Vision and hearing coverage: what insurance pays for
What Original Medicare, Medicare Advantage, Health First Colorado and vision plans pay for eye exams, glasses and hearing aids, with 2027 Adams County plan figures and a worked example.
Health insurance and Original Medicare generally pay for eye and ear care that is medical, such as a diabetic eye exam, glaucoma care, cataract surgery or a hearing test your doctor orders to diagnose a problem. They usually do not pay for a routine eye exam for glasses, for the glasses themselves, or for hearing aids (CMS, 2026). Those gaps are filled, partly, by vision plans, by the extra benefits in most Medicare Advantage plans, and since 2022 by over-the-counter hearing aids. This guide sets out who pays for what, shows what the 2027 Medicare Advantage plans in Adams County actually list for eyewear and hearing aids, and walks through a worked example for a Brighton household.
The short answer
Think of every eye and ear service as either medical or routine. Medical care, meaning care to diagnose or treat a condition, is usually covered by your health plan or by Medicare Part B. Routine care, meaning a vision check to update a prescription, the glasses and contacts that follow, and hearing aids, is usually not. If you wear glasses or are starting to struggle with conversations in a noisy room, the routine side is where your money goes, and that is what a vision plan or a Medicare Advantage extra is designed to help with.
The amounts involved are modest for glasses and larger for hearing aids. The National Institute on Deafness and Other Communication Disorders says hearing aids range from hundreds to several thousand dollars and that hearing aids are generally not covered by health insurance companies, although some do (NIDCD, 2026, nidcd.nih.gov/health/hearing-aids). That is why the hearing aid benefit is often the single most valuable extra to compare.
Medical versus routine: who pays for what
| Service | Original Medicare | Vision or hearing plan, or a Medicare Advantage extra |
|---|---|---|
| Eye injury, infection, glaucoma or cataract treatment | Covered as medical care under Part A or Part B | Not needed |
| Routine eye exam for glasses or contacts | Not covered | Typically one exam a year |
| Yearly diabetic retinopathy exam | Covered once a year if you have diabetes | Not needed |
| Glaucoma screening for people at high risk | Covered once every 12 months | Not needed |
| Glasses or contacts | Not covered, except one pair or set after cataract surgery with an implanted lens | An allowance on a set schedule |
| Diagnostic hearing and balance exam | Covered when ordered, or once every 12 months from an audiologist for non-acute hearing problems | Sometimes a routine hearing exam |
| Hearing aids and fitting exams | Not covered | An allowance or a fixed copay in many plans |
Eye care Medicare does cover
Original Medicare does not cover routine eye exams, sometimes called refractions, for eyeglasses or contact lenses, and you pay all costs for that exam (CMS, 2026). Three medical exceptions matter for many people over 65.
- Diabetes: Part B covers an eye exam for diabetic retinopathy once a year, done by an eye doctor who is legally allowed to do the test in your state. You pay 20% of the Medicare-approved amount after the Part B deductible, plus a copayment in a hospital outpatient setting (CMS, 2026).
- Glaucoma: Part B covers a glaucoma test once every 12 months if you are at high risk, which Medicare defines as having diabetes, a family history of glaucoma, being African American and 50 or older, or being Hispanic and 65 or older. The same 20% after the deductible applies (CMS, 2026).
- Cataract surgery: after surgery that implants an intraocular lens, Part B covers one pair of eyeglasses with standard frames or one set of contact lenses. You pay 20% of the Medicare-approved amount after the deductible, any extra for upgraded frames, and Medicare pays only if the supplier is enrolled in Medicare (CMS, 2026).
Hearing care Medicare does cover
Part B covers diagnostic hearing and balance exams when your doctor or other provider orders them for a medical reason. You can also see an audiologist once every 12 months without an order for non-acute hearing conditions, such as hearing loss that has come on slowly. You pay 20% of the Medicare-approved amount after the Part B deductible, which is $283 in 2026 (CMS, 2026; CMS, 2025, cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles).
What Original Medicare does not cover is the hearing aid itself or the exam to fit it (CMS, 2026). A Medigap policy does not change that: the Colorado Division of Insurance guide to Medigap lists vision, dental, hearing aids and eyeglasses among the things Medigap policies do not cover (Colorado Division of Insurance, 2025, doi.colorado.gov/sites/doi/files/documents/2025%202026%20Medigap%20GUIDE%20TEXT.pdf). The gap is common. Among adults 70 and older with hearing loss who could benefit from hearing aids, fewer than 1 in 3 (30%) has ever used them, and 55% of adults 75 and older have disabling hearing loss (NIDCD, 2026, nidcd.nih.gov/health/statistics/quick-statistics-hearing).
What 2027 Medicare Advantage plans in Adams County list for vision and hearing
Most Medicare Advantage plans add routine vision and hearing benefits, and the 2027 numbers are now public. The CMS Landscape file lists 36 Medicare Advantage plans, not counting Special Needs Plans, in Adams County for 2027 (CMS, 2026, cms.gov/files/zip/cy2027-landscape-202609.zip). In the CMS 2027 Plan Benefit Package file (CMS, 2026, cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/benefits-data/pbp-benefits-2027), 35 of those 36 plans list both a routine eye exam and an eyewear benefit, and 35 list a hearing aid benefit.
