State Hearing Aid Affordable Care Act Rules

The Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010 by President Barack Obama. According to the U.S. Department of Health and Human Services (HHS), the law’s goal is to make health insurance available and affordable to people and small groups, such as employees of small businesses and organizations, who are uninsured. While some provisions of the law have already taken effect, many more provisions will be implemented in the coming years.

HLAA Chapters and state organizations as well as individual HLAA members working with their state offices for hard of hearing and deaf people, with state insurance commissioners, and with state legislatures, have an opportunity to advocate to add or expand coverage for hearing aids in future ACA plans. It will take forethought, good planning, and some roll-up-your-sleeves advocacy for those willing to increase hearing aid coverage under the ACA.

Alabama

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: BCBS of Alabama, 320 Plan, PPO, Small Group Plan

Coverage: Hearing aids not covered.

Alaska

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: BCBS of Alaska – Alaska Heritage Select Envoy, PPO, Small Group Plan

Coverage: Hearing aids not covered.

Arizona

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: State Employee Benefit – United HealthCare EPO

Coverage: One (1) hearing aid per ear per year and hearing exam covered.

Arkansas

Status of Benchmark Plan: HHS conditionally approved State Partnership Marketplace plan.

Benchmark Plan Name: Arkansas BCBS Health HMO Advantage Partnership Open Access (POS)

Coverage: Hearing aids not covered.

California

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan.

Benchmark Plan Name: Kaiser Small Group HMO

Coverage: Hearing aids not covered.

Colorado

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan.

Benchmark Plan Name: Kaiser Ded/CO HMO 1200D Small Group Plan

Coverage: Hearing aids covered for persons under the age of 18. (State required benefit under Colo. Rev. Stat. §10-16-104(19).)

Connecticut

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan

Benchmark Plan Name: ConnectiCare HMO Commercial HMO

Coverage: Hearing aids covered for children age 12 and under. (State required benefit under Connecticut Gen. Stat. §38a-516b: §38a-490b.)

Delaware

Status of Benchmark Plan: HHS conditionally approved State Partnership Marketplace plan.

Benchmark Plan Name: BCBS Small Group EPO plan

Coverage: Hearing aids covered up to $1000 per hearing aid, per ear, every three years for persons under age 24. (State required benefit under Del. Code, Title 18, §3357 and §3571A.)

District of Columbia

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan

Benchmark Plan Name: BCBS CareFirst Blue Preferred, PPO Small Group Plan

Coverage: Hearing aids not covered.

Florida

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: BCBS of Florida – Blue Options, PPO, Small Group Plan

Coverage: Hearing aids not covered.

Georgia

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: BCBS of Georgia – HMO Urgent Care Copay Small Group Plan

Coverage: Excluded are all hearing services including hearing aids, hearing devices, and related or routine examinations and services.

Hawaii

Status of Benchmark Plan: HHS conditionally approved State Marketplace Plan

Benchmark Plan Name: Hawaii Medical Services Assoc. (BCBS), PPO, Small Group Plan

Coverage: One (1) hearing aid per ear, every 60 months. Fitting, adjustment, repair of hearing aids and batteries are not covered.

Idaho

Status of Benchmark Plan: HHS conditionally approved State Marketplace Plan

Benchmark Plan Name: Blue Cross of Idaho – Preferred Blue, Small Group Plan

Coverage: Hearing aids not covered.

Illinois

Status of Benchmark Plan: HHS conditionally approved State Partnership Marketplace plan

Benchmark Plan Name: BCBS of Illinois Blue Advantage Small Group Plan

Coverage: 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

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: Anthem (BCBS) – Blue Access, PPO, Small Group Plan

Coverage: Hearing aids and fitting and examinations for hearing aids not covered.

Iowa

Status of Benchmark Plans: HHS conditionally approved State Partnership Marketplace plan

Benchmark Plan Name: Wellmark (BCBS) – Alliance Select, PPO, Small Group Plan

Coverage: Hearing aids not covered.

Kansas

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: BCBS of Kansas Comprehensive, Major Medical PPO, Small Group Plan

Coverage: Hearing aids not covered.

Kentucky

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan

Benchmark Plan Name: Anthem (BCBS), PPO Small Group Plan

Coverage: 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 (State required benefit under Kentucky Revised Statute (KRS) 304.17A-132.)

Louisiana

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: BCBS of Louisiana – Group Care, PPO, Small Group Plan

Coverage: 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. (State required benefit under Louisiana Revised Statutes (RS) 22:1038.)

Maine

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: Anthem (BCBS) of Maine, Blue Choice, PPO, Small Group Plan

Coverage: 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

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan

Benchmark Plan Name: CareFirst (BCBS) – HMO HSA Open Access, Small Group Plan

Coverage: 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

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan

Benchmark Plan Name: BCBS of Massachusetts HMO Blue, Small Group Plan

Coverage: 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.)

Michigan

Status of Benchmark Plan: HHS conditionally approved State Partnership Marketplace plan.

