ME Payers Cover Hearing Aids, Self-Insured Companies Exempt

Maine law now requires payers to provide hearing aid coverage, but leaves self-insured companies exempt from covering them.

Representative Jim Handy (D-ME) has noted both social and professional reasons for this legislation.

"Hearing loss can have a profoundly negative impact on so many aspects of a person's life. Improving access to hearing aids would improve the social, family and work life of thousands of Mainers,” Handy said in a press release when he first proposed the bill. “This is also a workforce development matter. As we struggle to find employees to fill many positions, there are those with hearing impairments that are ready and willing to work.”

The legislation requires payers to cover up to $3,000 for each ear that needs a hearing aid every three years. To qualify, hearing loss must be documented by a licensed provider. The hearing aid must meet state regulations. 

Up to 173,000 Maine residents suffered hearing loss in 2014, the Portland Press Herald reported.

However, in a separate article, the Portland Press Herald later stated that only a fraction of those residents would be covered under the new hearing aid law.

According to the Portland Press Herald, the state’s exemptions release self-insured businesses from any responsibility to cover their employees’ hearing aids. The state’s officials estimate that only 6,000 of the 173,000 with hearing loss will receive coverage for hearing aids.

Despite the gap, this is still a step forward for Mainers. In previous years, only children under the age of 18 could obtain covered hearing aids and payers were only required to cover $1,400 of the expenditure, the Portland Press Herald noted.

For reference, a recent Consumer Report survey found that the typical out-of-pocket healthcare spending for a pair of hearing aids can amount to $2,691.

Should private health payers and self-insured organizations feel obligated to provide hearing healthcare benefits? The National Association of the Deaf (NAD) argues that they should.

“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,” the organization’s website states.

NAD goes on to cite affordability as the main social determinants of health barrier that prevents those with hearing loss from obtaining hearing aids.

“The cost of hearing aids is a significant barrier that prevents millions of children and adults with hearing loss from accessing needed technology,” the organization states.

Payers have been tracking these statistics and are taking action.

In July 2019, UnitedHealthcare (UHC) initiated its program UnitedHealthcare Hearing. The program offers hearing aids discounted up to 80 percent of the original price.

UHC also distributed 20,000 earplugs to law enforcement officers and firemen in ten major cities across the nation. 

These professions can experience tremendous hearing loss due to their sonic work environments. Hearing loss in such positions can be a matter of life and death.

UHC’s earplugs seek to decrease the risk of hearing loss and thereby curb the demand for hearing aids.

Another major payer, Blue Shield of California, incorporated a hearing healthcare benefit into its new Medicare supplemental Plan G Extra. The benefit encompasses hearing tests and mid- and premium-level hearing aids.

The question remains: will Maine’s self-insured employers also see a need to cover employees who would otherwise be eligible for hearing aids from a health payer?