Updated: July 1, 2015. Supreme court affirms Affordable Care Act, but hearing aid coverage still a gray area
The Affordable Care Act (ACA), informally known as Obamacare, is a lengthy piece of legislature that can be very difficult to sort through. To simplify it, there are 8 main facts that you should know about the ACA and how it will affect your hearing healthcare.
Fact #1: More Americans are now insured for hearing exams than ever before.
To put it simply, Obamacare assists Americans in purchasing health insurance through the Healthcare Marketplace by providing federal subsidies to those who qualify based on income. It will also penalize individuals who do not carry health insurance for 3 consecutive months or more, as well as companies who do not provide health insurance benefits to employees.
With the enactment of the ACA, more Americans are now insured for hearing exams and ENT office visits. Therefore, more people may seek hearing healthcare services through ENT physicians and Audiologists than in the past.
Fact #2: Your healthcare in-network providers may have changed.
Your healthcare plan and/or in-network providers may have changed with the enactment of the ACA. Because health insurance companies have been forced to change their plans to meet the guidelines of Obamacare, your plan may no longer be available. This means that you will need to choose a new plan that meets the ACA guidelines and may see an increase in premium. For those Americans who do not qualify for federal assistance, their healthcare premium cost will likely increase.
Fact #3: Screenings for children are (typically) covered.
Most health plans must cover preventative care screenings for children at no cost, including the newborn hearing screening. This means that hearing loss may be better detected at an early age.
Fact #4: Young adults with hearing loss can still be covered under their parent’s plan until age 26.
Young adults can still be covered under their parent’s healthcare coverage up to age 26. For those young adults with hearing loss, they are seen for many follow-ups throughout their lifetime. Being able to maintain their current health insurance until 26 would benefit those who have a pre-existing hearing impairment.
Fact #5: No pre-existing (hearing loss condition) will exclude you from coverage.
No one can be denied health coverage due to a pre-existing condition. If you or your child has a hearing loss, you can still obtain health coverage through the Healthcare Marketplace.
Fact #6: Having health insurance through the marketplace does not guarantee hearing health coverages.
Even though no one can be denied coverage due to a pre-existing condition, it does not mean that every service is covered. The person with hearing loss can not be denied health insurance coverage, but that does not mean that their hearing aids will be covered. Having health insurance isn’t a guarantee for coverage of specific services.
At this time, there is no Federal coverage for hearing aids under Medicare, Medicaid, or any mandate that requires private insurers to provide hearing aid coverage. There has been no change in this with the introduction of the Affordable Care Act. Although the federal health care act does not require any hearing aid coverage by insurers, some individual state laws may. See below for a list of states providing hearing aid coverage.
Fact #7: Increased Medicare reimbursement cuts.
As of March 31, 2015 there are significant Medicare reimbursement cuts for Medicare providers. This may result in providers changing their status from a participating Medicare provider to a non-participating or contractual Medicare provider. This means that more physicians may stop taking on new Medicare patients, or even continue to see existing ones. For those on Medicare, this may make it more difficult for you to see your physician of choice.
Fact #8: Cochlear implants are (generally) covered.
Cochlear implants are generally covered by Medicare and private insurers. This has not changed since the introduction of ACA, however since more people are now insured as a result of the Affordable Care Act, more people may seek cochlear implant evaluations and treatment who could not get them before.
There has been a lot of controversy surrounding the Affordable Care Act in America. For the purposes of this article, we are only discussing the facts about the ACA which may have an impact on your hearing healthcare. Personal opinions regarding Obamacare have been excluded.
Hearing Aid Coverage Under the Affordable Care Act by State
Hearing aid coverage differs on a state by state basis. We try to keep the table below as up to date as possible, but always consult a health insurance professional to confirm.
|State||Hearing Aids Coverage|
|Arizona||One (1) hearing aid per ear per year, and hearing exam covered|
|Colorado||Hearing aids covered for persons under the age of 18.|
|Connecticut||Hearing aids covered for children age 12 and under|
|Delaware||Hearing aids covered up to $1000 per hearing aid, per ear, every three years for persons under age 24|
|District of Columbia||Not covered|
|Georgia||Hearing aids covered up to $1000 per hearing aid, per ear, every three years for persons under age 24|
|Hawaii||One (1) hearing aid per ear, every 60 months. Fitting, adjustment, repair of hearing aids and batteries are not covered.|
|Illinois||Hearing aids not covered except for bone anchored hearing aids (osseo integrated auditory implants). Examinations for the prescription and fitting of hearing aids are not covered.|
|Indiana||Hearing aids and fitting and examinations for hearing aids not covered.|
|Kentucky||Hearing aids, fittings, and examinations for hearing aids covered for persons under 18 years of age, limited to no more than 1 per ear, every 3 years|
|Louisiana||Hearing aids covered for persons 17 years of age and under, limited to 1 hearing aid per ear, every 3 years. Maximum amount allowable is $1400 per hearing aid.|
|Maine||Hearing aids covered for persons age 18 and under, limited to 1 hearing aid per ear, every 3 years. (State required benefit under Maine Revised Statutes (RS) Title 24-A, §2762.)|
|Maryland||Hearing aids covered for persons up to age 18, limited to 1 hearing aid per ear, every|
3 years. (State required benefit under Maryland Code, Insurance Article, §15-838.)
