Advocacy: Hearing Health

Medicaid Coverage of Hearing Aids

What is Medicaid? Click here to see the State by State Listing

Title XIX of the Social Security Act outlines a program to provide medical assistance for certain individuals with low incomes and few resources. The program, known widely as Medicaid, is federal law and is funded jointly by State and Federal governments in order to provide States the ability to offer adequate medical care to those in need. Medicaid is run within broad federally mandated guidelines which allow states the flexibility to establish their own eligibility standards, determine the type, duration, and scope of services, and set the rate of payment for services. As a result benefits and programs vary considerably from state to state.

Hearing health services are optional under Federal guidelines for minimum coverage and as a result many states do not cover hearing health services for adults.

Children are covered by a federally mandated program referred to as EPSDT (Early and Periodic Screening, Diagnosis, and Treatment), which provides for hearing health services as well as other services for eligible children up to the age of 18.

Pennsylvania

Eligibility Requirements

Children, pregnant women, individuals 65 & over, disabled, blind, TANF families, GA recipients, an individual who is a nursing home patient for 30 days or more, juvenile detention residents after 35 consecutive days, individuals who are ventilator dependent and hospitalized for 30 days, uninsured breast and cervical cancer patients. 


Services Available

Not a covered service for adults. Children are covered under EPSDT and may receive any type of hearing aid including digital models. Dispensing fees, ear molds updated as frequently as necessary, replacements and up to 8 batteries a month are covered.

Restrictions

Must have an unaided and aided audiogram showing need and use of any devices. Hearing aids of any model are only covered up to $280. Any further cost may be covered under a waiver. FM systems are not covered. Children in need of one for school purposes must go through the school district. 

Website: www.dpw.state.pa.us/omap

Contact Numbers: 1-800-692-7462(V) and 1-800-451-4886(TTY)

 

Cochlear Implant Eligibility Gap for Medicare Clients

February 2, 2004

The Honorable Tommy Thompson
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Secretary Thompson:

I am writing to express my concern regarding the Center for Medicare and Medicaid Services’ (CMS) failure to align Medicare coverage criteria with current Food and Drug Administration (FDA) approved indications for the cochlear implant. I am concerned that Medicare beneficiaries who fall in the eligibility gap created by this misalignment are not being given the same opportunity to benefit from cochlear implant technology currently enjoyed by non-Medicare candidates.

In 1985, CMS first established coverage for cochlear implantation based upon FDA approved indications; at that time, the level of required speech understanding was 0%. Since then the FDA has approved expanded indications because, based upon clinical trials and outcomes, more pre-implant residual hearing is associated with better outcomes for cochlear implant patients. The latest FDA approved indications for cochlear implantation include speech-understanding scores higher than current Medicare coverage language. Since June 2001, a coalition of the cochlear implant community have worked with CMS to revise coverage language at Coverage Issues Manual 65-14 in an effort to address this disparity in access. CMS however, has yet to act to ensure access for the Medicare population that fall into the eligibility gap.

We believe the impasse is a result of timing. Unfortunately, the FDA approved expanded indications right at the time that CMS revised its national coverage policy and process. It is our contention that CMS reviewing staff are seeking additional information that does not exist and was not required prior to the change in CMS policy.
Despite extensive efforts to satisfy CMS questions, and provide data requested by that agency’s reviewing staff, the decision to align eligibility standards remains in a holding pattern. Since Medicare’s national coverage language for cochlear implants has not been updated since April 1998 and does not reflect current medical standards, we respectfully request that CMS immediately revise current Medicare coverage language to match FDA approved indications.

Respectfully,

Terry D. Portis, Ed.D.
Executive Director

 

HLAA Participates on Congressional Hearing Health Caucus (CHHC) Advisory Committee

The CHHC was founded in January 2001, and is a bipartisan, no-dues caucus of members of Congress committed to the support of hearing health issues. The CHHC holds luncheon briefings periodically, bringing to Congress the nation’s most prominent scientists, surgeons, physicians, and business and lay leaders. Presenting the latest research, findings, and technological advances, speakers explain how this information directly contributes to the detection, intervention, prevention, and research of hearing health issues.

The CHHC is dedicated to providing an educational forum for discussion and exchange of ideas on issues involving hearing health. Topics of quarterly meetings have ranged from community-based and educational resources and services to hearing technology, such as hearing aids and cochlear implants, and the Individuals with Disabilities Education Act and its impact on children with hearing loss.

Why Was the CHHC Created?