Eyewear benefits are dollar allowances, from $75 to $400 depending on the plan, and the period they cover also varies, so read whether the allowance renews every year or every two years. Hearing aid benefits come in two designs. Seventeen plans set a dollar allowance, from $300 to $1,500. Eighteen plans set a fixed copay instead, from $399 to $1,800 depending on the level of hearing aid you choose. An allowance design means you pay anything above the allowance; a copay design means you pay the copay for a device at the level you choose, and the plan may require a specific hearing aid vendor or network, so check which models are included.
These are plan design figures, not prices you will see at a shop, and each plan sets its own network or vendor. Annual Enrollment for 2027 Medicare plans runs October 15 to December 7, 2026, and a plan's Evidence of Coverage is the document that settles exactly how its allowance or copay works.
| Benefit | Plans that list it | Range in the CMS file |
|---|---|---|
| Routine eye exam | 35 of 36 | Exam copays listed as $0 where a copay is shown |
| Eyewear allowance | 35 of 36 | $75 to $400 |
| Hearing aids, allowance design | 17 plans | $300 to $1,500 |
| Hearing aids, copay design | 18 plans | $399 to $1,800 depending on device level |
| No vision or hearing extras | 1 of 36 | Not applicable |
Over-the-counter hearing aids
Since the FDA rule that took effect in October 2022, over-the-counter hearing aids are intended for people 18 and older with perceived mild to moderate hearing loss, and you can buy them without a medical exam, a prescription or a fitting by an audiologist (FDA, 2026, fda.gov/medical-devices/hearing-aids/otc-hearing-aids-what-you-should-know). Signs that point to mild to moderate loss include trouble hearing speech in noisy places, trouble following speech in groups and trouble hearing on the phone.
The FDA also lists reasons to see a professional instead, such as a sudden change in hearing in the past 6 months, or being unable to hear speech even in a quiet room. The FDA does not require a warranty, but the package must state the return policy, so check it gives you enough time to test the device in your own settings. Because Medicare covers a yearly audiologist visit for non-acute hearing loss without an order, a Medicare-covered hearing test before you buy OTC can tell you whether OTC is a reasonable fit.
Health First Colorado: vision and hearing for adults
Health First Colorado, the state Medicaid program, treats adults 21 and older differently from children. For adults it covers one comprehensive eye exam each year, but covers glasses only after eye surgery, with single or multi-focus plastic lenses and one standard frame, and one replacement every 24 months for adults who qualify for glasses. Contact lenses for adults are covered only if glasses cannot correct vision and the member had prior eye surgery (HCPF, 2026, hcpf.colorado.gov/vision-benefit).
On hearing, the state's audiology policy says hearing aids and cochlear implants for adults 21 and older are not covered, and hearing exams for adults are covered only when a concurrent medical condition exists (HCPF, 2026, hcpf.colorado.gov/audiology-0). Children have broader vision and hearing coverage in both programs.
Children and families under 65
Pediatric oral and vision care is one of the essential health benefits every marketplace plan must include (CMS, 2026), so a child on an ACA plan has eye care such as an exam and glasses on a set schedule. Adult vision is not an essential health benefit. In Colorado, the Colorado marketplace says you can enroll in an individual vision plan anytime throughout the year, unlike dental, which follows open enrollment (Colorado marketplace, 2026).
If you have a Health Savings Account, IRS Publication 502 lists eye exams, eyeglasses and contact lenses needed for medical reasons, and the cost of a hearing aid with its batteries, repairs and maintenance, as medical expenses (IRS, 2025, irs.gov/publications/p502). That means HSA money can be used for them, which matters for a family paying for glasses or hearing aids out of pocket.
A worked example: a Brighton couple sorting out eyes and ears
Hypothetical Colorado household, not a real client. A Brighton couple, both on Original Medicare with a Medigap Plan G. He is 68, has type 2 diabetes and wears progressive glasses. She is 70 and has noticed over two years that she misses words at family dinners. They want to know what Medicare already covers and what an Annual Enrollment switch would change.
What they have now. His yearly diabetic eye exam is covered by Part B; once the $283 Part B deductible for 2026 is met, Plan G picks up the 20% coinsurance. If the eye doctor also checks his glasses prescription, that refraction is routine and not covered, and new progressive glasses are his to pay. Her first step is a Medicare-covered visit to an audiologist, which she can book once every 12 months without a doctor's order because her loss came on gradually. If she then needs hearing aids, Original Medicare and Plan G pay nothing toward them.
Her options on hearing aids. If the audiologist finds mild to moderate loss, over-the-counter hearing aids are an option she can buy with no prescription. If the loss is greater, or she wants professional fitting, she pays the full price of prescription aids, which NIDCD describes as ranging from hundreds to several thousand dollars.
