Sources Of Hearing Aid & Cochlear Implant Funding

 

Your Insurance Medicaid/Medicare Other Sources

Click here to read the results of our Hearing Aid Insurance Poll

***** Please remember that if you have an unused hearing aid laying around, many of the organizations listed under Other Sources would be more than happy to receive it and pass it along to someone who can use it! *****

Your Insurance  

Most of the time (we hope), there are no problems getting your insurance to cover hearing aids or cochlear implants. We didn't have any problems with our insurance covering either our son's hearing aids, or his cochlear implant. Unfortunately, this is not always the case. See Does Your Insurance Company Cover Your Hearing Aid Expenses? from the  Where Do We Go From Hear? Website. We hope some of the following information will be helpful to you who are having problems getting your hearing aid or cochlear implant covered by your health care provider.

  • Advocating for Your Child: One Parent's Approach to Securing Health Insurance Coverage for Hearing Aids - From AG Bell.
  • Health Benefit Plans and the ADA - If your employer's Health Benefit Plan does not cover hearing aids or cochlear implants, they may be in violation of the ADA Title I.
  • Health Insurance Benefits for Cochlear Implants
  • Insurance Coverage of Hearing Aids - A SHHH Fact Sheet
  • If you were turned down by your insurance because they said a Cochlear Implant was a hearing aid, and hearing aids are not covered under their policy, it might be worth it to get a copy of the decision mentioned  in Arizona's Medicaid Agency to Pay for Cochlear Implant where it was  found that the cochlear implant is not a hearing aid. Once you have a copy of that document you'll be able to look and see what arguments brought success in this case.
  • One Mother's Insurance Battle - This extraordinary mom turned her battle into a national effort to advocate for Universal Reimbursement for Cochlear Implants and Hearing Aids with Hear Us. She recently left that organization, but will continue her efforts to advocate for universal reimbursement.
  • Steps to Obtaining Coverage for the Cochlear Implant - From Cochlear. 
  • Insurance Reimbursement  - From Advanced Bionics
  • Coverage for Hearing Aids
  • If you've been turned down by your insurance company and your insurance is self-funded through your employer, your employer can tell the insurance folks whether or not to approve the device. Try to find out who in administrator in your place of employment for the self-funded insurance and see if you can't get them to approve it.
  • Let Them Hear Foundation Advocacy - If your insurance provider has denied a request from your medical provider for certain hearing-related services, the Let Them Hear Foundation has a nationwide Insurance Advocacy Program to assist you in appealing the denial, free of charge.
  • Kentucky - Revised Statutes Chapter 304.17A.131 states "All health benefit plans shall provide coverage for cochlear implants for persons diagnosed with profound hearing impairment."  Bill SB 152 also passed and requires all health benefit plans to provide coverage for hearing aids and related services for persons under 18 years of age.
  • Oklahoma - as of Nov.1, 1999, any new or renewed insurance policy in the state will be required to cover hearing aids and audiological services for children up to age 13. You can also download the bill by clicking here.
  • Rhode Island - House Bill 00H7298 has passed both the House and Senate and will take effect April 1, 2001.  The bill amends Chapter 27 of the General Laws to include hearing aid coverage. 
  • Alabama - there is at least progress. SB189 (passed) reads: "This Act removes the prohibition, in §36-29-5, Code, against state health insurance coverage for hearing aids and provides that the State Employees Insurance Board may vote to cover these expenses in whole or in part on or after the Act’s effective date."
  • Missouri - Chapter 376 of the Missouri Revised Statutes states "...shall offer coverage for the necessary care and treatment of loss or impairment of speech or hearing subject to the same durational limits, dollar limits, deductibles and coinsurance factors as other covered services in such policies or contracts. All Missouri group contracts issued or renewed on or after December 31, 1984, shall be subject to this section."
  • Maryland's Governor just signed into law HB 160 which mandates health insurance companies provide $1400.00 worth of coverage per hearing aid every three years through the child's 18th birthday. The bill will go into affect for new plans on Oct 1st, 2001 and as plans are renewed through Oct 1st, 2001. He also signed a bill authorizing $250,000 in state funds to create a loaner bank for children birth to three years. As soon as a child is diagnosed with a hearing loss, hearing aids can be loaned out for 6 months until the family can get the child their own and/or decide which kind of hearing aids are appropriate (SB 281 & SB 282).
  • Texas - An issuer of a group health benefit plan shall offer and make available under the plan coverage for the necessary care and treatment of loss or impairment of speech or hearing. This offer of coverage is subject to the right of the group health benefit plan holder to reject the coverage. See the Texas Department of Insurance for more info.
  • In many states, insurance policies are required to cover  the necessary care and treatment of newborns with medically diagnosed congenital defects and birth abnormalities. The AG Bell document Advocating for Your Child: One Parent's Approach to Securing Health Insurance Coverage for Hearing Aids covers one parent's experience.
  • Read our Sample Letters of Justification
  • One Mom tells me that when she encountered some resistance from their insurer they called and wrote their local senator and the insurance provider responded immediately. 
  • I've gotten a number of requests for names of insurance providers who have paid for hearing aids. Here are some that folks have told me have paid for hearing aids. Please keep in mind that coverage can vary from region to region and by policy to policy. If your insurance isn't here and they've paid for hearing aids for you, please let us know so we can add them to the list.
    • Aetna/USHealthcare - Visit their online Cochlear Implant policy statement.
    • Blue Choice
    • BlueCross BlueShild
    • California Public Employees Retirement System (CalPERS)
    • Cigna HMO
    • Great West Life PPO 
    • Hartford Insurance
    • HealthTexas
    • Matthew Thornton
    • NYLCare
    • State of Minnesota Employees Insurance
    • Tricare - PFPWD (formerly PFTH)
    • United HealthCare
  • A Partial Listing of Hearing Aid Insurance Coverage In the United States, 2000 - From SHHH
  • Because I've heard from so many folks who are having insurance problems, here's some info from Appeal Solutions; Medical Insurance Recovery Specialists

