Insurance

Why aren’t hearing aids always covered?

Insurers offer health care coverage for a wide variety of medical needs, but what about hearing loss?

Currently, about 20 states require health insurance companies to cover full or partial coverage for hearing aids for children, but not for adults. In other states, people with private insurance may be covered for a hearing exam, but not for hearing aids, except in New Hampshire, Rhode Island, and Arkansas.

Reading: Why does insurance not cover hearing aids

If you have an insurance benefit in these three states, they require insurers to provide adult coverage. insurance companies in new hampshire are required to cover the cost of no less than $1,500 per hearing aid, once every five years. Rhode Island requires individual and group insurance policies to provide $700 per individual hearing aid, every three years for those 19 and older. Insurance companies in Arkansas must offer coverage to employers in the state, and if a company takes advantage of this, the plan must cover no less than $1,400 per ear, every three years.

The reason most insurance companies say they don’t offer coverage is because they say hearing aids aren’t an essential medical device—they’re considered “elective.”

but, more than 50 percent of people over the age of 75 with hearing loss may disagree.

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Hearing aids not only make it possible for wearers to communicate and understand speech, they also maintain a stable income, feel safe and engaged, stay connected (untreated hearing loss has been associated with depression), prevent cognitive decline and memory problems associated with untreated hearing loss and much more.

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So, is that the real reason insurance companies don’t cover hearing aids?

maybe not. insurance companies work by taking the cost of “a rare but insurable risk” and spreading it out over a large group of people. this is to help ensure that members pay a reasonable amount and that insurance companies continue to make money.

Hearing loss, on the other hand, is a likely risk: People with hearing loss will eventually file a claim. A large number of claims (about 37 million people suffer from hearing loss, according to the Centers for Disease Control and Prevention) coupled with the cost of hearing aids and replacements every five years or so, can mean that hearing aid companies insurance will not make a profit. If insurance companies eventually provide coverage for hearing devices, they will have a say in the price of hearing devices and the services provided.

so what about medicaid and medicare?

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Medicaid typically covers hearing aids, depending on state requirements. The Hearing Loss Association of America website has more information on state coverage http://www.hearingloss.org/content/medicaid-regulations.

Medicare, however, only covers services, not devices, and most insurance companies do the same.

obamacare & The Affordable Care Act (ACA) also does not consider hearing aids to be essential medical devices. Through this benchmark plan, there are only a few states with minimal coverage for hearing aids and related services. More information can be found by state from the Department of Health and Human Services and the Hearing Loss Association of America.

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To improve access and affordability of hearing aids, the National Academies of Science, Engineering, and Medicine released a report with a series of recommendations on how consumers receive and pay for hearing health care in the United States.

The committee listed 12 recommendations, including the following points:

  • create a new category of “basic” hearing aids, such as personal amplification devices (psaps), which would be sold over the counter without the need to consult a hearing specialist.
  • promote hearing tests at doctor’s visits. According to a Marketrak VIII survey of hearing impairment in the United States, physicians are the number one factor influencing hearing aid choice. But, statistics show that only about 15% of doctors ask about their patients’ hearing during their annual physical exam.
  • enhance hearing aid compatibility with other assistive listening devices and technologies, as well as having the ability to program device settings into any hearing aid from any manufacturer.
  • Whether your insurance covers hearing aids or you need to pay out of pocket, don’t delay. The best way to find the right hearing aid for you is to schedule a hearing exam and try out a pair of hearing aids.

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