|Massachusetts||Hearing aids covered for persons 21 years of age and under, limited to 1 hearing aid per ear, every 3 years. Maximum allowable amount per hearing aid is $2000. Related services, including the initial hearing aid evaluation, fittings and adjustments and supplies including ear molds are covered. (State required benefit under Massachusetts General Laws, Ch. 175, §47X.)|
|Minnesota||Hearing aids covered for persons 18 years of age or younger and have a hearing loss that is not correctable by any other means. Coverage is limited to 1 hearing aid per ear, every 3 years. (State required benefit under Minnesota Stat. §62Q.675.)|
|Mississippi||Treatment for hearing loss covered only for newborns.|
|New Hampshire||Hearing aids covered for persons age 18 and younger, with a limit of 1 hearing aid per ear each time a hearing aid prescription changes. (State required benefit under New Hampshire RSA §415:6-p; §415:18-u; §420-B:20; §420-A:2.)|
|New Jersey||Hearing aids covered for children 15 years of age and younger, with a limit of 1 hearing aid per ear every 2 years. (State required benefit under New Jersey Stat. 17B:26-2.1aa; 17B:27A-7.14; 17B:27-46.1gg.)|
|New Mexico||Hearing aids covered for persons 17 years of age and younger, or 20 years of age and younger if still attending high school. Limited to $2200 per hearing aid every 3 years. (State required benefit under New Mexico Stat. Ann. 59A22.34.5.)|
|New York||Hearing aids covered for persons 17 years of age and younger, or 20 years of age and younger if still attending high school. Limited to $2200 per hearing aid every 3 years. (State required benefit under New Mexico Stat. Ann. 59A22.34.5.)|
|North Carolina||Hearing aids covered for persons 21 years of age and younger. Limited to 1 hearing aid per ear up to $2500 per hearing aid every 3 years. (State required benefit under N.C. Gen. Stat. §58-3-285.)|
|North Dakota||Not covered|
|Oklahoma||Hearing aids and audiological services for persons up to age 18, limited to 1 per ear every 4 years. (State required benefit under Okla. Stat., Title 36, §6060.7.)|
|Oregon||Hearing aids covered for persons 18 years of age and younger, or 25 years of age and younger for persons enrolled in a secondary school or accredited educational institution, limited to 1 hearing aid per ear per year up to $4000. The benefit amount is adjusted on January 1 of each year. (State required benefit under Ore. Rev. Stat. §743A.141.)|
|Rhode Island||Hearing aids are covered. For persons 19 years of age and older, coverage is limited to a maximum amount of $700 per ear every 3 years. For persons 18 years of age and younger, coverage is limited to a maximum amount of $1500 per ear every 3 years. (State required benefit under Rhode Island Gen. Laws §27-20-46; §27-18-60.)|
|South Carolina||Not covered|
|South Dakota||Not covered|
|Tennessee||Hearing aids covered for persons age 17 and younger, limited to $1000 per year every 3 years. Infant hearing screening is covered as a state required benefit under Tenn. Code §56-7-2508.|
|Texas||Hearing aids covered up to $1000 every 3 years. Infant hearing screening is covered as a state required benefit under Texas Health and Safety Code, Title 2, Subtitle B, Ch. 47.|
|VIrginia||Hearing aids, exams and fitting for hearing aids are excluded.|
|West Virginia||Not covered|
|Wisconsin||Hearing aids covered; however, bone anchored hearing aids are excluded except when either of the following applies: (a) persons with craniofacial anomalies whose abnormal or absent ear canals preclude the use of a wearable hearing aid, or (b) persons with hearing loss of sufficient severity that it not be remedied by a wearable hearing aid. A maximum allowable amount is $2500 per year, except for dependent children for whom there is no limit. For persons age 18 and older, coverage is limited to a single purchase (including repair and replacement) every 3 years. For persons age 17 and younger, coverage is limited to one hearing aid per ear every 3 years. For bone anchored hearing aids, coverage is limited to 1 per lifetime. (Coverage for persons age 17 and younger is a state required benefit under Wis. Stat. §632.895.)|