CHHC was originally a project of the National Campaign for Hearing Health and will continue to be administered by it. The Advisory Committee, made up of interested hearing health organizations, consumer and professional, will be responsible for recruitment of new members, topics for caucus presentations, special event planning, and securing sponsors for caucus presentations and special events.

Congressional Hearing Health Caucus Co-Chairs:
Representative Lois Capps (R-NY)
Representative Carolyn McCarthy (D-NY)

HLAA Supports Direct Access to Audiologists for Consumers on Medicare

HLAA supports H.R. 3024, proposed legislation to give Medicare beneficiaries the option of going directly to a qualified audiologist for hearing evaluations.

Currently, Medicare requires that consumers with hearing loss see a physician and obtain a physician referral before being assessed by an audiologist. HLAA supports giving consumers on Medicare the option to see either a physician or an audiologist first for their hearing needs.

Direct access would give consumers choice and therefore improve access to hearing care. Being able to see either a physician or an audiologist provides more options to the consumer and would be less costly to Medicare.

Hearing loss may be an indication of a medical condition and audiologists are educated to recognize problems requiring medical attention and to immediately refer those patients to a physician. It is recommended that physicians specializing in diseases of the ear be consulted.

In contrast, physicians do not always detect hearing problems or make appropriate referrals to audiologists for hearing testing. When suspecting "nerve" deafness, physicians may erroneously tell the patient there is nothing that can be done and fail to inform consumers of beneficial treatment options. Direct access to audiology services would help to address this current gap in health care.

Other federal health care programs such as the Department of Veterans Affairs and the Federal Employees Health Benefits Program and many private health plans already allow direct access to audiologists.

Medicare currently allows beneficiaries access to a range of non-physician practitioners such as optometrist, podiatrist, nurse-midwife, and nurse practitioner among others.

For more information contact:
Brenda Battat
battat@hearingloss.org

 

HLAA Supports Bill H.R. 1646 to Provide a Tax Credit for Hearing Aids

U.S. Representative Carolyn Murphy (D-NY), along with Rep. Vern Ehlers (R-Mich) has reintroduced H.R.1646, the Hearing Aid Assistance Tax Credit Act, which will provide a tax credit of up to $500 per device toward the purchase of hearing aids.

The tax credit may be taken by an individual age 55 or older purchasing a hearing aid for his/her own use, or by a parent purchasing a hearing aid for a dependent child. The tax credit is not refundable and may be used once every five years.

The bill has no restrictions on which type of hearing aid and professional provider the consumer may select. The credit will apply to any hearing aid that is considered a "qualified hearing aid" under the Federal Food, Drug, and Cosmetic Act.

Other organizations supporting the bill are Better Hearing Institute, A.G. Bell Association for the Deaf and Hard of Hearing, International Hearing Society, American Speech Language Hearing Association, Deaf and Hard of Hearing Alliance, Deafness Research Foundation, Hearing Industries Association, and the American Academy of Audiology.

To contact your congressional representative to support the Hearing Aid Tax Credit, go to www.hearingaidtaxcredit.org.

 

Update on Hearing Aid Insurance Legislation

Why do we need this special tax treatment for hearing aids?

What is the extent of the problem with hearing loss in this country?

What is the cost impact of untreated hearing loss?

Conversely, hearing aid usage among those with hearing loss was found to significantly impact the following areas:

What is the potential utilization of H.R. 1646?
Currently 1.28 million Americans of all ages purchase hearing aids each year, with some individuals requiring two devices, bringing the total number of hearing aids purchased across all age groups to approximately 2 million. This number has remained constant over recent years.

H.R. 1646 would provide a potential benefit to a population of around 2 million individuals, many of whom cite financial reasons as the primary barrier to treatment, and would be available only once every 5 years. H.R. 3103 is not intended to cover the full cost of hearing aids, but will simply provide some measure of financial assistance to the groups who are most in need of these devices but are unable to afford them: those approaching or in retirement, and families with children.

 

New Jersey Governor Signs “Grace's Law” to Provide Insurance Coverage for Children's Hearing Aids

January 12, 2009

Noting that health insurers have a responsibility to provide coverage for necessary health care expenses, New Jersey’s Acting Governor Richard J. Codey signed legislation which will require all state-regulated health insurers to cover the cost of medically-necessary hearing aids for children 15 years old and younger.

“With today’s bill signing, we are making sure that the gift of hearing is not out-of-reach for New Jersey children living with hearing loss,” said Acting Governor Codey. “No child should be without access to medically-necessary hearing aids, which are especially critical in the formative years when kids develop the skills to speak and communicate. This new law is about guaranteeing children a level playing field to succeed, and build the skills they need to do well in life.”

