Affordable Care Act (ACA) State Plans and Hearing Aids

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Hearing aids covered up to $1,000 per hearing aid, per ear, every three years for ... Excluded are all hearing services
Affordable Care Act (ACA) State Plans and Hearing Aids STATE

STATUS OF BENCHMARK

BENCHMARK PLAN

COVERAGE

Alabama

Default to Federal Exchange

BCBS of Alabama, 320 Plan, PPO, Small Group Plan

Hearing aids not covered.

Alaska

Default to Federal Exchange

BCBS of Alaska – Alaska Heritage Select Envoy, PPO, Small Group Plan

Hearing aids not covered.

Arizona

Default to Federal Exchange

State Employee Benefit – United HealthCare EPO

One (1) hearing aid per ear per year and hearing exam covered.

Arkansas

HHS conditionally approved State Partnership Marketplace plan.

Arkansas BCBS Health HMO Advantage Partnership Open Access (POS)

Hearing aids not covered.

California

HHS conditionally approved State Marketplace plan.

Kaiser Small Group HMO

Hearing aids not covered.

Colorado

HHS conditionally approved State Marketplace plan.

Kaiser Ded/CO HMO 1200D Small Group Plan

Hearing aids covered for persons under the age of 18. (State required benefit under Colo. Rev. Stat. §10-16-104(19).)

Connecticut

HHS conditionally approved State Marketplace plan

ConnectiCare HMO Commercial HMO

Hearing aids covered for children age 12 and under. (State required benefit under Connecticut Gen. Stat. §38a-516b: §38a-490b.)

Delaware

HHS conditionally approved State Partnership Marketplace plan.

BCBS Small Group EPO plan

Hearing aids covered up to $1,000 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

HHS conditionally approved State Marketplace plan

BCBS CareFirst Blue Preferred, PPO Small Group Plan

Hearing aids not covered.

Florida

Default to Federal Exchange

BCBS of Florida – Blue Options, PPO, Small Group Plan

Hearing aids not covered.

As of August 6, 2013

Affordable Care Act (ACA) State Plans and Hearing Aids STATE

STATUS OF BENCHMARK

BENCHMARK PLAN

COVERAGE

Georgia

Default to Federal Exchange

BCBS of Georgia – HMO Urgent Care Copay Small Group Plan

Excluded are all hearing services including hearing aids, hearing devices, and related or routine examinations and services.

Hawaii

HHS conditionally approved State Marketplace Plan

Hawaii Medical Services Assoc. (BCBS), PPO, Small Group Plan

One (1) hearing aid per ear, every 60 months. Fitting, adjustment, repair of hearing aids and batteries are not covered.

Idaho

HHS conditionally approved State Marketplace Plan

Blue Cross of Idaho – Preferred Blue, Small Group Plan

Hearing aids not covered.

Illinois

HHS conditionally approved State Partnership Marketplace plan

BCBS of Illinois Blue Advantage Small Group Plan

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

Default to Federal Exchange

Anthem (BCBS) – Blue Access, PPO, Small Group Plan

Hearing aids and fitting and examinations for hearing aids not covered.

Iowa

HHS conditionally approved State Partnership Marketplace plan

Wellmark (BCBS) – Alliance Select, PPO, Small Group Plan

Hearing aids not covered.

Kansas

Default to Federal Exchange

BCBS of Kansas Comprehensive, Major Medical PPO, Small Group Plan

Hearing aids not covered.

Kentucky

HHS conditionally approved State Marketplace plan

Anthem (BCBS), PPO Small Group Plan

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

Default to Federal Exchange

BCBS of Louisiana – Group Care, PPO, Small Group Plan

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.)

As of August 6, 2013

Affordable Care Act (ACA) State Plans and Hearing Aids STATE

STATUS OF BENCHMARK

BENCHMARK PLAN

COVERAGE

Maine

Default to Federal Exchange

Anthem (BCBS) of Maine, Blue Choice, PPO, Small Group Plan

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

HHS conditionally approved State Marketplace plan

CareFirst (BCBS) – HMO HSA Open Access, Small Group Plan

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

HHS conditionally approved State Marketplace plan

BCBS of Massachusetts HMO Blue, Small Group Plan

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

HHS conditionally approved State Partnership Marketplace plan.

Priority Health HMO, commercial HMO

Hearing aids not covered.

Minnesota

HHS conditionally approved State Marketplace plan.

Health Partners – Small Group Product, PPO, Small Group Plan

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

State-based blueprint rejected by HHS. Default to Federal Exchange.

BCBS Network Blue, PPO, Small Group Plan

Hearing aids not covered.

