The Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010 by President Barack Obama. According to the U.S. Department of Health and Human Services (HHS), the law’s goal is to make health insurance available and affordable to people and small groups, such as employees of small businesses and organizations, who are uninsured. While some provisions of the law have already taken effect, many more provisions will be implemented in the coming years.
HLAA Chapters and state organizations as well as individual HLAA members working with their state offices for hard of hearing and deaf people, with state insurance commissioners, and with state legislatures, have an opportunity to advocate to add or expand coverage for hearing aids in future ACA plans. It will take forethought, good planning, and some roll-up-your-sleeves advocacy for those willing to increase hearing aid coverage under the ACA.
Background on the ACA
The Affordable Care Act provides the opportunity for each state to establish an “exchange” or marketplace that facilitates the purchase of health insurance policies by qualified individuals and groups.
As of May 2013: 17 states and the District of Columbia are setting up their own exchanges; seven states are developing partnership exchanges; and, 26 states have defaulted to a federal exchange. The exchanges will provide a competitive marketplace for individuals and small businesses to directly compare offered health insurance policies on the basis of price, quality, and other factors.
Minimum coverage that must be included in qualified health plans that might be marketed through the exchanges is defined in the ACA. There are 10 general benefit categories, such as hospitalization, prescription drugs, maternity and newborn care, and rehabilitative and habilitative services and devices, that are required areas of coverage. These “essential health benefits” are intended to represent a typical employer health plan. Health services may be excluded if they are not typically included in medical plans offered by a typical employer. However, health insurers offering qualified plans on exchanges may include additional benefits to those mandated as essential health benefits.
States may require qualified health plans to include benefits in addition to the federally-mandated essential health benefits. A state required benefit that was enacted as state law on or before December 31, 2011, is incorporated in that state’s essential health benefits. For state required benefits that do not qualify as essential health benefits, the state must make payments to enrollees or to enrollees’ insurance providers to defray the cost of these additional benefits.
Hearing Aids and the ACA
Twenty-two states include some coverage for hearing aids and related services, of which 18 are included as state required benefits. The “benchmark plans” for each state covering hearing aids specify the minimum requirements for the qualified health plans that may be offered on the exchange in that state. This information is available online from HHS by visiting http://cciio.cms.gov/resources/data/ehb.html.
“Hearing aids” are listed as standard health benefit number 36 on HHS’s benchmark plan format for each state. HHS appears to recognize that coverage for hearing aids should be considered a standard component of health insurance plans.
The exchanges are expected to be fully operational by October 1, 2013, to support the initial open enrollment period for coverage taking effect January 1, 2014. The specific essential health benefits contained in the benchmark plans are intended to apply only for plan years 2014 and 2015. It is HHS’s view that maintaining a consistent set of benefits during the initial two years would limit market disruption during this transition period. HHS intends to propose a process to update essential health benefits beginning with plan year 2016.
Benchmark Plans for Each State
The specific benchmark plans selected for each state are identified and posted on the Affordable Care Act page. Working with particular insurers as well as other private insurers operating in each state to add or expand coverage for hearing aids holds the possibility of this coverage finding itself into future benchmark plans or be included as additional (to essential health benefits) benefits in insurance plans offered through the exchanges. Advocacy to include hearing aid coverage under the ADA could also result in more insurance providers covering hearing aids under all their health care policies, public and private.