Why aren't hearing aids always covered?


Insurers offer healthcare 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 hearing aid coverage for children—but not for adults. In other states individuals with private insurance may be covered for a hearing exam, but not for hearing aids—except for New Hampshire, Rhode Island and Arkansas.

If you have an insurance benefit in these three states, they require insurers to provide coverage for adults. New Hampshire insurance companies 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 over the age of 19. Insurance companies in Arkansas are required to 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 according to them, hearing aids are not an essential medical device—they are considered “elective.”

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

Hearing aids not only make it possible for users to communicate and comprehend speech, but to also maintain a steady income, feel confident and engaged, stay connected (untreated hearing loss has been associated with depression), ward off the cognitive decline and memory problems associated with untreated hearing loss and much more.

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

Maybe not. Insurance companies work by taking the cost of “an uncommon, but insurable risk,” and spreading it over a large group of people. This is to help ensure members pay a reasonable amount and the insurance companies still make money.

Hearing loss, on the other hand, is a likely risk—individuals with hearing loss will eventually make a claim. A large number of claims—some 37 million people suffer from hearing loss, according to the Centers for Disease Control and Prevention—along with the cost of hearing aids, and replacements every five years or so, may mean that insurance companies won’t make a profit. If insurance companies do eventually provide coverage for hearing devices, they will have a say about the pricing of hearing devices and services delivered. 

So what about Medicaid and Medicare?

Medicaid often covers hearing aids, depending on each state’s requirements. The Hearing Loss Association of America’s 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 follow suit.

Obamacare & the Affordable Care Act (ACA) also doesn’t 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. You can find more information by state from the Department of Health and Human Services and the Hearing Loss Association of America.

To improve access and affordability of hearing aids, the National Academies of Sciences, Engineering and Medicine issued a report with a series of recommendations for 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—like personal amplification devices (PSAPS)— that would be sold over the counter with no requirement to see a hearing care specialist.
  • Promote hearing screenings at doctor visits. Based on a MarkeTrak VIII survey on hearing impairment in the US, physicians are the top influencing factor whether someone gets hearing aids. But, statistics show that only about 15% of doctors, ask about their patient’s hearing during their annual physical exam.
  • Improve the compatibility of hearing aids with other hearing assistive devices and technologies, as well as having the ability to program device settings on 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 book a hearing exam and test out a pair of hearing aids.

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