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Life Health > Health Insurance

What PPACA could do to your clients’ ears

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Marketers of hearing testing and hearing aid benefits may have more trouble getting customers and policymakers to listen than marketers of just about any other health-related benefit.

Dental insurance specialists envy the ability of major medical sellers to sit by the phone and take orders, but most people have had cavities, and dental sellers can point to many recent, dramatic studies on links between oral health and general health.

Sellers of vision insurance have even more trouble with gaining mindshare, but they can hold up studies showing how often signs of diabetes first surface during eye exams.

Sellers of long-term care insurance (LTCI) have to contend with general resistance to the idea of thinking about old age, but most people recognize that they will grow old, and that care for the aged can be expensive.

Sellers of hearing benefits face…a collective blank stare. 

About 11 percent of all Americans have some degree of hearing loss, according to the Better Hearing Institute. But, before 2010, the year the Patient Protection and Affordable Care Act (PPACA) became law, fewer than 15 percent who had received a physical exam in the previous 12 months could remember getting any kind of hearing screening.

Only 9 percent of U.S. residents with mild hearing loss, and only 40 percent of those with moderate to severe hearing loss, were wearing hearing aids.

See also: To make hearing aids affordable, firm turns on Bluetooth

Businesses like EPIC Hearing Healthcare, a hearing aid benefits provider, and hi HealthInnovations, a hearing aid benefits unit of UnitedHealth Group Inc. (NYSE:UNH), have been trying to mobilize insurance agents and brokers to help them sell buyers and policymakers on the idea that ears matter, too.

Buyers and policymakers may neglect hearing health in part because of a general lack of ear health literacy.

Dr. Lisa Tseng, chief executive officer of hi HealthInnovations, said many people brush off concerns about mild hearing loss.

“They say, ‘Oh, it’s not bad enough to be treated,’” Tseng said in an interview. 

But hearing specialists now believe that people should correct any hearing loss as quickly as possible, to preserve the brain’s ability to process sounds in a normal fashion, Tseng said.

Hearing tests may be less known for uncovering signs of general physical health problems than dental exams or vision tests, but people with diabetes are twice as likely to have hearing loss as people without diabetes, and researchers at Johns Hopkins reported in 2011 that members of a study group who had severe hearing loss but no known dementia at the time the study began were five times more likely to develop dementia than study group members with no hearing loss. The researchers speculated that a common factor might be leading to both hearing loss and dementia, but they also said that doctors and patients should consider the possibility that taking a step as simple as encouraging people with hearing loss to wear hearing aids might help fight dementia.

See also: Does that plan cover 3-D printer skin toner?

PPACA itself may have reduced the insurance community’s ability to promote access to hearing benefits, by forcing insurers, producers and primary care providers into a desperate fight for survival, and by forcing employers and individual coverage buyers to spend time re-learning how major medical coverage works.

But PPACA may also help promote access to hearing aids. For some ideas about how that may happen, read on.


1. If your clients are newborn babies, health plans will certainly pay for their hearing tests.

The U.S. Department of Health and Human Services (HHS) approved a basic PPACA preventive services package that includes a variety of services all major medical plans are supposed to cover without imposing cost-sharing requirements on enrollees who get the services from in-network providers.

The idea is that the services provide so much value for the money spent that covering them is a no-brainer.

One class of services in the package is highly controversial: Contraceptive services.

Another class of services in the package has gotten almost no attention, perhaps because most people recognize its importance: Hearing testing for children.

See also: Wisconsin Adds Pediatric Cochlear Implant Mandate

Hearing aid

2. PPACA-compliant plans may offer the enrollees some coverage for hearing aids. 

Economists at the University of Pennsylvania looked at EHB packages in all 50 states and the District of Columbia for the Robert Wood Johnson Foundation and found that 26 include some kind of hearing aid benefit, at least for babies or children, in their EHB packages.

Groups representing the deaf and people with hearing loss, including the Hearing Loss Association of America and the National Association of the Deaf, have asked HHS to explicitly include coverage for “habilitative devices,” such as “hearing aids, cochlear implants, bone-anchored hearing devices), in the regulations setting the minimum standards for states’ EHB packages. The groups asked regulators to require states to offer any EHB hearing device benefits to people of all ages, not just to babies, and not just to children.

The EHB standards apply directly only to PPACA-compliant individual coverage and PPACA-compliant small-group coverage, but they could also have an indirect influence on expectations in the self-insured and large fully insured group markets.

(Image: UnitedHealth photo)

See also: Mass. Lawmakers OK Child Hearing Aid Mandate home page

3. Coverage standardization may give carriers more incentive to set themselves apart by highlighting hearing benefits.

At UnitedHealth, for example, Tseng has trying to promote hearing benefits packages aimed at employer plans, working-age retail customers and the Medicare Advantage plan market.

Hearing aids normally cost about $6,000 to $8,000 per pair, Tseng said.

A UnitedHealth commercial plan that provides hearing benefits will provide $2,500 in hearing aid benefits every three years.

Consumers who buy hearing aid discount program benefits on a retail basis have to pay for their own hearing aids but will pay a price of only about $1,600 per pair of hearing aids.

Consumers who come in through UnitedHealth’s Medicare Advantage plans get both a hearing aid insurance benefit and access to the discount program. For consumers who buy the hearing aids available through the discount program, the benefit is high enough to eliminate any significant out-of-pocket costs, Tseng said.

See also: EPIC Signs CaliforniaChoice


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