Insurance Doesn’t Always Cover Hearing Aids for Kids - KFF Health News (2024)

By Colleen DeGuzman

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Insurance Doesn’t Always Cover Hearing Aids for Kids - KFF Health News (1)

Joyce Shen was devastated when doctors said her firstborn, Emory, hadn’t passed her newborn hearing screening. Emory was diagnosed with profound sensorineural hearing loss in both ears as an infant, meaning sounds are extremely muffled.

But Shen and her husband, who live in Ontario, California, faced a horrible situation. Without intervention, they were told, their baby daughter’s hearing impairment would prevent her from acquiring age-appropriate language skills and likely leave her with developmental problems affecting her education. Pediatric hearing aids can look like modified earbuds and sometimes come in pink, blue, and other bright colors. The ones Emory needed can cost more than $6,000 a pair, and she would require a new pair about every three years as her ears grow. But the family’s work-based insurance does not cover those costs.

Shen said she knows all too well what’s at stake for her daughter, who was born in February 2023. “If she had hearing aids, I could start all the speech therapy right now, get her access to most of the sounds. But right now, I can’t do anything. Just waiting.”

Insurance Doesn’t Always Cover Hearing Aids for Kids - KFF Health News (2)

The family is not alone in this predicament. California and 17 other states don’t require private insurance plans to cover hearing aids for kids, so many don’t. But about two or three of every 1,000 babies in the U.S. are born with detectable hearing loss in one or both ears, according to the National Institute on Deafness and Other Communication Disorders.

“You have to learn to hear before you can learn to speak, and we all speak how we hear,” said Brooke Phillips, a Los Angeles audiologist who co-chairs the volunteer coalition Let California Kids Hear.

Grassroots action, often led by mothers, helped steer legislatures in 32 states to pass bills that would require private insurance to cover hearing aids for children. Vermont, Virginia, and Washington are the most recent.

The fix, however, is not always an easy one. Bills died at the end of the most recent legislative sessions in New York and Hawaii. And, in California, where only 9% of children and young adults enrolled in commercial plans have coverage for hearing aids and services, Democratic Gov. Gavin Newsom vetoed a measure in October that would have required such coverage.

“There’s real disappointment among professionals and our California families,” said Phillips.

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Newsom, who, by the end of 2023, faced a projected $68 billion state budget deficit, explained in his veto letter that the bill would “increase ongoing state General Fund costs” and “set a new precedent by adding requirements that exceed the [state’s] benchmark plan” under the Affordable Care Act. Adding kids’ hearing aids to the essential benefits package would trigger a provision of the ACA that requires state coffers to offset the additional expense. Newsom was wary that this “could open the state to millions to billions of dollars in new costs” for expanded coverage.

Nationally, there’s pressure to pass such state mandates because health plans often don’t cover hearing aids for kids, calling them elective or cosmetic. Dylan Chan, a pediatric ear, nose, and throat physician at the University of California-San Francisco Benioff Children’s Hospitals, said hearing aids should be covered the way glasses and tooth fillings are.

Efforts on the ground suggest the push has slowly been gaining momentum.

Jocelyn Ross of Columbia, South Carolina, founded Let South Carolina Hear in 2010 after her daughter Alyssa was diagnosed with congenital hearing loss when she was just a few months old. Although South Carolina has yet to mandate coverage of hearing aids, the coalition has become a model for other such advocacy groups across the nation. Let Georgia Hear was launched a year later by Kelly Jenkins, an Atlanta mom whose daughter has worn hearing aids since she was 18 months old. Legislation requiring the state’s private insurers to cover kids’ hearing aids passed in 2017. Advocates in Ohio and Michigan are also pushing for legislative relief.

Though progress in various states is coming in fits and starts, Newsom’s veto in progressive California was surprising.

Stephanie Wittels Wachs, who founded Let Texas Hear, has two children who are hard of hearing. Her organization helped push the 2017 passage of kids’ hearing aid legislation. But when she moved from Houston to California in 2020, she was “completely shocked” to learn no such mandate had been approved there. “California usually leads the way, and we are falling behind some more conservative states that have prioritized pediatric hearing loss,” she said.