The bill, S-467 / A-1571, known as “Grace’s Law,” will require all health insurers in New Jersey to provide coverage for medically-necessary hearing aids for children 15 years of age and younger. The bill requires insurers to provide this coverage every 24 months, and provide up to $1,000 per hearing aid. Under the bill, a covered individual could opt for a hearing aid priced higher than the maximum payable benefit, but would have to pay the difference.

Article appeared in PolitickerNJ.com, By CNoel, December 30, 2008. For the complete article, http://www.politickernj.com/cnoel/26287/acting-governor-codey-signs-graces-law-provide-insurance-coverage-childrens-hearing-aids

For more background on the almost nine years of hard work that went into passage of this law, visit: www.graceslaw.com .

For information about hearing aid insurance coverage in other states, visit
http://www.hearingloss.org/advocacy/govtassistance.asp

 

Great News on Insurance Coverage for Hearing Aids

Our hard work has paid off. Hearing Loss Association of America (HLAA) has been pushing for hearing aid coverage in federal health plans. HLAA has learned that several of the Federal Employee Health Benefits (FEHB) insurance plans have expanded their coverage to include coverage of hearing aids for adults. The Federal Government is the largest employer in the US. FEHB covers some 8 million federal employees, retirees and their dependants. That’s a lot of health insurance!

Expanded hearing health care coverage is great news not only for federal employees, but for everyone who depends on their employer for health insurance. As the Office of Personnel Management (OPM) points out in their news release, the FEHB program is often seen as a model program that serves to show the way for other insurers. Below are examples of added coverage offered in the FEHB plans:

  1. Blue Cross/Blue Shield is adding hearing aids for adults up to $1,000 per ear, every 3 years in both options.
  2. APWU is adding a new benefit with one exam and testing every 2 years paid at 90 percent of PPO allowance or 70 percent of allowance for non-PPO. Hearing aids every three years limited to $1,500 maximum.
  3. Mail Handlers, which already provided benefits of $200 per hearing aid per ear, is increasing the amount to $500, with replacement available every five years.
  4. GEHA is adding a new benefit with a maximum of $500 per ear, every five years.
  5. Panama Canal is adding a new benefit with a $1,000 lifetime maximum.
  6. Foreign Service is adding a new benefit of 100 percent coverage, up to a maximum of $1,200 per aid per ear per person and hearing exam, once every five years.
  7. Rural Carriers is adding a new benefit up to $1,100 per hearing aid per ear once every five years.
  8. The Association is changing their hearing benefit coinsurance from 10 percent to 0 percent and will cover up to a maximum of $1,400 for one hearing aid per ear.
  9. Samba is adding hearing benefits up to $500 per lifetime for hearing aids.
  10. NALC is providing a lifetime maximum of $1,000 for hearing aids
  11. Health Alliance is adding a new benefit at a maximum of $500 for hearing aids/devices once every three years.

FEHB’s inclusion of hearing aids makes it clear they see the lack of hearing aids for their employees as a health care issue. It’s our expectation that other carriers will follow the lead of FEHB. HLAA will be watching to see whether more carriers pick up expanded hearing health coverage.

Ask your employer if they cover hearing aids in your plan now. Let us know if they do. If your employer doesn’t provide similar coverage, show them what’s happening with FEHB. If federal employees enjoy hearing aid health insurance coverage, why shouldn’t the rest of us benefit too?!

E-mail Lise Hamlin with your information.

 

Governor Minner Signs Bill Requiring Improved Insurance Coverage for Hearing Aids

Dover, DE 18 June 2008 – Governor Ruth Ann Minner today signed a bill in her Legislative Hall office that will improve insurance coverage for children in Delaware. House Bill 355 will benefit hearing impaired youth, and House Bill 286 is designed to ensure that children without health insurance receive coverage.

H.B. 355, sponsored by Rep. Gerald Brady, requires individual and group health insurance contracts to provide coverage for hearing aids of up to $1,000 per ear, every three years, for their customers who are 24 and under.

“This is obviously a bill that will be of tremendous help to our hearing impaired youth and their families,” Gov. Minner said. “I thank Rep. Brady and our General Assembly for passing this important legislation.”

“I am very proud that my colleagues in the General Assembly supported my efforts to provide these benefits for children throughout our state, and I thank Governor Minner for signing this legislation as quickly as possible,” Brady said.

The bill's co-sponsors included: Representatives Carson, Ewing, Keeley, Kowalko, Longhurst, Manolakos, Mitchell, Outten, Schooley, Williams; and Senators Henry, Marshall, McDowell.