The Affordable Care Act & hearing aids

Despite hearing loss being linked to depression, dementia, social isolation, falls and reduced quality of life, at least 25 million people who could benefit from hearing aids do not wear them. This could be as a result of the cost of hearing aids or a lack of available hearing healthcare. However, the Affordable Care Act (ACA), known as Obamacare, was introduced in 2010 to overhaul the US healthcare system, including hearing healthcare. It aimed to lower the cost of health care by making health insurance more available and affordable to those who most need it the most.

Unlike Medicare, the ACA doesn’t specifically exclude coverage for hearing aids. The Act was written in a positive way which described several categories of benefits that must be included in insurance policies, referred to as benchmarks for essential health benefits. But the ACA is complex legislation and coverage for hearing evaluations, hearing aids and hearing aid accessories are a gray area.

There are eight key features that you should know if you or a member of your family rely on using hearing aids, or may do so in the future.

ACA assists people with buying health insurance by offering federal subsidies to those who qualify based on income. It also penalizes those who fail to carry health insurance for three consecutive months or more. There are also penalties for companies that don’t provide adequate health insurance benefits to employees. This has seen more Americans than ever before getting insurance for hearing evaluations and ENT office visits.

Since the introduction of the ACA, your in-network providers or healthcare plan may have changed or been no longer available. You will have to ensure you choose a new plan that meets the ACA’s guidelines which could lead to an increase in your premiums. If you don’t qualify for any type of federal assistance, you may find your healthcare costs going up.

The ACA has led to more health plans for children now covering preventative care screenings at no cost. This includes the newborn hearing screening. Hearing loss is now much more likely to be detected at an earlier age.

Young adults with hearing loss continue to be covered by their parent’s healthcare plan until they reach 26.

If you or your children have hearing loss or some other pre-existing condition that could affect your hearing, you can still get a health insurance policy that covers pre-existing conditions.

there is no other pre existing hearing condition, you either have hearing loss or you don't. Perhaps you mean pre-existing condition that could affect your hearing?

Although you cannot be denied health coverage due to a pre-existing hearing condition, you may find that not every service is covered, such as hearing tests. There is no coverage for hearing aids under Medicare and this hasn’t changed under the Affordable Care Act. There is also no specific directive that requires private insurance companies to provide coverage for hearing aids.

Since 2015, there have been considerable cuts to Medicare reimbursements. This means that some providers may no longer be a Medicare provider. This may mean that physicians stop taking on new Medicare patients or stop altogether seeing existing ones. If you are on Medicare, this could make it more difficult for you to see the physician you want regarding your hearing healthcare.

Medicare and private insurances generally cover cochlear implants. This has not changed since the ACA was introduced. However, as more people are now insured following the introduction of the Affordable Care Act, more people are seeking evaluations for cochlear implants and treatments who weren’t able to get them before.

Despite the Affordable Care Act not requiring insurers to provide hearing aid coverage, some individual states do. Twenty-five states in the US provide some level of coverage for hearing aids and related services. However, most limit it to just children and teenagers. From 2013, the following states stopped providing any coverage for hearing aids for both children and adults:

Alabama, Alaska, Arkansas, California, District of Columbia, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Michigan, Mississippi, Montana, Nebraska, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia, and Wyoming.

While there has been much controversy surrounding America’s Affordable Care Act since its introduction, it has transformed the way the country delivers healthcare. However, for Americans living with hearing loss and requiring the use of hearing aids, there is still a long way to go to create a level playing field where everyone can access the affordable hearing healthcare they need.