Medicaid/Medicare

Medicaid - We would like to thank Mark, a consultant on CI reimbursement issues, for sending us the following information about Medicaid and their coverage of Cochlear Implants:

Children

In November 1994, I secured a directive from the Health Care Financing Administration (HCFA) requiring all States with the sole exception of Oregon to cover CI for all children under age 21, and any services and aural rehabilitation necessary to effectively use the CI.  This directive was based on a law called EPSDT passed in 1989.
 
Oregon is the only State with a waiver from this law (however due to an appeal I filed in 1994, they still cover CI).
 
Hawaii's Medicaid officials mistakenly state they have a waver from this law (since they are the only State exempt from a different law known as ERISA)  And to my knowledge they continue to fight it.  However, Hawaii's HCFA waiver (found at www.hcfa.gov) clearly states:

"Hawaii QUEST provides a standard benefit package consistent with the services currently offered under Hawaii's traditional Medicaid program, and includes coverage for medical, dental and behavioral health services. The program emphasizes preventive care for adults and children and requires that plans provide EPSDT services for all children up to age 21"

States must cover CI for children even if their Medicaid program excludes coverage.  So if you call Medicaid and ask whether their plan covers CIs for children, you may receive "no" for an answer--which is technically correct. However, if your physician submits a prior authorization request for an appropriate CI candidate, Medicaid must provide benefits.

Adults
 
Even though EPSDT does not apply to those 21 or over, Medicaid must still cover CI for adults based on laws such as the ADA and Section 504 of the Rehabilitation Act.
 
Again, Medicaid's written State Plan may technically not provide benefits. But if your physician submits a PA request, they legally cannot refuse coverage.  I have filed appeals in several States on behalf of adults, most recently in Arizona.  In every case, the adult received coverage.

Hope this helps to clarify this information.

Mark Hobratschk

You can visit the Medicaid Section of Mark's Website by clicking HERE.

Medicare 

Medicare & Cochlear Implants

Occasionally I hear folks complaining of Medicare or Medicaid refusing coverage for Cochlear Implant hookup and mapping sessions.  Here is a little something I found in Health Care Financing Administration's (HCFA) Medicare and Medicaid Program Manuals with Transmittals and Program Memorandums:

15300. OTOLARYNGOLOGY AND AUDIOLOGY/SPEECH/LANGUAGE TESTS AND TREATMENTS (CODES V5299, V5362-V5364, 69000-69979, AND 92502-92599)

A. Cochlear Implant "Tune Up" Not In Global Surgical Fee.--Payment for cochlear rehabilitation services following cochlear implantation surgery is not included in the global fee for the surgery. When these services are provided by an employee of a physician (typically an audiologist) and the requirements for coverage as "incident to a physician's service" are met, for services rendered prior to January 1, 1996, the physician bills for the services using CPT code 69949 and you pay for the service on a "by report" basis. For services rendered on or after January 1, 1996, new CPT code 92510 is used and you make payment based on the fee schedule amount for code 92510.

 


Other Sources

***** Please remember that if you have an unused hearing aid laying around, many of these organizations would be more than happy to receive it and pass it along to someone who can use it! *****

Air Force Aid Society

Children of the Silent World

Children with Special Health Care Needs - Directory of State Title V CSHCN Programs: Eligibility and Scope of Services

Colorado Neurological Institute

Department of Veterans Affairs (VA)

Department of Developmental Disabilities - Each state dictates how their funding is spent and therefore each state offers different types of services. As reported to me by one parent, deafness alone is not enough to qualify for their program. You are able to use their financial aid funds the way you see fit, with some limitations. It has to be directly related to the disability. Another parent tells me that their state assists individuals or families with funding (up to $1000/year) to travel to programs that would provide educational information regarding the particular disability.

