Hearing Aids Covered by Insuranve and the Affordable Care Act -- I cannot post enough about this.... 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. See list below Background on the ACA The Affordable Care Act provides the opportunity for each state to establish an “exchange” or marketplace that facilitates the purchase of health insurance policies by qualified individuals and groups. As of May 2013: 17 states and the District of Columbia are setting up their own exchanges; seven states are developing partnership exchanges; and, 26 states have defaulted to a federal exchange. The exchanges will provide a competitive marketplace for individuals and small businesses to directly compare offered health insurance policies on the basis of price, quality, and other factors. Minimum coverage that must be included in qualified health plans that might be marketed through the exchanges is defined in the ACA. There are 10 general benefit categories, such as hospitalization, prescription drugs, maternity and newborn care, and rehabilitative and habilitative services and devices, that are required areas of coverage. These “essential health benefits” are intended to represent a typical employer health plan. Health services may be excluded if they are not typically included in medical plans offered by a typical employer. However, health insurers offering qualified plans on exchanges may include additional benefits to those mandated as essential health benefits. States may require qualified health plans to include benefits in addition to the federally-mandated essential health benefits. A state required benefit that was enacted as state law on or before December 31, 2011, is incorporated in that state’s essential health benefits. For state required benefits that do not qualify as essential health benefits, the state must make payments to enrollees or to enrollees’ insurance providers to defray the cost of these additional benefits. Hearing Aids and the ACA Twenty-two states include some coverage for hearing aids and related services, of which 18 are included as state required benefits. The “benchmark plans” for each state covering hearing aids specify the minimum requirements for the qualified health plans that may be offered on the exchange in that state. This information is available online from HHS by visiting http://cciio.cms.gov/resources/data/ehb.html. “Hearing aids” are listed as standard health benefit number 36 on HHS’s benchmark plan format for each state. HHS appears to recognize that coverage for hearing aids should be considered a standard component of health insurance plans. The exchanges are expected to be fully operational by October 1, 2013, to support the initial open enrollment period for coverage taking effect January 1, 2014. The specific essential health benefits contained in the benchmark plans are intended to apply only for plan years 2014 and 2015. It is HHS’s view that maintaining a consistent set of benefits during the initial two years would limit market disruption during this transition period. HHS intends to propose a process to update essential health benefits beginning with plan year 2016. Benchmark Plans for Each State The specific benchmark plans selected for each state are identified and posted on the Affordable Care Act page. Working with particular insurers as well as other private insurers operating in each state to add or expand coverage for hearing aids holds the possibility of this coverage finding itself into future benchmark plans or be included as additional (to essential health benefits) benefits in insurance plans offered through the exchanges. Advocacy to include hearing aid coverage under the ADA could also result in more insurance providers covering hearing aids under all their health care policies, public and private.   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.