On January 1, 2020, Maine became one of only a handful of states that require private insurers to cover the cost of hearing aids for adults.
The change is the result of a bill, “L.D. 38 An Act To Require Insurance Coverage for Hearing Aids for Adults,” which was sponsored by Representative James Handy, and passed by the Maine Legislature in 2019. The law requires private health insurers to cover one hearing aid per ear for adults, every three years, with a minimum coverage of up to $3000 per aid.
Hearing aids are a simple measure that can significantly improve health and self-sufficiency for Mainers with hearing loss. And the need is high: a 2013 report by the state Bureau of Insurance estimated that as many as 173,000 Mainers experience hearing loss.
However, most Maine households do not have the resources to pay the out-of-pocket cost to purchase hearing aids, which typically run from $1500 - $6000…per aid.
Unaided hearing loss carries a steep financial cost for Mainers and their families. A 2007 study by the National Better Hearing Institute concluded that unaided hearing loss for a Wage earner resulted in an average loss of $12,000 per year in household income. It is estimated that 24 million Americans with hearing loss currently do not have access to hearing aids, with unrealized earnings and tax revenue reaching into the billions. In 2017, the Maine Dept. of Labor estimated that approximately half of the individuals on a waiting list for state vocational rehabilitation services were individuals who said they needed a hearing aid in order to find work or keep their current job.
For all of these reasons and more, many cheered when Maine’s new law went into effect. The law marks an important turning point in the recognition that hearing aids are health care, and the cost of hearing aids are medical costs.
However, those hoping that the new law provides a simple solution to a seemingly straightforward problem may be disappointed. Not all Mainers will be able to benefit, and many have been confused by how their insurance interacts with the new law.
One issue is that Maine has limits on what it can mandate insurers to cover. Medicare, Medicare Advantage plans, and self-insured plans are not affected Maine’s new law. The state does not have the power to regulate Medicare or Medicare Advantage plans, which instead are governed by the federal government. And, self-insured plans (including those used by some of Maine’s largest employers) are also exempt from State health insurance benefit mandates.
For those with plans that are covered, they may still find the same problems that plague much of American health care. Annual deductibles could mean an individual could still be responsible for all or part of the cost of a hearing aid before their plan will pay. Individuals could also be responsible for all or part of the cost if they use a provider who is not part of their plan’s network. And since the law only requires coverage up to $3000, a hearing aid that costs more will likely require additional out-of-pocket spending.
Regardless, the new law is a step in the right direction. Maine will now be one of only five states that require state-regulated insurance plans to cover hearing aids for adults.
And many hope that it marks a growing momentum to expand access to hearing aids nationally, as a bill to require Medicare to cover the cost of hearing aids is being considered at the federal level.
For questions about the new hearing aid insurance mandates, or about which insurance plans are required to provide the hearing aid benefit, individuals can contact the Maine Bureau of Insurance at (207) 624-8475 or (800) 300-5000.