Key takeaways
- In national hearing tests of adults 20 to 69, almost 1 in 4 who called their hearing excellent or good had a pattern that signals likely noise damage1.
- The U.S. Preventive Services Task Force found too little evidence to recommend for or against routine hearing, vision or glaucoma screening in people without symptoms, which is different from advising against it24.
- The American Academy of Ophthalmology advises a baseline eye exam at 40, and people with diabetes need dilated eye exams on a set schedule312.
- Original Medicare doesn’t cover routine eye exams, most glasses or hearing aids, but it does cover yearly diabetic eye exams and glaucoma tests for high-risk groups13.
- Sudden hearing loss, a burst of new floaters or flashes, or a curtain over your vision needs care right away, and sudden trouble seeing with other stroke signs means calling 9117910.
In 2011 and 2012, federal researchers gave hearing tests to a national sample of U.S. adults aged 20 to 691. Many had told interviewers their hearing was excellent or good.
The tests disagreed. Almost 1 in 4 of those confident listeners had an audiometric notch, a dip in hearing at certain high pitches1. CDC researchers treat the notch as a stand-in for noise damage, though other causes can produce one1. Among adults who said they had never worked a noisy job, nearly 20% had one too1.
The CDC, which published the findings in 2017, also cited a 2014 survey: only 46% of adults with hearing trouble had seen a health professional about it in the past five years1.
Eyes keep secrets, too. Glaucoma, a family of eye diseases that harm the optic nerve, affects an estimated 2.7 million Americans3. It progresses slowly and is a leading cause of irreversible blindness in the U.S.4.
Yet the U.S. Preventive Services Task Force, the federal panel that grades screening tests, doesn’t recommend routine hearing tests at 50, vision screening at 65 or glaucoma screening at 4024. It doesn’t advise against them, either. It says the evidence is too thin to call24.
Eye and hearing specialists fill that gap with schedules of their own. This article covers how to read the disagreement, who should get checked and when, what Medicare covers and the warning signs that can’t wait.
“Not enough evidence” isn’t the same as “don’t bother”
The Task Force gave all three screenings an “I” grade, short for insufficient evidence. It means the Task Force can’t tell whether the benefits outweigh the harms, and it is neither for nor against screening24.
Two details explain the gap with specialists. First, these statements cover only people with no symptoms who are seen in primary care24. If you’ve noticed a problem, you’re outside them. The Task Force leaves testing for people with symptoms to clinicians’ judgment, and it tells anyone having vision problems to talk with a health professional24.
Second, the Task Force asks a hard question: does testing people who feel fine lead to better lives?
For hearing, the main trial, called SAI-WHAT, screened 2,305 mostly male veterans 50 and older, with an average age of 612. Screening raised hearing-aid use a year later. Still, fewer than 10 in 100 were using aids, and among people who hadn’t noticed a problem, fewer than 2 in 100 were2. Quality of life didn’t differ2.
No study has tested whether treating hearing loss found by screening changes dementia risk, the Task Force noted2.
For glaucoma, treatment clearly helps. In trials pooled by the Task Force, glaucoma medicines cut the risk of the disease getting worse by about a third over 2 to 10 years, an absolute drop of 4.8 percentage points3. By our arithmetic, that’s about 48 fewer people out of every 1,000 treated whose glaucoma progressed.
What’s missing is proof that finding glaucoma in primary care, among people with no symptoms, protects vision3. Most glaucoma tests need specialized equipment found in eye-care offices, and the eye-pressure test alone caught fewer than half of cases3.
Screening can also carry harms. In one trial of 616 frail adults with an average age of 81, those who got an optometrist’s vision screening had 57% more falls, and the reason was unclear3.
If you’re wary of overtesting, the Task Force is being cautious in that same spirit. But caution about testing everyone isn’t a reason to ignore symptoms, and it isn’t the last word for people at higher risk.
Hearing slips slowly, then steeply after 75
Hearing loss climbs with age. The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates disabling hearing loss in about 5% of adults 45 to 54, 10% at 55 to 64, 22% at 65 to 74 and 55% at 75 and older, based on 2015 to 2020 data6. Among adults 20 to 69, men are almost twice as likely as women to have hearing loss6.
Most people who could use help don’t get it. Of adults 70 and older who could benefit from hearing aids, fewer than 1 in 3 have ever used them6.
