Hearing Aid Coverage Mandates Health insurance coverage for hearing aids varies widely. Some states mandate coverage for certain populations. Health insurance for federal employees includes some coverage, and individual employers may offer the benefit even if not mandated. Those interested in obtaining health plan coverage for hearing aids may want to try one of ... Bottom Line
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Bottom Line  |   April 01, 2010
Hearing Aid Coverage Mandates
Author Notes
  • Janet McCarty, ME, CCC-SLP, private health plans advisor, can be reached at jmccarty@asha.org.
    Janet McCarty, ME, CCC-SLP, private health plans advisor, can be reached at jmccarty@asha.org.×
  • Steven C. White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.
    Steven C. White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.×
Article Information
Hearing Aids, Cochlear Implants & Assistive Technology / Bottom Line
Bottom Line   |   April 01, 2010
Hearing Aid Coverage Mandates
The ASHA Leader, April 2010, Vol. 15, 3-9. doi:10.1044/leader.BML.15042010.3
The ASHA Leader, April 2010, Vol. 15, 3-9. doi:10.1044/leader.BML.15042010.3
Health insurance coverage for hearing aids varies widely. Some states mandate coverage for certain populations. Health insurance for federal employees includes some coverage, and individual employers may offer the benefit even if not mandated.
Those interested in obtaining health plan coverage for hearing aids may want to try one of several methods:
  • A general approach, such as employees and/or state speech-language-hearing associations asking employers to put the benefit in a health plan and working directly with health plans to design benefits.

  • A specific approach, such as working at the national level with the federal Office of Personnel Management to push for coverage in the Federal Employee Health Benefits Program.

  • A legislative approach, such as lobbying for state laws that mandate hearing aid coverage in health plans.

Fifteen states have mandated hearing aid coverage; most cover children only. These legislative successes have been the result of efforts by consumer organizations in collaboration with state speech-language-hearing associations. The impetus for these mandates comes in part from Early Hearing Detection and Intervention (EHDI) laws, which call for universal newborn hearing screening and follow-up intervention services when hearing loss is detected.
State Mandates
Although some of the hearing aid mandate legislation has passed relatively quickly, other states have taken years to pass mandated coverage of hearing aids. Consumer demand, costs, and political dynamics all play a role, although costs are minimal for adding hearing aid benefits because incidence rates are low, with hearing loss affecting four infants per 1,000 births.
Most hearing aid mandates provide coverage for children; the age limits range from younger than 12 years of age (Connecticut) to younger than 24 years of age (Delaware). The typical mandate calls for hearing aids for those 18 years and younger. Rhode Island requires coverage for children and adults. Legislation also may define dollar amounts and time periods. For example, Kentucky law requires coverage for one hearing aid per ear (up to $1,400) every 36 months. New Jersey coverage includes $1,000 per hearing aid for each ear every 24 months. Oregon allows a maximum benefit amount of $4,000 every 48 months.
Wisconsin is the only state that requires coverage for cochlear implants and hearing aids for children younger than age 18.
Arkansas requires health plans to offer coverage for hearing aids to employers. If the employer chooses the option, the health plan must provide hearing aid coverage of $1,400 per ear every three years for individuals of all ages.
Mandate Limitations
Hearing aid mandates include some limitations. In general, mandates usually do not apply to self-funded health plans—typical of most large and moderate-sized companies—which cover 40% to 60% of the U.S. population. However, self-funded employers might offer the coverage because of the low cost and high consumer satisfaction of such a benefit. The local health plan should be able to advise the employer on the cost-effectiveness of such a benefit.
Audiologists who are participating providers in health plan networks need to be aware of contract language regarding hearing aid payments. Some plans may not allow balance billing by participating providers; as a result, the dollar cost per hearing aid may actually be the limit of the reimbursement rather than a payment toward a hearing aid. Audiologists should know and understand these limitations.
A complete list of hearing aid mandates is available at ASHA’s Web site.
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April 2010
Volume 15, Issue 4