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Affordable Care Act (ACA) State Plans and Hearing Aids
As of August 6, 2013
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.
Affordable Care Act (ACA) State Plans and Hearing Aids
As of August 6, 2013
STATE STATUS OF BENCHMARK BENCHMARK PLAN COVERAGE Georgia Default to Federal Exchange BCBS of Georgia – HMO Urgent Care Co-
pay 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.)
Affordable Care Act (ACA) State Plans and Hearing Aids
As of August 6, 2013
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.
Affordable Care Act (ACA) State Plans and Hearing Aids
As of August 6, 2013
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 C-XV-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.)
Affordable Care Act (ACA) State Plans and Hearing Aids
As of August 6, 2013
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.)
Affordable Care Act (ACA) State Plans and Hearing Aids
As of August 6, 2013
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 §56-7-2508.
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.
Affordable Care Act (ACA) State Plans and Hearing Aids
As of August 6, 2013
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.