A first check can be simple. The Task Force found that one question, “Do you have difficulty with your hearing?”, caught 66% of mild hearing loss and 80% of moderate loss2. A whispered-voice test caught 94% of mild loss in pooled studies, but results vary with the person giving it, and the Task Force doubts its accuracy2.
Medicare’s first annual wellness visit is supposed to include a hearing screen. A Johns Hopkins guide for clinicians suggests that single question or a whisper test from two feet away14.
If a screen raises doubts, the confirming test is a pure-tone audiogram, the familiar beeps in a quiet booth2. An audiologist measures hearing and may fit aids. An otolaryngologist, an ear, nose and throat doctor, diagnoses and treats ear disease. A state-licensed hearing aid specialist does basic tests and fits devices15.
Two related stories live elsewhere in this library. Our article on modifiable risk factors weighs the 2024 Lancet Commission’s dementia estimates for hearing loss. Our article on staying independent covers over-the-counter hearing aids.
Noise is the hearing loss you can prevent
Noise damage builds up over years. Among adults 20 to 69 who had worked five or more years in very loud jobs, about 18% had hearing loss in both ears at speech pitches, compared with 5.5% of those with no job noise6.
The CDC’s workplace safety institute, NIOSH, sets a recommended limit of 85 decibels averaged over an eight-hour day11. For every 3 decibels louder, the safe time is cut in half11. By our arithmetic, that’s about four hours at 88 decibels and two hours at 91.
Everyday sources get there fast. Lawn mowers, vacuums and power tools run around 85 to 90 decibels, and chain saws, sirens, bars and big sporting events can reach 95 or more11.
Watch for the warning: ringing ears, or sounds that seem dull or flat after you leave a noisy place11. The fixes are low-tech. Wear earplugs or earmuffs correctly, keep device volume low, and take breaks from the noise111.
Sudden hearing loss is a race against the calendar
Most hearing loss creeps in. Some arrives overnight.
Sudden sensorineural hearing loss, the inner-ear or nerve kind, means a drop of at least 30 decibels across three neighboring pitches within 72 hours7. It strikes an estimated 5 to 27 of every 100,000 people a year, about 66,000 Americans7.
The 2019 guideline from the American Academy of Otolaryngology–Head and Neck Surgery Foundation stresses speed, because treatments are more likely to work when offered early7. Its timeline for clinicians is tight7:
- Tell conductive loss (a blockage, such as packed earwax) from sensorineural loss at the first visit.
- Get a hearing test as soon as possible, within 14 days of onset.
- Consider steroid medicine within two weeks of onset.
The evidence for steroids is mixed. Of three randomized trials, two found no significant benefit over a placebo, and how much steroids add beyond natural recovery is unknown8. Between 32% and 65% of people may recover on their own, though the guideline’s authors suspect those figures run high7.
Mixed evidence is a reason to decide with a clinician quickly, not a reason to wait. The treatment windows close in weeks7.
The eye diseases that stay quiet until late
Vision trouble becomes common with age. About 12% of adults 65 to 74 and 15% of those 75 and older say they have trouble seeing even with glasses or contacts5.
The usual causes are familiar. Refractive error, the need for glasses, is the most common5. Half of U.S. adults 75 and older have cataracts, a clouding of the eye’s lens5.
Age-related macular degeneration (AMD), which damages central vision, affects 13.4% of adults 60 and older. It is the leading cause of blindness after 655. Glaucoma cases climb from about 250,000 people in their 40s to 1.5 million at 70 and older, and rates are higher in Black and Hispanic or Latino people34.
Specialists don’t wait for symptoms. The American Academy of Ophthalmology (AAO) recommends a baseline comprehensive eye exam at 403. For people with no risk factors for eye disease, it then advises exams every 2 to 4 years from 40 to 54, every 1 to 3 years from 55 to 64, and every 1 to 2 years from 65 on3. The American Optometric Association also backs a baseline exam at 403.
Diabetes changes the schedule. The American Diabetes Association’s 2024 Standards of Care, as cited in Medicare’s 2026 quality measure, call for a dilated eye exam within five years of a type 1 diagnosis, and at diagnosis for type 212. If yearly exams show no retinopathy, or diabetes-related retina damage, and blood sugar is well controlled, exams every one to two years may be enough12. Any retinopathy means exams at least yearly12.
