiometric report must be dated within the last 12 months, unless you are replacing a hearing aid purchased within the previous three months.⁷ A lost, stolen, or damaged device also requires that signed description of circumstances.

All testing and documentation have to come from a provider enrolled in Medi-Cal. If your current audiologist or ear specialist is not enrolled, they can apply through the Medi-Cal provider enrollment process.⁸ Paperwork from a non-enrolled provider will be rejected.

After approval, your provider orders the authorized device and schedules a fitting to program it based on your audiologic results. You then have up to six follow-up visits with that same provider for adjustments and training.

If You Are in a Medi-Cal Managed Care Plan

Many beneficiaries receive Medi-Cal through a managed care plan rather than fee-for-service. If you are in a plan, your plan may run its own prior authorization process and may contract with a specific hearing aid vendor. Coverage must be at least as generous as fee-for-service Medi-Cal, but the steps and the in-network providers available to you can differ. Call your plan directly to confirm how to request a hearing aid and which audiologists and ear specialists you can use. If you are in fee-for-service, your provider sends the TAR to the state’s TAR Processing Center.⁷

If Your Hearing Aid Is Denied

When Medi-Cal denies a claim, the agency must tell you in writing how to request a fair hearing and the deadline for doing so. You generally have up to 90 days from the mailing date of the denial notice to ask for a hearing.⁹ Requests can be made by phone, online, or in writing. You can represent yourself or have an attorney, relative, friend, or other representative speak for you, and you can ask for an expedited hearing if the matter is urgent.

Denials most often come from incomplete documentation, test results that fall short of the decibel thresholds, or use of a provider who is not enrolled with Medi-Cal. Read the denial notice before you file an appeal. If the problem is missing paperwork, your provider can often resubmit the TAR with the correct documentation, which is faster than going through a formal hearing.

1
Department of Health Care Services. Medi-Cal Coverage for EPSDT
2
eCFR. Subpart B – Early and Periodic Screening, Diagnosis, and Treatment of Individuals Under Age 21
3
Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment
4
Cornell Law School. California Code of Regulations Title 22 51319 – Hearing Aids
5
DHCS – CA.gov. Hearing Aid Benefit Cap and Benefits – Frequently Asked Questions for Members
6
DHCS – CA.gov. Hearing Benefits for Patients Dually Eligible for Medicare and Medi-Cal – Information for Audiology Providers
7
Medi-Cal Providers. Hearing Aids – Medi-Cal Providers
8
Department of Health Care Services. Find a Provider – Hearing Aid Coverage for Children Program
9
eCFR. Subpart E – Fair Hearings for Applicants and Beneficiaries