Coverage of Hearing Aids by Health Care Benefits Plans

Position Statement of the Deaf and Hard of Hearing Alliance (DHHA):
Coverage of Hearing Aids and Associated Professional Services by Health Care Benefits Plans

The cost of hearing aids is a significant barrier that prevents millions of children and adults with hearing loss from accessing needed technology.  To maximize the use of residual hearing and to promote communication, education, employment, socialization, and general health for people with hearing loss, it is the position of the Deaf and Hard of Hearing Alliance (DHHA) that:

Private and public health benefits plans should provide coverage for (a) the purchase of appropriate hearing aids for both children and adults, and (b) the professional services necessary for medical evaluation and diagnosis, audiological assessment, hearing aid fitting, and follow-up care.    

Findings

DHHA takes this position based on the following findings:

  • There are an estimated 28 million Americans with hearing loss.  However, only 1 out of 5 people who could benefit from a hearing aid actually wears one.1
  • The high cost of hearing aids is a strong deterrent to their utilization.  Cost varies depending on individual needs, features required, style of hearing aid, and market factors, but the average cost of a hearing aid in 2003 was estimated to be $1,800.2
  • At present, health benefits plans rarely include coverage for hearing aids so that consumers pay for hearing aids as an out-of- pocket expense (or forego purchase entirely).
    • Medicare statute specifically excludes coverage for hearing aids.
    • Medicaid requires hearing aid coverage for children and allows coverage of such devices for adults as an optional benefit.  Only 2/3 of the states exercise this option and often limit the types and models to basic, lower-end hearing aids.3
    • No states mandate that private health benefits plans provide hearing aid coverage for adults, and only seven (7)4mandate any kind of coverage for children.
  • Persons with hearing loss should be able to choose the technology that is appropriate for them.  Customers gave higher-end programmable, directional hearing instruments overall satisfaction ratings of 81% while lower end, non-programmable hearing aids received ratings of 58%.5
  • In randomized trials, hearing aids have been shown to improve outcomes for people with hearing loss.6,7  A large study by the National Council on Aging of adults demonstrated that hearing aid use increased earnings power by approximately 50%; enhanced emotional and mental stability and reduced anger anxiety, depression, and paranoia; and improved general health status.8  Early identification and appropriate intervention for children with hearing loss, which frequently includes hearing aids, has lifelong implications for their language development and education.9

Extent of Coverage

Coverage of hearing aids by health benefits plans should allow people with hearing loss, regardless of age, to realize the potential benefits from appropriate amplification that is properly fit, adjusted, and used as part of a comprehensive intervention plan.  Coverage should also recognize the need for replacement of hearing aids due to maturation, change in hearing ability, normal wear and tear, and technological improvements that better meet a user’s communication needs.  Therefore, DHHA recommends that health benefits plans provide a hearing aid benefit with the following minimum coverage:

  • medical evaluation, if not waived by the patient in accordance with federal regulations;10
  • audiological assessment by a qualified provider;
  • hearing aid evaluation and fitting;
  • a hearing aid for each ear with impairment;
  • appropriate instruction on use and care of the hearing aids, including necessary adjustments;
  • replacement of the hearing aid as appropriate.

If policies do not cover the entire cost of the hearing aid, the consumer should have the option to select the hearing aid of choice by paying the difference between the market price of the hearing aid and the maximum benefit allowed.

References/Notes

  1. National Institute on Deafness and Other Communication Disorders at http://www.nidcd.nih.gov/health/statistics/hearing.asp#1.
  2. Strom, Karl E.  “A Brightening Future? A Review of Today’s Hearing Instrument Market,” The Hearing Review, Vol. 11(3), March 2004.
  3. State by State Listing of Medicaid Coverage at http://www.hearingloss.org/html/medicaid_by_state1.HTM.
  4. The States are Connecticut, Kentucky, Louisiana, Maryland, Minnesota, Missouri, and Oklahoma. State Insurance Mandates for Hearing Aids at http://www.asha.org/advocacy/state/issues/ha_reimbursement.htm.
  5. Kochkin, Sergei. “On the Issue of Value: Hearing Aid Benefit, Price, Satisfaction and Brand Repurchase Rates,” The Hearing Review, Vol. 10(2), February 2003, pp. 12-25.
  6. Larson, Vernon et. al. “Efficacy of 3 Commonly Used Hearing Aid Circuits,” Journal of the American Medical Association, Vol. 284 (14), October 11, 2000.
  7. Yueh, B et al. “Screening and Management of Adult Hearing Loss in Primary Care: Scientific Review,” Journal of the American Medical Association, Vol. 289 (15), April 16, 2003, pp. 1976-1985.
  8. Seniors Research Group. The Consequences of Untreated Hearing Loss in Older Persons.  National Council on Aging, May 1999.
  9. National Institutes for Health, Healthy People 2010.
  10. Typically, health plans already provide coverage for medical evaluation.