Vision also shapes how safely you move. Our article on hidden causes of poor balance covers multifocal glasses and falls, and our article on mobility covers vision and older drivers.
What Medicare pays for, and the gaps
Original Medicare’s eye and ear coverage follows a pattern: it pays to diagnose and treat disease, not for routine checks or most devices13.
| Service | Original Medicare | Note |
|---|---|---|
| Routine eye exam for glasses or contacts | Not covered | Sometimes called a refraction13 |
| Eyeglasses or contact lenses | Not covered, with one exception | One pair of glasses with standard frames, or one set of contacts, after each cataract surgery with an implanted lens13 |
| Diabetic retinopathy exam | Covered once a year | You must have diabetes13 |
| Glaucoma test | Covered once every 12 months for high risk | Diabetes, family history, African American 50+, Hispanic 65+13 |
| Diagnostic hearing and balance exam | Covered when a provider orders it | An audiologist visit without an order is allowed once every 12 months for gradual hearing loss13 |
| Hearing aids and fitting exams | Not covered | Check other coverage13 |
For covered tests, you generally pay 20% of the Medicare-approved amount after the Part B deductible, which is $283 in 2026. A hospital outpatient setting adds a copayment13.
Medicare Advantage plans may cover services that Original Medicare doesn’t, so check your plan’s vision and hearing benefits before you pay out of pocket13.
Your hearing and vision schedule
This schedule is our own, assembled from the recommendations above. It’s for people without symptoms; symptoms mean an appointment now, whatever your age.
| Who | Check | Who recommends it | Coverage note |
|---|---|---|---|
| Adults through age 50 | Hearing screen at least once a decade | American Speech-Language-Hearing Association (ASHA)12 | Varies by plan |
| Age 40 | Baseline comprehensive eye exam | AAO; American Optometric Association3 | Varies by plan |
| Ages 40 to 54 | Eye exam every 2 to 4 years | AAO3 | Varies by plan |
| Over 50 | Hearing screen every 3 years | ASHA12 | Medicare: audiologist without an order once a year for gradual loss13 |
| Ages 55 to 64 | Eye exam every 1 to 3 years | AAO3 | Varies by plan |
| 65 and older | Eye exam every 1 to 2 years | AAO3 | Original Medicare doesn’t cover routine exams13 |
| First Medicare wellness visit | Hearing question or whisper test | Medicare visit rules, per clinician guide14 | Part of the visit14 |
| Type 2 diabetes | Dilated exam at diagnosis, then every 1 to 2 years if clear, yearly with retinopathy | ADA12 | Medicare covers yearly13 |
| Type 1 diabetes | Dilated exam within 5 years of onset, then as above | ADA12 | Medicare covers yearly13 |
| Family history of glaucoma, African American 50+, Hispanic 65+ | Glaucoma test | Medicare’s high-risk groups; the Task Force names similar risk factors313 | Medicare covers yearly13 |
| Loud job or hobby | Hearing protection; ask about a hearing test if ringing or dullness lingers | CDC; NIOSH111 | Varies |
Remember the Task Force’s position. It found the evidence insufficient for routine screening in primary care, and it asks primary care clinicians to use their judgment about whether to screen4.
What the evidence says
| Claim | Evidence level | What it rests on |
|---|---|---|
| Treating glaucoma slows it | Seven pooled trials; risk of progression cut by about a third, 4.8 points absolute3 | |
| Long exposure to loud noise damages hearing | NIOSH’s exposure limit; national hearing-test data1611 | |
| Screening people without symptoms in primary care improves hearing or vision outcomes | Task Force I statements, 2021 and 202224 | |
| Hearing screening gets more people using hearing aids | One trial; use stayed under 10%2 | |
| Steroids help sudden hearing loss | Two of three trials found no clear benefit; the guideline calls them an option78 | |
| Not smoking and limiting UV lower cataract risk | The Task Force lists both as cataract risk factors but reports no prevention trials5 |
Your senses are part of self-reliance
Natural health prizes independence: cooking your own food, walking your own errands, keeping up with the people you love. Hearing and sight make all of that possible.
Many of the protective steps are simple and cheap. Earplugs near the mower, sunglasses outdoors and not smoking ask little of you511. A baseline eye exam isn’t overmedicalizing your life. It’s a reference point, like knowing your blood pressure, that makes a later change easier to catch.
Questions readers ask
My doctor never offered a hearing or eye test. Did I miss something?
