Approximately 48 million Americans live with some degree of hearing loss[1]. While cochlear implants, surgically implanted electronic devices, were previously reserved for people with severe to profound hearing loss in both ears, now expanded eligibility criteria means that more people are eligible and can benefit from these devices. While cochlear implants and accompanying surgical fees can cost thousands of dollars, they’re often a covered benefit under most insurances, including Medicare, making them affordable for more people.
“The technology has gotten better, the surgical process has gotten better and how we can rehabilitate these patients has gotten better, which has broadened how many people will benefit,” says Laura Jones, Au.D., a clinical audiologist at MedStar Georgetown University Hospital in Washington, D.C.
What Is A Cochlear Implant?
A cochlear implant is an assistive hearing device that converts sound waves in a person’s environment into electrical impulses that stimulate the auditory (hearing) nerve, essentially bypassing damaged parts of the ear. While hearing aids make sounds louder, they still need sensory cells in the inner ear to receive and send the sounds to the nerve. A cochlear implant bypasses these cells to stimulate the nerve directly, which can improve clarity of speech.
Cochlear implant surgery is typically performed in a hospital. While the patient is under general anesthesia, the surgeon makes a small incision behind the ear and places the implant inside. The implant includes an electrode array, which is placed inside the cochlea, a shell-shaped bone in the inner ear that transmits sound information to the brain. The surgeon then closes the incision. The procedure typically takes less than two hours, and the patient can typically return home afterward on the same day, according to Oliver Adunka, M.D., professor of otolaryngology at the Ohio State University Wexner Medical Center and president of the American Cochlear Implant Alliance.
Types of Cochlear Implants
Three manufacturers make cochlear implants in the U.S. that are approved by the Food and Drug Administration (FDA): Cochlear Americas Corporation, Med-El Corporation and Advanced Bionics Corporation. All cochlear implants have the same basic components: an internal implant, an electrode array and an external sound processor, says Dr. Jones.
“They all work, no matter what brand you choose, but the three manufacturers do have a different approach to how they design their implants and what they specialize in,” explains Marquitta Merkison, Au.D., associate director of audiology practices at the American Speech-Language-Hearing Association (ASHA).
Cochlear Americas Corporation is the largest manufacturer of cochlear implants in the U.S. Its internal implant is premade with a curve to hug the natural structure of the cochlea, which can be particularly helpful for patients with anatomical needs in their cochlea, explains Dr. Merkison. The company is also known for setting the trends in external component design as well.
Meanwhile, Mel-El Corporation designs its internal implants to be both long enough to cover the full length of the cochlea and gentle, prioritizing the health of the structures of the inner ear, says Dr. Merkison. It also focuses on the long term and whether the technology is going to be backward and forward compatible for current and future users, she adds.
Lastly, Advanced Bionics Corporation designs its internal implant with a focus on sound quality that’s going to best meet the user’s needs, says Dr. Merkison. While it doesn’t necessarily specialize in an internal part that’s going to be gentle, stiff or rigid, it focuses on maintaining a robust signal once the internal is implanted and meeting the specific needs of its users.
Determining the best cochlear implant for a given individual requires a collaborative conversation between the patient, their surgeon and their audiologist. “If you have anatomical needs, your surgeon might select a certain brand for you,” explains Dr. Merkison. “Or if you have a cochlea that has a lot of ossification, or hardening, your surgeon might select a specific company because they make the type of device that your anatomy requires. More commonly, if there isn’t a surgical preference or anatomical need, the patient can talk to their surgeon and audiologist about whether they have professional experience with all three manufacturers. It’s becoming more common for cochlear implant centers to offer all three to meet the needs of their patients and switch between manufacturers if there’s a need for a specific device.”
“It’s really important—and everyone benefits—when the patient can actually connect with someone from the manufacturers, learn about the companies and connect with people currently implanted with each company to learn about their experiences,” she adds.
Average Cost of Cochlear Implants
The total costs of cochlear implants, including the devices, surgery and rehabilitation, range from $50,000 to $100,000, according to experts. Fortunately, cochlear implants are covered at least in part by most private insurance companies, as well as by Medicare and Medicaid.
“It’s one of those things where it’s not a hard-and-fast cost, and there’s no real way to pinpoint it,” notes Heather Toth, Au.D., an audiologist with Duke Health in Durham, North Carolina. But that doesn’t always mean it’s expensive. “In my career [spanning more than a decade], I’ve had only one patient pay out of pocket entirely (with no insurance coverage) because they flew in from another country. It’s not common [to pay out of pocket fully] because it’s such a covered option for people nowadays.”
Factors That Can Alter Cochlear Implant Costs
The costs you’re ultimately responsible for depend on where you live, which surgical center you visit, the specific benefits of your health insurance coverage and whether the facility and your surgeon are considered in-network providers. The price can also vary from one region of the country to another, experts say. Before making any decisions, reach out to your health insurance provider (if you have coverage) to find out how much of the total cost your plan will cover before you have the surgery, recommends Michael Hoa, M.D., medical director of the cochlear implant program at MedStar Georgetown University Hospital.
For those with a secondary form of health insurance, the costs of cochlear implants can be further reduced, depending on the specific details of their plan.
Are Cochlear Implants Covered by Medicare?
Original Medicare typically covers 80% of the costs of cochlear implants if you’re deemed an eligible candidate, and the Centers for Medicare and Medicaid Services expanded its eligibility criteria significantly in 2022, making it even more likely for a person to qualify for coverage, explains Dr. Toth.
Medicare beneficiaries are then responsible for the remaining 20%, says Dr. Jones. With that said, a number of Original Medicare beneficiaries are also enrolled in a Medicare Supplement plan (which serves as a secondary form of insurance), and even more beneficiaries elect to enroll in a Medicare Advantage plan in lieu of Original Medicare. Both of these options ultimately change a person’s specific coverage and benefits details depending on the plan they select and where they live.
For example, Dr. Merkison notes that some of her patients specifically opt to wait for Medicare eligibility before getting cochlear implants because the coverage is more robust than that of their employer-sponsored health insurance plans.
“It’s important to have an ongoing conversation between patient and provider to make sure they understand their benefits,” she says. “A lot of cochlear implant centers will have someone available to help patients go over the approval process and understand if everything is going to be covered or if they’re going to be responsible for a certain amount,” she adds. “It’s a big decision and money is a large part of it.”
Additional Payment Options and Considerations
Fortunately, more than 90% of private insurance companies, along with Medicaid and the Veterans Administration, help cover the cost of cochlear implants for qualifying individuals[2]. What’s more, private insurance providers often cover follow-up care fairly extensively, adds Dr. Merkison. Cost specifics are determined by your insurance provider, plan details, geographic location and health care providers.
How much you actually pay depends on the rate your insurance company has negotiated with the hospital, as well as how much of your deductible you have remaining. You’re responsible for covering the coinsurance, copays and deductibles your plan requires. If your provider denies you coverage for cochlear implants, Dr. Merkison notes that you have the right to appeal, and your cochlear implant center can help you navigate that process. “Oftentimes they’re successful,” she adds. Cochlear implant manufacturers also offer support in appealing such denials of coverage.
If you need extra help covering the cost of cochlear implants, payment assistance programs are available through organizations like the Cochlear Implant Awareness Foundation. Some state vocational rehabilitation programs also cover part or all of the costs associated with cochlear implants for those who qualify.
For those without insurance coverage, both Dr. Merkison and Dr. Toth highly recommend exploring resources offered by the American Cochlear Implant Alliance for assistance.