Including each state’s mandates for hearing aid coverage.
Hearing health insurance can help a company prevent cognitive decline, slip and falls, accidents that can affect one or more of your members, poorly executed tasks and miscommunications that can have catastrophic results. All these things can negatively impact company productivity and morale.
Hearing benefits are crucial and can vary state by state. Not all insurance plans are the same. Whether you are looking for a new hearing health benefit or seeking to upgrade your current plan, here is what you should know when searching for a hearing health insurance plan.
Hearing aid coverage.
Hearing aids are expensive ranging from $1,000 to $6,000. Hearing aids are also considered a non-essential medical device, but a hearing aid can significantly improve the quality of life of your members with hearing loss and cut costs should your member begin to suffer with chronic health issues that are related to hearing loss.
Repairs for damaged devices.
Some health plans offer benefits for repairing damaged hearing devices.
Pay out for a single device.
Some health insurance plans generally pay out for a single device. However, most funds have a specified limit for how many times your members can file a claim, such as one device every five years.
Many insurance programs offer Medicare advantage plans that can assist with hearing health costs. Coverages can include:
- 100% coverage of one routine yearly hearing exam and hearing aid fitting
- up to $1,250 per ear each year toward the cost of a hearing aid
- $0 or $35–$40 copay for hearing exam with in-network doctors
- set maximum per year for hearing care, such as $1,500 or $3,000
- a 20% copayment for: audiological exams, hearing aids, and hearing aid fittings
Know the state mandates for hearing aid coverage.
Certain insurance plans are exempt from state mandates, but some are not. Below are summaries of each statute that may affect your members and their families.
Requires insurance companies to offer coverage to employers in the state. If the employer chooses to add this option, the health plan must provide hearing aid coverage of no less than $1,400 per ear every three years for individuals of all ages.
Requires insurance providers to cover hearing aids for children under 18 years of age when medically necessary. Coverage must include a new hearing aid every five years.
Requires individual and group health insurance policies to provide coverage for hearing aids for children 12 years old or younger; classifies hearing aids as durable medical equipment and allows policies to limit the benefit to $1,000 every 24 months.
Requires individual and group health insurance contracts to provide coverage for hearing aids of up to $1,000 per ear, every 3 years, for children under 24 years of age, covered as a dependent by the policyholder.
Requires health benefit policy to provide coverage of up to $3,000 per ear every 48 months for covered individuals 18 years and under.
Requires insurers to provide coverage for all insured individuals, subject to all applicable co-payments, co-insurance, deductibles, and out-of-pocket limits, for hearing aids once every 12 months, unless there is a significant change in the insured’s hearing status.
Requires health benefit plans to provide coverage for the full cost of one hearing aid per hearing-impaired ear up to $1,400 every 36 months for individuals under 18 years of age as needed, and all related services necessary to assess, select, and fit the hearing aid. The insured may choose a higher price hearing aid and pay the difference in cost; the hearing aid must be prescribed by a licensed audiologist and dispensed by a licensed audiologist or hearing instrument specialist.
Requires individual and group insurers to provide coverage for hearing aids for a child under the age of 18 if the hearing aids are fitted and dispensed by a licensed audiologist or licensed hearing aid specialist following medical clearance by a physician licensed to practice medicine and an audiological evaluation medically appropriate to the age of the child. The insurer may limit the benefit payable to $1,400 per hearing aid for each hearing-impaired ear every 36 months. The insured may purchase a hearing aid priced higher than the benefit payable and pay the difference to the hearing aid provider.
Requires health insurance policies to provide coverage for hearing aids; coverage may be limited to $3,000 per hearing aid every 36 months.
Requires insurers to provide coverage for hearing aids for a minor child if the hearing aids are prescribed, fitted, and dispensed by a licensed audiologist; coverage may be limited to $1,400 per hearing aid for each hearing-impaired ear every 36 months; insured may choose a more expensive hearing aid and pay the difference.
Requires certain health plans to provide to any minor 21 years of age or younger coverage for the full cost of one hearing aid per hearing-impaired ear up to $2,000 for each hearing aid, every 36 months upon a written statement from such minor’s treating physician that the hearing aids are medically necessary.
Requires health plans to cover hearing aids for children under the age of 18 year for hearing loss that is not correctable by other covered procedures. The coverage is limited to one hearing aid per ear every three years.
Requires health insurance and Medicaid coverage for infant hearing screening, re-screening (if necessary), audiological assessment and follow-up, and initial amplification, including hearing aids.
Insurers are required to cover the cost of no less than $1,500 per hearing aid every 60 months. The insured may choose a higher price hearing aid and pay the difference in cost.
Requires health insurers, State Health Benefits Program and NJ FamilyCare to provide coverage for medically necessary expenses incurred in the purchase of a hearing aid for covered children 15 years of age or younger. Coverage includes the $1,000 per hearing aid for each hearing-impaired ear every 24 months when medically necessary and prescribed or recommended by a licensed physician or audiologist.
Requires individual and group health insurance policies to cover $2,200 per hearing aid every three years for children under 18 years of age, or under 21 years of age if still attending high school. Coverage includes fitting and dispensing services, including providing ear molds as necessary to maintain optimal fit, provided by an audiologist, a hearing aid dispenser or a physician, licensed in New Mexico.
Health plans are required to provide coverage for one hearing aid per hearing-impaired ear up to two thousand five hundred dollars ($2,500) per hearing aid every 36 months for covered individuals under the age of 22 years.
Requires any group health insurance or health benefit plan to provide coverage for audiological services and hearing aids for children up to 18 years of age; adds requirement of hearing aid prescription and dispensing by a licensed audiologist; allows hearing aid benefit every 48 months without a dollar limit.
Requires health benefits plans to cover one hearing aid per hearing impaired ear for enrollees under 18 years of age, or 18 years of age or older if eligible as a dependent under the plan and enrolled in an accredited educational institution. Hearing aids must be prescribed, fitted and dispensed by a licensed audiologist with the approval of a licensed physician and the maximum benefit amount is $4,000 every 48 months.
Requires every individual or group health insurance policy renewed on or after January 1, 2012 to provide coverage of one thousand dollars ($1,000) per individual hearing aid per ear, every three (3) years, for every child under 18 years of age covered by such policy whether as a dependent of the policy holder.
Requires a health benefit plan to provide coverage for the cost of a medically necessary hearing aid or cochlear implant and related services and supplies for a covered individual who is 18 years of age or younger.
Requires health insurers, health maintenance organizations, and corporations providing health care coverage subscription contracts to provide coverage for hearing aids and related services for children 18 years of age or younger when an otolaryngologist recommends such hearing aids and related services.
Requires individual and group insurance policies to provide coverage for $1,500 per individual hearing aid, every three years, for children under the age of 19, and $700 per individual hearing aid for those over 19 years of age.
Requires health insurance plans and policies to pay for cochlear implants, hearing aids and related treatment that are prescribed by a physician or audiologist for any child under the age of 18. Coverage for hearing aids includes the cost of one hearing aid per ear per child once every three years.
The better the hearing health benefit, the more improved the quality of life for your members and efficiency of your organization. It’s important to know your options and the requirements of your state so you can choose the best plan for your group. When choosing or changing your hearing benefits, make sure those benefits include hearing aid coverage.