Benchmark Plan Name: Priority Health HMO, commercial HMO

Coverage: Hearing aids not covered.

Minnesota

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan.

Benchmark Plan Name: Health Partners – Small Group Product, PPO, Small Group Plan

Coverage: 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

Status of Benchmark Plan: State – based blueprint rejected by HHS. Default to Federal Exchange.

Benchmark Plan Name: BCBS Network Blue, PPO, Small Group Plan

Coverage: Hearing aids not covered.

Missouri

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: Healthy Alliance (BCBS) – Blue Access Choice, PPO, Small Group Plan

Coverage: Treatment for hearing loss covered only for newborns.

Montana

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: BCBS of Montana – Blue Dimensions, PPO, Small Group Plan

Coverage: Hearing aids not covered.

Nebraska

Status of Benchmark Plan: Default to Federal Exchange

Benchmark Plan Name: BCBS of Nebraska – Blue Pride, PPO, Small Group Plan

Coverage: Hearing aids not covered.

Nevada

Status of Benchmark Plan: HHS conditionally approved State Marketplace Plan

Name of Benchmark Plan: Health Plan of Nevada (United) – POS C-XV-500-HCR, Small Group Plan

Coverage: Hearing aids covered up to a maximum amount of $5000, and limited to a single purchase per calendar year. Repairs and replacement are allowable, but limited to once every 3 years.

New Hampshire

Status of Benchmark Plan: HHS conditionally approved State Partnership Marketplace plan

Name of Plan: Anthem (BCBS) – Matthew Thornton Blue, HMO, Small Group Plan

Coverage: 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

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: Horizon (BCBS) – HMO Access, Small Group Plan

Coverage: 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

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan

Name of Benchmark Plan: Lovelace Classic PPO plan, Small Group Plan

Coverage: 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

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan

Name of Benchmark Plan: Oxford EPO, Small Group Plan

Coverage: 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. Covered hearing aids, except for bone anchored hearing aids, are limited to a single purchase (including repair/replacement) every 3 years, with a maximum recoverable amount of $1500. Covered bone anchored hearing aids are limited to 1 per lifetime.

North Carolina

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: BCBS of North Carolina – Blue Options, PPO, Small Group Plan

Coverage: 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

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: Sanford Health Plan, HMO, Commercial HMO

Coverage: Hearing aids not covered.

Ohio

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: Community Insurance Co. (Anthem BCBS) – Blue Access, PPO, Small Group Plan

Coverage: Hearing aids not covered.

Oklahoma

Status of Benchmark Plan: Default to Federal Exchange

Name of benchmark Plan: BCBS of Oklahoma – Blue Options, PPO, Small Group Plan

Coverage: 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

Status of Benchmark Plan: HHS conditionally approved State Marketplace Exchange

Name of Benchmark Plan: Pacific Source Preferred CoDeduct Small Group Plan

Coverage: 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.)

Pennsylvania

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: Aetna, POS, Small Group Plan

Coverage: Hearing aids not covered.

Rhode Island

Status of Benchmark Plan: HHS conditionally approved State Marketplace Exchange

Name of Benchmark Plan: BCBS of Rhode Island – Vantage Blue PPO, Small Group Plan

Coverage: 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

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: BCBS of South Carolina – Business Blue Complete, PPO, Small Group Plan

Coverage: Hearing aids not covered

South Dakota

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: Wellmark (BCBS) – Blue Select PPO, Small Group Plan

Coverage: Hearing aids not covered

Tennessee

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: BCBS of Tennessee, PPO, Small Group Plan

Coverage: 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

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: BCBS of Texas – Best Choice, PPO, Small Group Plan

Coverage: 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.

Utah

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan

Name of Benchmark Plan: Utah Basic Plus State Employee Pan, HMO

Coverage: Hearing aids not covered.

Vermont

Status of Plan: HHS conditionally approved State Marketplace plan

Name of Benchmark Plan: Vermont Health Plan (BCBS) – BlueCare, HMO, Commercial HMO

Coverage: Hearing aids not covered.

Virginia

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: Anthem (BCBS) – Key Care, PPO, Small Group Plan

Coverage: Hearing aids, exams and fitting for hearing aids are excluded.

Washington

Status of Benchmark Plan: HHS conditionally approved State Marketplace plan

Name of Benchmark Plan: Blue Shield Regence Innova, PPO, Small Group Plan

Coverage: Hearing aids not covered.

West Virginia

Status of Benchmark Plan: HHS conditionally approved State Partnership Marketplace plan

Name of Benchmark Plan: Highmark (BCBS of West Virginia) – Super Blue Plus 2000, PPO, Small Group Plan

Coverage: Hearing aids not covered.

Wisconsin

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: United – Choice Plus, POS, Small Group Plan

Coverage: 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.)

Wyoming

Status of Benchmark Plan: Default to Federal Exchange

Name of Benchmark Plan: BCBS of Wyoming – Blue Choice Businesss, PPO, Small Group Plan

Coverage: Hearing aids not covered.

Share:

Browse This Section