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Insurers Pressure State Regulators to Deny Expanded Access to Hearing Aids

If a ruling by Insurance Commissioner Laura Cali stands, insurance companies would have to pay for hearing aids for adults, a benefit currently limited to those on the Oregon Health Plan. Insurers are required to cover the devices for children, and the feds insist they cannot discriminate by age.
April 22, 2016

Representatives from Oregon’s leading health insurers urged state regulators to fight a federal requirement that their companies be required to provide hearing aids to anyone who needs them, an expansion of their current coverage, which is limited to children.

Hearing aids, which are covered for adults under Medicaid but not Medicare, would become available next year to people who have insurance coverage under a pending rule from Oregon Insurance Commissioner Laura Cali.

The rule is taking effect because federal health regulators have told state regulators that Oregon’s policy of covering children but not adults is discriminatory and ageist. “It’s something they’ve been concerned about as discriminatory,” said Tashia Sample of the Division of Financial Regulation at the Department of Consumer & Business Services.

The insurance representatives spent the bulk of the meeting at the state agency’s Healthcare Reform Rulemaking Advisory Committee trying to get the state to back down and renegotiate  with the federal government, but Sample said the state had been told repeatedly it must mandate hearing aids for everyone.

Although the meeting was open to the public, the only people who attended were insurance representatives. Others listened by teleconference.

“Affordability in this market is a real problem, and it’s not going to get any better,” said Aaron Bals of the Catholic non-profit Providence Health Plan, who threatened to ask for a rate increase if they suddenly had to pick up the tab for hearing aids. “Right now we had prepared rates that said we didn’t have to provide hearing aids for people who are 63 and don’t want to wait till they’re on Medicare.”

“We’re just automatically as a state rolling over to CMS,” chimed in Gary Holliday of PacificSource Health Plan, referring to the federal Centers for Medicare & Medicaid Systems. Representatives of Kaiser Permanente and Moda Health also asked the state to reconsider its decision.

Although Bals said the commercial insurance market would be the only place where hearing aid coverage was provided for age-related hearing loss, the benefit is available to Oregon Health Plan members.

In 2009, former Rep. Ben Cannon, D-Portland, who’s now executive director of the Oregon Higher Education Coordinating Commission, led the charge for Oregon insurers to cover hearing aids for children up to 18, arguing their ability to hear was essential for learning.

Not all states require hearing aids for adults or children, but federal officials have told the state it cannot discriminate by restricting coverage for one age group unless the age-based restriction was based on medical need, which Oregon’s was not.

A 2014 study by the Hearing Review found that the average retail price of a quality hearing aid from an audiologist was $4,400. Since insurers have leverage purchasing at bulk rates, they would pay much less than consumers are now forced to pay.

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