What a 2027 Medicare Advantage plan in Adams County would change. On a copay design plan, two hearing aids at a $599 copay each would cost $1,198, and at the top device level in the county's range, $1,800 each, they would cost $3,600; confirm in the plan's Evidence of Coverage whether the copay applies per hearing aid. On an allowance design plan with a $700 allowance, she would pay whatever the chosen aids cost above $700. His eyewear allowance would be somewhere from $75 to $400 depending on the plan, with any amount above it paid by him.
The trade-off. Switching from Medigap to Medicare Advantage brings networks, prior authorization and copays on medical care, and moving back to a Medigap plan later can mean answering health questions unless you have a federal Medigap protection such as a trial right. For this couple the honest comparison is the yearly value of the hearing aid and eyewear extras against the medical cost sharing and network rules they would accept in exchange. Lisa lays those side by side; she does not assume the extras should win.
| Need | Original Medicare with Plan G | 2027 Adams County Medicare Advantage plan |
|---|---|---|
| His yearly diabetic eye exam | Covered; $283 Part B deductible, then Plan G pays the 20% | Covered, plan copay applies |
| His routine refraction and new glasses | Not covered; he pays in full | Exam benefit plus an eyewear allowance of $75 to $400 |
| Her audiologist visit for gradual hearing loss | Covered once every 12 months without an order | Covered; many plans also list a routine hearing exam |
| Two hearing aids | Not covered; she pays in full | Copay design: $1,198 at $599 each, up to $3,600 at $1,800 each. Allowance design: price above $300 to $1,500 |
What Lisa checks for you
Lisa starts by separating your medical eye and ear needs from your routine ones, because the medical side is usually already covered and the routine side is where the money is. Then she looks at the coverage you have and the coverage you could have.
- She confirms whether a condition such as diabetes or glaucoma risk makes your yearly eye exam a Medicare-covered service.
- For hearing, she checks whether your plan lists an allowance or a copay, how often the benefit renews, and whether you must use a specific vendor or network.
- She compares the eyewear and hearing aid benefits of the Medicare Advantage plans in your county against what you would pay on your own with Original Medicare and a Medigap plan.
- If you are under 65, she checks whether a stand-alone vision plan, which you can buy at any time of year through the Colorado marketplace, costs less than paying for exams and glasses yourself.
- She flags when an over-the-counter hearing aid may be worth trying first, and when the FDA warning signs mean you should see a professional.
Questions to ask
- Is my eye doctor or audiologist in the plan network, or does the plan require a specific hearing aid vendor?
- Is the eyewear allowance every year or every two years, and does it cover frames and lenses together?
- Is the hearing aid benefit an allowance or a copay, is it per hearing aid, and how often can I replace them?
- Do I qualify for a Medicare-covered diabetic eye exam or glaucoma test?
- If I am on Medicare, is this benefit already in a Medicare Advantage plan available in my county, and what would I give up to get it?
The bottom line
Routine eye care and hearing aids are two of the most common gaps people discover after they enroll in Medicare. In Adams County for 2027, almost every Medicare Advantage plan lists an eyewear allowance and a hearing aid benefit, but the amounts range widely, from a $75 eyewear allowance to $400 and from a $300 hearing aid allowance to $1,500. If you wear glasses or are thinking about hearing aids, compare those extras against what you would pay on your own before Annual Enrollment closes on December 7. Send Lisa a message or call (303) 887-8584.
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Lisa Asmussen at our Brighton office will go through your doctors, your prescriptions and your real numbers, and explain plainly what we found. Take the Stress Out of Medicare
Sources
- CMS: Eye exams (routine), Centers for Medicare & Medicaid Services
- CMS: Eye exams (for diabetes), Centers for Medicare & Medicaid Services
- CMS: Glaucoma screenings, Centers for Medicare & Medicaid Services
- CMS: Eyeglasses and contact lenses, Centers for Medicare & Medicaid Services
- CMS: Hearing and balance exams, Centers for Medicare & Medicaid Services
- CMS: Hearing aids, Centers for Medicare & Medicaid Services
- CMS: 2026 Medicare Parts A and B premiums and deductibles fact sheet, Centers for Medicare & Medicaid Services
- Colorado Division of Insurance: Medicare Supplement Insurance Policies in Colorado, 2025 to 2026 (PDF), Colorado Division of Insurance
- CMS: Medicare Advantage and Part D Landscape, Contract Year 2027, Centers for Medicare & Medicaid Services
- CMS: Plan Benefit Package (PBP) Benefits 2027, Centers for Medicare & Medicaid Services
- FDA: OTC hearing aids, what you should know, fda.gov
- NIDCD: Hearing aids, nidcd.nih.gov
- NIDCD: Quick statistics about hearing, nidcd.nih.gov
- HCPF: Health First Colorado vision benefits, Colorado Department of Health Care Policy and Financing (Health First Colorado)
- HCPF: Audiology, Colorado Department of Health Care Policy and Financing (Health First Colorado)
- Federal marketplace (CMS): What Marketplace health insurance plans cover, Centers for Medicare & Medicaid Services
- Colorado marketplace: Dental and vision insurance, Colorado state marketplace
- IRS Publication 502: Medical and Dental Expenses (for 2025 returns), Internal Revenue Service
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