Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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UPDATED: Nov 23, 2021

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The Lowdown

  • Most ear, nose, and throat doctors accept Medicare for medically necessary treatment
  • You don’t need a referral to see a specialist with Original Medicare
  • Medicare doesn’t cover hearing aids or ear wax removal

Otolaryngologists — more commonly known as ear, nose, and throat (ENT) doctors — perform a variety of procedures. ENTs can fit a patient with hearing aids to doing reconstructive nose surgery, an ear, nose, and throat doctor has you covered.

If you’re eligible for Medicare, you’ll have a good selection of ear, nose, and throat doctors to choose from. However, Medicare health insurance doesn’t cover every ENT service.

“Do I need a referral to see an ENT with Medicare or Medicaid?” “What procedures are considered medically necessary?” We will answer your questions and help you find the right doctor, so read on.

Ready to find ear, nose, and throat doctors that accept Medicare? Start by entering your ZIP code into our free tool to see Medicare insurance quotes.

Ear, Nose, and Throat Doctors That Accept Medicare

Waking up with a stuffed-up nose, a sore throat, and plugged ears may be a minor issue. But sometimes it can be more than just the common cold.

Ear, nose, and throat doctors are experts on conditions that affect those body parts. After all, common ear, nose, and throat issues pop up for many reasons, some of which can be serious.

Medicare is health insurance coverage for those over 65 and a select group of younger people. With Medicare, you can have most if not all of your health care needs met.

As with most types of health insurance, Medicare covers ear, nose, and throat care when the procedure is medically necessary. You will be responsible for your health insurance deductible as well as copay and coinsurance amounts, but Medigap insurance can help.

Ear, nose, and throat doctors treat things like allergies, reconstructive and plastic surgery, and tinnitus, and they see patients of all ages.

Finding affordable ear, nose, and throat doctors that accept Medicare doesn’t have to be complicated. Fortunately, many ENT doctors accept Medicare. To find one, check the provider list on the Medicare website or look at your Advantage company’s provider list.

What ear, nose, and throat procedures does Medicare cover?

As with all types of health care, Medicare only covers what they deem medically necessary.

To be medically necessary, a procedure or diagnostic test needs to meet the general requirements. In other words, procedures that treat a medical condition and that have demonstrable value.

Services that are not considered medically necessary include health care you could’ve received at a cheaper facility, hospital stays that are longer than Medicare allows for, and screening tests for conditions you show no symptoms of.

The good news is that Medicare covers many of the services an ear, nose, and throat doctor provides.

Medicare Coverage for ENT (Ear, Nose, and Throat) Procedures
Ear, nose, and throat proceduresAverage costCovered by Medicare?
Adenoid removal$6,000Yes
Chronic ear infections$250 per visitYes
Cleft Palate$7,500Yes
Cochlear ear implants$80,000Yes
Deviated septum$8,131Yes
Ear tube inserts$3,000Yes
Eardrum perforation$4,552Yes
Hearing aid fittings$300No
Reconstructive surgery$5,483Yes
Sleep apnea$2,105Yes
Speech disorders$200 per visitYes
Tinnitus treatments$200 per visitNo
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Medicare rarely covers cleaning services like ear wax removal. 

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Do you need a referral to see an ENT with Medicare?

Does Original Medicare require a referral to see a specialist? Fortunately, the answer is no. Just like other health care specialists, you don’t need a referral as long as you have a medical reason to schedule an appointment. However, if you have an HMO Advantage plan you may need a referral.

About 50 million Americans suffer from tinnitus, and many of them have coverage through Medicare. Just like those millions of Americans, you don’t have to wait for approval if you’re suffering symptoms of tinnitus or any other ear, nose, or throat disorders.

If you’re worried about price, ask about rates for ear, nose, and throat doctors that accept Medicare before you accept any treatment. This can be done over the phone or during your first consultation.

Ear, Nose, and Throat Doctors That Accept Medicare: The Bottom Line

From minor annoyances like a sore throat to things like reconstructive surgery, ear, nose, and throat doctors can treat a variety of illnesses and injuries.

If you need an ear, nose, or throat doctor that accepts Medicare, you might pay less with the right coverage. Enter your ZIP code in our free tool to get started looking at Medicare quotes today.