Disabled Children's Relief Fund

Dorothy Ames Trust Fund - help for New England kids who need aids/FM/etc to pursue an oral education.

Dorothy Ames Trust Fund
Key Trust Company of Maine
P.O. Box 1054
Augusta, ME  04332-1054

Attn:  Christina Cook

Easter Seals

ESCO -  Finance new hearing instruments with the use of their "HELPcard". Basically it's a credit card for healthcare.

Financial Assistance for Hearing Aids - From the Massachusetts Commission for the Deaf & Hard of Hearing. ** This link changes often.  Follow hyperlink then use the search box to find Financial Assistance for Hearing Aids.**

Funding Sources - This is at our sister site...or should that be daughter site? Either way, Sherry's a good friend of mine and she's got some good info.

Hearing Aid Bank

Hearing Aid Banks - Here's another list Hearing Aid Banks 

Hearing Impaired Kids Endowment Fund (The HIKE Fund, Inc.)

Hear Now - The Starkey foundation took over the Hear Now program, but the Program is still in operation. For more info Contact 

HEAR NOW
The Domestic Program of Starkey Hearing Foundation
4248 Park Glen Road
Minneapolis, MN 55416
1-800-648-4327 [voice]
1-952-828-6946 [fax]
nonprofit@starkey.com

Update: Their website now reflects the Hear Now program.

Hike Fund

Lions Clubs

Local CI Support Groups - Many local CI support groups have fundraisers to help those who couldn't otherwise afford one. Check with your local support group to see how to qualify, or ask what you can do to help with their fundraiser.

Minnesota Hearing Project - a pilot program of HearNow Minnesota, A division of the Starkey Hearing Foundation. There are also Hearing Aide Chapters in Arizona, California, Colorado, & Florida.

Miracle-Ear Children's Foundation 

New Hearing Program Takes Shape - Connecticut

Optimists

Paying for the Assistive Technology You Need - A Consumer Guide to Funding Sources in Washington State

Program for Amplification for Children of Texas (PACT)

Public Schools - A possible source for hearing aids for children. Many times it's difficult to get hearing aids to be provided by the school system for use during school hours. It's often even more difficult to get the hearing aids to be allowed to go home with the children. The following may be helpful:

The Office of Special Education Programs (OSEP) has written guidance letters clarifying for schools that Hearing Aids are Assistive Technology and that Presumptively Denying Assistive Technology is a big "No-No". Also, the Final Regulations of the IDEA '97, §300.308 reads, "On a case-by-case basis, the use of school-purchased assistive technology devices in a child's home or in other settings is required if the child's IEP team determines that the child needs access to those devices in order to receive FAPE."

Quota International - You can find out if there is one near you on by clicking here.

Resources for Financial Assistance: Habilitation, Rehabilitation Services, Hearing Aids and Other Assistive Devices

Scholarship Trust for the Deaf and Near Deaf - Provides financial assistance for those in need.

Sertoma International - While they don't appear to have an International program for helping fund hearing aids, many of their State Clubs have programs that will help out. Use their site to find the contact info for the Club in your state. You'll even find a link for the few that have Web Sites.

Title V Children with Special Healthcare Needs (CSHCN)

Travelers Protective Association's National Scholarship Program for the Deaf and Near Deaf - Can be used for equipment.

The AgrAbility Project - Assists agricultural and agribusiness workers who have physical and mental disabilities, including such disabilities as amputation, arthritis, spinal cord injury and hearing impairments. Education and assistance are available to accommodate disabilities, eliminate barriers, and create a favorable climate among rural service providers for people with disabilities.

VA Hearing Aid Benefits - Explains which veterans are eligible for hearing aids.

Vocational Rehab (VR) - In some states, the Vocational Rehabilitation program will cover hearing aids. When I contacted our VR program in Texas in 1998, if amplification was necessary for employment (to either get or keep a job), VR would pay for it. Click on the link to go to an info page about the  Texas Rehabilitation Commission's Hearing Impaired Program.


Check with your local Department of Health, or your audiologist to see if there are any local or state programs not listed here.


These following links are not about places that will help cover the costs of hearing aids, but they offer discounted hearing aids or services and might be helpful. When choosing a hearing aid that is discounted in price, please look into it thoroughly. Sometimes a reduced price means a reduction in services. 


Articles About Denial of Hearing Aids or Cochlear Implants 

 


Lost your way?  Try the Listen-Up Web Map or use our Search Engine.

The "Listen Up!" and "Talk It Up!" programs are copyright protected. All rights including the use of the "Listen Up!" and "Talk It Up!" logos are reserved. For more information about "Listen Up! and Talk It Up!" feel free to contact the author   

Request a link on Listen-Up!    Report a dead link