Topic:
HEARING AIDS; MEDICAID; HEALTH INSURANCE; PUBLIC ASSISTANCE SEE INCOME MAINTENANCE; HEARING DISORDERS;
Location:
HEARING IMPAIRMENT; WELFARE - MEDICAL ASSISTANCE (MEDICAID);
Scope:
Program Description;

OLR Research Report


December 22, 2000

 

2000-R-1191

COVERAGE FOR HEARING AIDS

 

By: Jerome Harleston, Senior Attorney

You want to know (1) about Connecticut programs that cover the cost of hearing aids and their eligibility requirements and (2) the cost of hearing aid coverage in Rhode Island and Oklahoma.

COVERAGE IN CONNECTICUT

Medicaid, Medicare Managed Care (HMO), Husky, State Administered General Assistance, and the Bureau of Rehabilitation Services provide some coverage for hearing aids for children and adults of modest means, children with special health care needs, those 65 and over or disabled, and working adults.

On Table 1 below, we have identified state programs that cover hearing aids and those who are eligible to participate in them.

Table 1: COVERAGE FOR HEARING AIDS

Age Group

Program

Eligibility

Hearing Aid Coverage

0 to 3

Birth to Three

Child must have physical, mental, or emotional condition requiring “medically necessary” early intervention services and “significant” hearing loss.

Individual and group policies must offer at least $5,000 of early intervention service coverage, which includes assistive technology devices (CGS 38a-490a and 38a-516a). Program bills insurance and pays difference. If uninsured, parents pay according to sliding scale.

0 to 19

Husky A (Medicaid)

Family income up to 185% of Federal Poverty Level (FPL).

*Yes, prior authorization required.

0 to 19

Husky B (State Children's Health Insurance Program)

(1) Family income between 185% to 300% of FPL.

(2) Family income greater than 300% of FPL.

*Yes, prior authorization required. (1) Covered by special subsidized health insurance policy.

(2) Family may purchase special policy at group rate.

0 to 19

Husky Plus (supplemental benefits)

Uninsured children with special physical or emotional health care needs enrolled in Husky B.

Yes, prior authorization required, one per year for new or two times per year for repaired.

0 to 19

Title V (Children with Special Health Care Needs)

Underinsured children with family income up to 300% FPL.

Yes, once insurance benefits have been exhausted.

20 to 65

Medicaid

Aged, blind, disabled, adults receiving Temporary Family Assistance (TFA) benefits, pregnant women with incomes up to 185% of FPL, and medically needy with incomes up to 143% of the cash assistance benefits.

*Yes, prior authorization required.

20 to 65

Medicaid (section 1931(b) of the Social Security Act)

Parents and adult caretaker relatives of children in Husky A with incomes up to 150% of FPL.

*Yes, prior authorization required.

18 to 65

State Administered General Assistance

Low-income adults who do not qualify for Medicaid.

*Yes, prior authorization required.

65 and over or disabled

Qualified Medicare Beneficiary (dually eligible for Medicare and Medicaid)

Recipient of Medicare Part A, income up to 100% of FPL and assets no more than twice the Supplemental Security Income (SSI) limit.

*Yes, prior authorization required.

20 to 65

Bureau of Rehabilitation Services

Hearing loss or impairment must be substantial and have a direct adverse impact on the ability to continue working or maintain employment.

^Yes

65 and over or disabled

ConnecticCare Managed Care (HMO)

Social Security recipients who are 65 years old or older, and to those who are permanently disabled and receiving Social Security for 24 months.

Yes, plan pays up to $360 for hearing aids every 36 months.

Same as above

MedSpan Medicare Managed Care (HMO)

Same as above

Yes, for options (C2) and (C3) plan pays reimbursement up to $300 every 36 months.

*Medicaid Reimbursement Schedule

Reimbursement for hearing aids covered under Medicaid are paid as follows:

1. Monaural (1 ear)

In or behind the ear $439.00

Body-worn $500.00

2. Binaural (2 ears)

In or behind the ear $781.75

Body-worn $904.00

3. Cross (1 ear) $598.75

Bi-cross (2 ears) $755.00

^Bureau of Rehabilitation Services (BRS)

In federal fiscal year 2000, BRS provided 246 hearing aids to 146 clients at a cost of $1,116 per person. Total hearing aid expense was $162,950 and includes the device and cost of visits for fitting. BRS pays 60% of the suggested retail price or $700 for one or $1,075 for two non-programmable units. It pays $1,500 for one programmable unit and $2,750 for two.

Additional Sources of Coverage

All World War I veterans are eligible to receive free hearing aids.

The Department of Veterans Affairs' Uniform Benefit Package offers limited coverage for hearing aids. Enrollment in the plan is determined according to priority groups ranging from 1-7 with 1 being the highest priority for enrollment (e.g., veterans with service-connected disabilities rated 50% or more disabling).

As a general rule, hearing aids require a service-connected disability, but the department appears to have relaxed this requirement. Thus, hearing aids may be provided to nonservice-connected veterans for naturally occurring hearing loss.

Although public schools do not provide hearing aids, they do provide other devices intended to improve a hearing-impaired child's ability to learn in the classroom. A device in common use is a frequency-

modulated (FM) radio transmitter and receiver. Special education funds administered under the federal Individuals with Disabilities Education Act cover the equipment's cost. Schools must provide an FM unit if the pupil's individual education plan calls for it.

Special-need pupils in low-income families that qualify may get coverage for hearing aids under the Husky Plus program.

The Bureau of Rehabilitation Services through Peoples Bank, administers the Technology Loan Program that offers low-interest loans to credit-worthy borrowers to purchase hearing aids and other assistive devices.

COVERAGE COST IN OKLAHOMA AND RHODE ISLAND

The Oklahoma Insurance Department has no information on the cost of the state's mandate requiring individual and group health benefit plans to cover audiological services and hearing aids for children up to age 13. Prudential Insurance Company and Physicians Mutual are the leaders in the group and individual health insurance markets in Oklahoma. We have requested cost and premium information from them and will share it with the taskforce when received.

Actuaries at Blue Cross and Blue Shield of Rhode Island stated that they had not as yet priced the optional hearing aid benefit rider that takes effect April 1, 2001.

By law, the Maryland Health Care Commission is required to assess the financial, medical, and social impact of proposed health service mandates. The commission contracted with William M. Mercer, Inc. to prepare a report on three bills introduced in the 2000 legislative session.

All three bills would require insurers, nonprofit health service plans, and HMOs to provide coverage for a standard model hearing aid.

The Mercer Report includes testing, ear impressions, and office visits in the price of hearing aids. It estimates that the cost for hearing aids, depending on type and style, would range from $500 to $6,000 and, based on prevailing charge data, that the average cost was $1,400 per aid. Mercer estimates the average annual cost per member at $7.88 and the annual cost per contract at $16.54 based on 2.1 members per contract.

According to Mercer, the financial cost of mandated health insurance benefits can be defined as the “full” cost of the benefit, or it can be defined as the “marginal” cost of the mandate, where the marginal cost equals the full cost of the benefit minus the value of the service that would be covered in the absence of the mandate.

Full and marginal hearing aid cost as a percentage of average cost per group policy was 0.3%. The estimated annual per employee full and marginal costs for group policies was $17 and $16, respectively.

The insurance carrier survey responses ranged from no impact to a 0.5% increase in premium. Overall, the carriers projected a 0.3% increase in premium.

JH:ts