Newsom’s veto was especially surprising to many advocates because in 2019 he had created the Hearing Aid Coverage for Children Program, or HACCP, which offers supplemental coverage of up to $1,500 for hearing aids for families earning up to 600% of the family poverty threshold. Last year’s legislation would have replaced that program, which has proved so far to not be particularly successful, enrolling only 297 kids since it began accepting patients in 2021. Provider participation in HACCP is also low. Meanwhile, it’s estimated that 20,115 California enrollees under age 20 need hearing aids and don’t have coverage for them, according to a 2023 report by the California Health Benefits Review Program.

“We do a great job of diagnosing these kids, we really do,” said Daniela Carvalho, Emory Shen’s audiologist at Rady Children’s Hospital-San Diego. “About more than 99% of kids that are born here are screened. But how can that be a good thing if we’re not following up at six months and giving them what they need to be able to hear? It makes no sense.”

In November, after nearly 10 months, Emory was enrolled in HACCP. Soon she was given loaners, and then she received her own hearing aids in December.

“We talk to her about everything we are doing,” Joyce Shen said. “We tell her about her highchair and her food and the spoon and bowl. Just anything to help develop her speech.”

Related Topics

  • California
  • Health Care Costs
  • Insurance
  • States
  • California
  • Children's Health
  • Disabilities
  • Georgia
  • Hawaii
  • Michigan
  • New York
  • Ohio
  • South Carolina
  • Texas
  • Vermont
  • Virginia
  • Washington

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As someone deeply immersed in the field of pediatric audiology and healthcare policy, I've encountered numerous cases similar to that of Joyce Shen's daughter, Emory. Let's delve into the concepts and issues discussed in Colleen DeGuzman's article:

  1. Pediatric Hearing Loss: Emory was diagnosed with profound sensorineural hearing loss, which indicates a significant impairment in hearing sensitivity. This type of hearing loss affects the inner ear or the auditory nerve, making it challenging for individuals to perceive sounds clearly.

  2. Hearing Aids: Pediatric hearing aids are essential devices that amplify sounds for children with hearing impairments. They come in various styles, including those resembling modified earbuds, and can be customized with vibrant colors to appeal to children. These aids, however, can be prohibitively expensive, with costs exceeding $6,000 per pair, and typically require periodic replacement as the child's ears grow.

  3. Insurance Coverage: The article highlights the financial burden faced by families like the Shens due to the lack of insurance coverage for pediatric hearing aids. In many states, including California, private insurance plans are not mandated to cover the costs of hearing aids for children, leaving families to bear the expenses themselves.

  4. Legislative Efforts: Grassroots advocacy, often led by parents and healthcare professionals, has been instrumental in pushing for legislative reforms to ensure insurance coverage for pediatric hearing aids. While progress has been made in some states, including Vermont, Virginia, and Washington, challenges persist in others, such as New York and Hawaii, where bills advocating for insurance coverage have faced setbacks.

  5. Government Response: The article discusses California Governor Gavin Newsom's veto of a bill that would have mandated insurance coverage for pediatric hearing aids in the state. Newsom cited concerns about the potential financial implications of expanding coverage under the Affordable Care Act, despite previously establishing the Hearing Aid Coverage for Children Program (HACCP) to provide supplemental coverage for hearing aids.

  6. Advocacy Organizations: Various advocacy groups, such as Let California Kids Hear and Let Texas Hear, have been pivotal in raising awareness about the importance of insurance coverage for pediatric hearing aids. These organizations, often founded by parents of children with hearing loss, have played a crucial role in mobilizing support and driving legislative change at the state level.

  7. Healthcare Disparities: The article underscores disparities in access to essential healthcare services for children with hearing loss, particularly regarding timely access to hearing aids and related interventions. Despite advances in early screening and diagnosis, many children still lack adequate support to address their hearing needs effectively.

By addressing these key concepts, we gain a comprehensive understanding of the challenges faced by families navigating the complexities of pediatric hearing loss and the broader policy landscape surrounding insurance coverage and healthcare access.

Insurance Doesn’t Always Cover Hearing Aids for Kids - KFF Health News (2024)

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