Not necessarily. The Task Force found too little evidence to recommend routine screening in primary care24. But if you notice a problem, say so, because that puts you outside those statements2. The AAO’s age-based eye exams happen with eye specialists, not in a routine physical3.
Does Medicare pay for my yearly eye exam?
Only in certain cases. Original Medicare covers a yearly diabetic eye exam and a yearly glaucoma test for high-risk groups13. Routine exams for glasses aren’t covered, though some Medicare Advantage plans add vision benefits13.
Can I skip the hearing test and buy over-the-counter hearing aids?
Our article on staying independent covers who over-the-counter aids suit and when to see a doctor first. A hearing test still tells you how much loss you have and what kind215.
I see fine. Why would I need a dilated eye exam?
Glaucoma progresses slowly and can cause blindness that can’t be reversed, which is why eye specialists set a baseline exam at 4034. Diabetes adds a specific reason, since retina damage is checked through dilated exams12.
The bottom line
Federal screening experts aren’t telling you to skip hearing and eye checks. They’re saying the case for testing everyone in primary care hasn’t been proven. Specialists set their own schedules, and some groups, including people with diabetes or a family history of glaucoma, have clear reasons to go.
Protect what you can, especially from noise. Use the schedule to plan your checks, know what Medicare will and won’t pay, and treat sudden changes in hearing or vision as urgent.
Related reading
About this article
This article was researched using U.S. Preventive Services Task Force statements, NIH and CDC data and patient guidance, a specialty-society clinical guideline, a Medicare quality measure and Medicare coverage documents, all listed below. It was reviewed in October 2026. It is general education, not medical, legal or financial advice.
Sources
- Carroll YI, Eichwald J, Scinicariello F, et al. “Vital Signs: Noise-Induced Hearing Loss Among Adults — United States 2011–2012.” Morbidity and Mortality Weekly Report, 2017;66(5):139–144. cdc.gov
- U.S. Preventive Services Task Force. “Hearing Loss in Older Adults: Screening.” Final recommendation statement, March 23, 2021. uspreventiveservicestaskforce.org
- U.S. Preventive Services Task Force. “Primary Open-Angle Glaucoma: Screening.” Final recommendation statement, May 24, 2022. uspreventiveservicestaskforce.org
- U.S. Preventive Services Task Force. “Screening for Glaucoma and Impaired Visual Acuity” (final recommendation bulletin). May 24, 2022. uspreventiveservicestaskforce.org
- U.S. Preventive Services Task Force. “Screening for Impaired Visual Acuity in Older Adults: Recommendation Statement.” American Family Physician, August 2022. aafp.org
- National Institute on Deafness and Other Communication Disorders. “Quick Statistics About Hearing, Balance, & Dizziness.” NIH, updated September 20, 2024. nidcd.nih.gov
- Chandrasekhar SS, Tsai Do BS, Schwartz SR, et al. “Clinical Practice Guideline: Sudden Hearing Loss (Update) Executive Summary.” Otolaryngology–Head and Neck Surgery, 2019;161(2). pubmed.ncbi.nlm.nih.gov
- American Academy of Audiology. “Sudden Hearing Loss: The Audiologist’s Important Role.” August 5, 2019. audiology.org
- National Eye Institute. “Retinal Detachment.” NIH, last updated November 5, 2025. nei.nih.gov
- Centers for Disease Control and Prevention. “Signs and Symptoms of Stroke.” CDC, last updated May 19, 2026. cdc.gov
- National Institute for Occupational Safety and Health. “Noise-Induced Hearing Loss.” CDC, 2024. cdc.gov
- Centers for Medicare & Medicaid Services and National Committee for Quality Assurance. “Diabetes: Eye Exam” (CMS131v14, 2026 performance period; cites the American Diabetes Association’s Standards of Care in Diabetes—2024). eCQI Resource Center. ecqi.healthit.gov
- Centers for Medicare & Medicaid Services. “Your Medicare Benefits.” Medicare.gov, 2026 edition. medicare.gov
- Nothelle S, Cayea D, Colburn J. “Medicare Annual Wellness Visits.” Elder Care (Johns Hopkins University School of Medicine), January 2023. aging.arizona.edu
- National Institute on Deafness and Other Communication Disorders. “Hearing Loss and Older Adults.” NIH Publication No. 01-4913, March 2016. nidcd.nih.gov