Medicare does not generally cover ear cleaning. However, in some cases, a doctor will consider earwax removal medically necessary. As a result, 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, whether Medicare may cover the service, and what the costs might be.

Glossary of Medicare terms

We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:

  • Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
  • Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
  • Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
  • Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
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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 the age of 65 years with certain disabilities or conditions.

Medicare includes Original Medicare (parts A and B), Part C (Medicare Advantage), and Part D.

It is important to note that Part D is for prescription drug coverage and will not cover ear cleaning.

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Original Medicare is made up of parts A and B. 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 whether medical treatment is necessary.

Medicare Advantage (Part C) 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, though they may also offer other benefits, such as hearing tests and hearing aids.

A person can contact their Medicare Advantage plan provider to check whether 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). People with Medicare Advantage cannot also have Medigap.

The plans are standardized by Medicare, and they help fill gaps in Original Medicare coverage. This means the plans often cover costs like 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.

Original Medicare (Part A and Part B)

An individual may have out-of-pocket costs under Original Medicare.

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 $240 per year in 2024. In a hospital outpatient setting, a person will pay the hospital copay as well. They will also pay the monthly Part B premium, which is $174.70 in 2024, though this cost may increase depending on a person’s income.

Medicare Advantage (Part C)

A person with a Medicare Advantage plan will pay the plan’s monthly premium, which is estimated to average $18.50 in 2024.

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 costs. After reaching this limit, a person will pay nothing for covered services.

This plan comparison tool can help a person find a Medicare Advantage plan and compare their costs.

Medigap

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.

Medicare resources

For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.

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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.

Blockage

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. This can lead to a blockage, called an impaction, in the ear canal.

People with conditions that produce dry, flaky skin have a higher risk of developing hard earwax.

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
  • a feeling of fullness in the ear
  • vertigo, or feeling dizzy and sick

Another potential symptom is hearing loss. Chronic hearing loss with an impaction is associated with a higher risk of dementia, and treatment may be medically necessary.

Medicare may pay for that medically necessary service.

Several treatment options exist for removing impacted earwax.

Although a person can do some of the treatments at home, the American Academy of Otolaryngology recommends that an individual talk 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

A person may wait and see if the earwax blockage clears up by itself. They could also use ear drops to soften the earwax. Sometimes, a doctor would need to remove the softened earwax.

Doctors do not recommend the following options because they may result in more damage to the ear:

  • clearing the earwax by using a syringe to direct warm water into the ear canal
  • removing the earwax using a cotton swab, which might push the wax farther back into the ear and increase the risk of impaction

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:

  • Softening 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 removal: A doctor may choose to manually remove the earwax using a curette, which has a curved tip that aids in the removal.

Original Medicare (parts A and B) does not generally cover ear cleaning. However, if a person’s ear is blocked and their doctor believes 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, also known as Medicare supplement insurance, may help pay for Medicare coinsurance. If the ear cleaning is medically necessary, this will be 20% of the allowable charge.