Are hearing aids covered by insurance? Hearing aids can be expensive, and if the hearing loss affects both ears, the cost of two even more so. You may understandably be wondering if you can afford them, or perhaps you’re concerned about how you will afford them. Perhaps you have asked yourself which insurance covers hearing aids? This article will address that question by looking at different health plans in detail.
How will you pay for your hearing aids?
Sensori-neural hearing loss is usually due to abnormal or damaged parts of the hearing organ (cochlea) or hearing nerve that cannot be fixed with medical or surgical treatment. In these cases, the amplification provided by hearing aids is often the only solution and should be fitted as soon as possible.
You’ll be relieved to discover that, depending on your insurance plan and the state you live in, you may have cover for hearing aids. Nonetheless, if you are thinking about investing in hearing aids, it can be challenging to figure out what insurance options are available and whether your insurance will cover or contribute towards your purchase.
What are the different types of health plans?
There are two main types of health insurance plans available:
- Private (or commercial) health insurance refers to any non-governmental health insurance. These are the most common health plans. They are offered to employees by employers, but can also be purchased individually.
- Public (or government) health insurance is state-subsidized insurance in exchange for a premium.
- Medicaid: Medicaid is government-funded health care, usually provided for individuals and families with low income.
- Medicare: Medicare is government-funded health care, generally provided from age 65.
- Other examples of public health insurance:
- the Veteran’s Health Administration
- the Indian Health Service.
Which insurance pays for hearing aids?
It is important to understand that insurance cover for hearing aids and cochlear implants differs according to your state. Every state has its own mandates regarding cover, but even then, there are some insurance plans that are exempt from them. It is recommended that you contact your plan administrator to find out if your plan includes state-mandated insurance benefits aimed at hearing aids or cochlear implants.
According to the American Speech-Language-Hearing Association (ASHA), the following states require health insurance plans to pay for hearing aids for children: Colorado, Delaware, Georgia, Kentucky, Louisiana, Maine, Maryland,
Wisconsin requires cover for hearing aids as well as cochlear implants for children.
Requirements vary from state to state in terms of ages covered, amount of cover, provider qualifications, and benefit period. Bear in mind that laws, regulations, and policies are subject to change. To make sure that you have the most recent information, it is advisable to check with your state.
Private health insurance
According to the National Center for Biotechnology Information (NCBI), employers and individuals can contract with private health insurance companies to either administer or pay specified health care costs for entitled individuals. If employers are “self-insured,” they are responsible for health care costs, although their plans are usually administered by an insurance provider. On the other hand, “fully insured” employers pay premiums to the insurance provider, which is then liable for the covered costs when an entitled employee requires health care. Fully insured plans need to comply with federal and state regulations.
Currently, there are more than 900 health insurance companies that offer medical cover in the United States. The National Association of Insurance Commissioners (NAIC), 2018 Market Share Reports For the Top 125 Accident and Health Insurance Groups and Companies by State and Countrywide is based on data collected through the end of 2018.
The top 25 health insurance companies are listed below in descending order according to the size of market share, as per this report:
- Kaiser Foundation
- Anthem Inc.
- Health Care Service Corporation (HCSC)
- Centene Corp
- Cigna Health
- Molina Healthcare Inc.
- Guidewell Mutual Holding
- California Physicians Service
- Independence Health Group Inc.
- Blue Cross of California
- Highmark Group
- Blue Cross Blue Shield of Michigan
- Horizon Blue Cross Blue Shield of New Jersey
- Blue Cross Blue Shield of North Carolina
- Carefirst Inc.
- Health Net of California, Inc.
- UPMC Health System
- Blue Cross Blue Shield of Massachusetts
- Blue Cross Blue Shield of Tennessee
According to The American Speech-Language-Hearing Association (ASHA), some private health plans provide coverage for hearing tests as well as hearing aid evaluations, and they may pay in full or in part for your hearing aids. However, private health insurance plans range widely in terms of price and benefits, with various factors affecting the available benefits, client rights, etc. The terms of the plan determine eligibility for coverage and payment of benefits.
If not mandated by the state, hearing aids are frequently not covered under private insurance plans, or, the cover may be sold as an optional rider. Aetna excludes hearing aid cover from the majority of its benefit plans. Any applicable exclusions and limitations for the cover of hearing aids would apply to air conduction hearing aids, implantable hearing aids, and semi-implantable hearing aids. Where they are covered, they must meet certain criteria in order to be considered medically necessary.
At the same time, Tufts Health Plan “covers medically necessary audiology evaluations and related services, including hearing aids prescribed by an appropriately licensed physician for hearing disorders, in accordance with the member’s benefits”. Again, benefits are state-specific – for members in Massachusetts aged 21 and younger, and members over 21 in New Hampshire and Rhode Island (according to state requirements).
Some private insurance companies like Aetna and United Healthcare offer more affordable hearing aids or discounts on hearing aids by means of arrangements or collaboration with outside companies.
Contact your insurance company to find out what benefits your plan offers. Your benefits manager at work may also know what cover you have.
Medicaid offers medical assistance to some individuals and families who have low incomes and resources. It is funded jointly by the federal and state governments, and although the federal government establishes national guidelines, every state administers its own program and determines its own eligibility standards, services covered, and payment rates, but these need to be reviewed and approved by the federal Centers for Medicare and Medicaid Services (CMS).
As part of the plan, the state is required to provide some basic services for those living below the poverty level. The states do not have to provide audiology services for adults over 21.
The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program, is the child health component under Medicaid that requires states to provide hearing services (e.g. screening, diagnostic, and treatment services, including hearing aids, hearing aid accessories and related services) to Medicaid beneficiaries under 21.
While Medicaid is required to pay for hearing aids for children, they often provide cover for hearing aids for adults too. While Medicaid coverage of hearing aids for adults 21 and over varies by state, more than half of the 50 states do offer some cover for hearing aids and/or related services such as hearing tests, batteries, accessories, and hearing aid repairs. You may be eligible for Medicaid if you have a disability or low income.
Click here to check your state cover.