Missouri

Default to Federal Exchange

Healthy Alliance (BCBS) – Blue Access Choice, PPO, Small Group Plan

Treatment for hearing loss covered only for newborns.

As of August 6, 2013

Affordable Care Act (ACA) State Plans and Hearing Aids STATE

STATUS OF BENCHMARK

BENCHMARK PLAN

COVERAGE

Montana

Default to Federal Exchange

BCBS of Montana – Blue Dimensions, PPO, Small Group Plan

Hearing aids not covered.

Nebraska

Default to Federal Exchange

BCBS of Nebraska – Blue Pride, PPO, Small Group Plan

Hearing aids not covered.

Nevada

HHS conditionally approved State Marketplace Plan

Health Plan of Nevada (United) – POS CXV-500-HCR, Small Group Plan

Hearing aids covered up to a maximum amount of $5,000 and limited to a single purchase per calendar year. Repairs and replacement are allowable, but limited to once every 3 years.

New Hampshire

HHS conditionally approved State Partnership Marketplace plan

Anthem (BCBS) – Matthew Thornton Blue, HMO, Small Group Plan

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

Default to Federal Exchange

Horizon (BCBS) – HMO Access, Small Group Plan

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

HHS conditionally approved State Marketplace plan

Lovelace Classic PPO plan, Small Group Plan

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.)

As of August 6, 2013

Affordable Care Act (ACA) State Plans and Hearing Aids STATE

STATUS OF BENCHMARK

BENCHMARK PLAN

COVERAGE

New York

HHS conditionally approved State Marketplace plan

Oxford EPO, Small Group Plan

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

Default to Federal Exchange

BCBS of North Carolina – Blue Options, PPO, Small Group Plan

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

Default to Federal Exchange

Sanford Health Plan, HMO, Commercial HMO

Hearing aids not covered.

Ohio

Default to Federal Exchange

Community Insurance Co. (Anthem BCBS) – Blue Access, PPO, Small Group Plan

Hearing aids not covered.

Oklahoma

Default to Federal Exchange

BCBS of Oklahoma – Blue Options, PPO, Small Group Plan

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

HHS conditionally approved State Marketplace Exchange

Pacific Source Preferred CoDeduct Small Group Plan

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.)

As of August 6, 2013

Affordable Care Act (ACA) State Plans and Hearing Aids STATE

STATUS OF BENCHMARK

BENCHMARK PLAN

COVERAGE

Pennsylvania

Default to Federal Exchange

Aetna, POS, Small Group Plan

Hearing aids not covered.

Rhode Island

HHS conditionally approved State Marketplace Exchange

BCBS of Rhode Island – Vantage Blue PPO, Small Group Plan

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 $1,500 per ear every 3 years. (State required benefit under Rhode Island Gen. Laws §27-20-46; §27-18-60.)

South Carolina

Default to Federal Exchange

BCBS of South Carolina – Business Blue Complete, PPO, Small Group Plan

Hearing aids not covered

South Dakota

Default to Federal Exchange

Wellmark (BCBS) – Blue Select PPO, Small Group Plan

Hearing aids not covered

Tennessee

Default to Federal Exchange

BCBS of Tennessee, PPO, Small Group Plan

Hearing aids covered for persons age 17 and younger, limited to $1,000 per year every 3 years. Infant hearing screening is covered as a state required benefit under Tenn. Code §56-72508.

Texas

Default to Federal Exchange

BCBS of Texas – Best Choice, PPO, Small Group Plan

Hearing aids covered up to $1,000 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

HHS conditionally approved State Marketplace plan

Utah Basic Plus State Employee Plan, HMO

Hearing aids not covered.

Vermont

HHS conditionally approved State Marketplace plan

Vermont Health Plan (BCBS) – BlueCare, HMO, Commercial HMO

Hearing aids not covered.

Virginia

Default to Federal Exchange

Anthem (BCBS) – Key Care, PPO, Small Group Plan

Hearing aids, exams and fitting for hearing aids are excluded.

As of August 6, 2013

Affordable Care Act (ACA) State Plans and Hearing Aids STATE

STATUS OF BENCHMARK

BENCHMARK PLAN

COVERAGE

Washington

HHS conditionally approved State Marketplace plan

Blue Shield Regence Innova, PPO, Small Group Plan

Hearing aids not covered.

West Virginia

HHS conditionally approved State Partnership Marketplace plan

Highmark (BCBS of West Virginia) – Super Blue Plus 2000, PPO, Small Group Plan

Hearing aids not covered.

Wisconsin

Default to Federal Exchange

United – Choice Plus, POS, Small Group Plan

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

Default to Federal Exchange

BCBS of Wyoming – Blue Choice Businesss, PPO, Small Group Plan

Hearing aids not covered.

As of August 6, 2013