Medicare does not generally cover ear cleaning. However, in some cases, a doctor will consider the removal of earwax as medically necessary. Therefore, some parts of Medicare may cover the procedure.
This article will explore earwax in some detail and look at the symptoms of and treatments for a blockage.
It will also discuss earwax removal at a doctor’s office and whether or not Medicare may cover the service. It will also look at costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The ear canal is lined with tiny hairs and glands that produce a waxy type of oil called cerumen, or earwax.
The function of these tiny hairs is to move the earwax down the canal to the ear opening. The earwax helps collect debris, dust, and bacteria and prevents it from entering and potentially damaging the ear.
In small amounts, earwax is a natural cleanser and keeps the ear canal moist. In fact, without enough earwax, the ear canal is likely to dry out and feel uncomfortable.
When earwax sits in the canal and picks up a lot of debris, it can harden. Hard wax is more difficult for the tiny hairs to move out of the ear, which can lead to a blockage, or an impaction, in the ear canal.
People with conditions that produce dry, flaky skin have a higher risk of developing hard earwax.
Also, earwax consistency changes as a person gets older, and harder wax does not easily leave the ear canal. In fact, excessive earwax occurs in more than 30% of older adults.
Symptoms of a blockage
Other than pain and itching in the ear, the symptoms of an earwax impaction may include:
- a ringing noise, or tinnitus
- odor or discharge from the ear
- a cough
- a feeling of fullness in the ear
- changes in the effectiveness of a hearing aid
Medicare may pay for that medically necessary service.
There are several treatment options for removing impacted earwax.
Although some of the treatments are doable at home, the American Academy of Otolaryngology recommend that a person talks with their doctor about the best treatments before trying any home remedies themselves.
The following sections will look at some treatment options in more detail.
Removal of earwax at home
Doctors do not recommend most of the following remedies, as they may result in more damage to the ear.
However, a person may try some of the following:
- Wait and see if the earwax blockage clears up by itself.
- Use ear drops to soften the earwax. Sometimes, a doctor would need to remove the softened earwax.
- Clear the earwax by using a syringe to direct warm water into the ear canal. However, this process could damage a person’s ear, so doctors do not recommend it.
- Remove earwax at home using a cotton swab. However, this method might push the wax farther back into the ear and increase the risk of impaction. Doctors do not recommend it.
Ear candling is not a safe option for earwax removal. People should not try this method.
Removal of earwax by a doctor
Earwax removal and general ear cleaning in a doctor’s office may include the use of specific fluids and specialized instruments, as follows:
- Soften the wax: A doctor may use fluid to help soften the earwax before using a surgical instrument to remove it.
- Irrigation: A doctor may use a specialized instrument to add fluid to the ear canal to help remove the earwax.
- Manual: A doctor may choose to manually remove the earwax using a curette, which has a curved tip to remove the earwax.
Federally funded Medicare is a health insurance program for people in the United States who are aged 65 years and over. It also extends to some people under 65 years of age with certain disabilities or conditions.
Medicare includes original Medicare (parts A and B), Part C (or Medicare Advantage), and Part D.
It is important to note that Part D is for prescription drug coverage and will not cover ear cleaning.
Original Medicare Part A offers hospital coverage, while Part B offers medical insurance. Both parts cover only medically necessary services and items.
Medicare does not generally consider earwax removal as medically necessary. However, if a person has an earwax impaction, Part B may cover its removal by ear irrigation if a doctor performs the procedure.
Medicare Part B will also cover tests for balance and hearing if a person’s doctor orders them to find out if medical treatment is necessary.
Medicare Advantage plans combine the benefits of original Medicare (parts A and B). Private health insurance companies offer these plans.
All Medicare Advantage plans must provide all the basic coverage of original Medicare, and they may also offer other benefits, such as hearing tests and hearing aids.
A person can contact their Medicare Advantage plan provider to check if their chosen plan covers routine ear cleaning and earwax removal.
Medigap is a supplement insurance plan that private companies offer. It is available to people enrolled in original Medicare (parts A and B).
The plans are standardized by Medicare, and they help fill gaps in original Medicare coverage. These gaps often include coinsurance and deductibles.
As of January 1, 2020, people who are new to Medicare cannot purchase a Medigap policy that pays for the Part B deductible.
Generally, Medigap policies do not cover vision, dental, or hearing care, so they may not cover ear cleaning.
Costs vary among the different parts of Medicare. The following sections will look at costs in more detail.
If a person is covered for tests or treatment under Medicare Part B, they will pay 20% of the Medicare-approved amount for their doctor’s services.
The Part B deductible also applies, which is $203 per year in 2021. In a hospital outpatient setting, a person will also pay the hospital copay. They will also pay the monthly Part B premium, which is $148.50 in 2021, though this cost may increase depending on a person’s income.
A person with a Medicare Advantage plan will pay the plan’s monthly premium, which averaged $29 in 2019.
A person may also have to pay copays and deductibles, as well as other out-of-pocket costs. However, Medicare Advantage plans impose a yearly limit on these out-of-pocket costs, after which a person will pay nothing for covered services.
This online tool can help a person find a Medicare Advantage plan and compare costs.
With Medigap coverage, a person will pay a monthly premium for the Medigap policy and a monthly premium for Medicare. Costs will vary by plan.
Medigap may assist in paying the 20% coinsurance when ear cleaning is medically necessary, as the Medigap plan pays its portion of costs to the doctor or healthcare facility.
This online tool can help a person check the costs of different Medigap policies.
Original Medicare (parts A and B) does not generally cover ear cleaning. However, if a person’s ear is blocked and their doctor believes that it is medically necessary to remove the impaction, Medicare Part B may pay for the service.
People with a Medicare Advantage plan may have additional benefits to help cover a hearing test, hearing aids, and ear cleaning.
Medigap supplement insurance may help pay the Medicare coinsurance. If the ear cleaning is medically necessary, this will be 20% of the allowable charge.