When most of us think about health insurance, we think it covers every part of the body, from the tips of the toes all the way to the tips of the ears. Sadly, this is not the case, and devices related to two of the most important parts of the body–the ears and eyes–often are not covered. While health problems such as ear infections and eye health problems are routinely covered, treatment for deficits in vision or hearing often are not.
This article will detail which devices are covered by insurance and Medicaid, and suggest alternative funding for additional devices.
Children with Medicaid coverage, including Medicaid waiver participants, are fortunate that federal EPSDT laws specifically mandate coverage for hearing and vision. States are required to screen children in Medicaid for vision and hearing problems, and are also mandated to provide vision and hearing treatment for children. As such, Medicaid covers glasses and hearing aids for all children until they reach adulthood. Once reaching adulthood, coverage unfortunately becomes optional, and states vary widely in their coverage policies.
Medicaid also routinely covers surgical treatments for deafness, including cochlear implants and bone-anchored hearing devices (BAHAs). Medicaid in most states also covers other hearing devices, such as amplifiers and listening devices.
Medicaid typically covers a low-vision evaluation if it is performed by an optometrist, but rarely covers ongoing low-vision therapy. Orientation and mobility training for people with vision impairments may be covered.
In almost all cases, Medicaid does not cover any additional devices to assist with vision or hearing. These include certain communication devices, special phones (including TTY), safety and convenience devices (adapted clocks, smoke detectors, doorbells, or watches), basic low vision devices (lamps or acetate sheets), Braille readers or embossers, magnifiers, or computer software.
Individuals who have Medicaid waivers may be able to obtain some of these devices if the waiver includes the category of special medical devices. States with waivers for children who are deaf-blind, have multiple disabilities, or are medically fragile often cover these types of devices, though it may take some time and effort.
Insurance coverage for vision and hearing devices varies widely, and depends greatly on the type of insurance plan you have and the state you live in. There are, however, a few services that are provided by almost all insurers. These include cochlear implants, which are covered by about 90% of insurers, and bone-anchored hearing devices (BAHAs).
If you purchase an individual or family plan on the marketplace, it must provide vision services for children as part of the Essential Health Benefits mandate of the Affordable Care Act. Typically, this means vision exams and glasses are covered through the plan. Unfortunately, hearing is not considered an Essential Health Benefit and may not be covered. Most plans do cover childhood vision and hearing screening as part of normal pediatric examinations. Occasionally, some hearing aids and devices may be covered under the rehabilitation component of these plans, but that is unusual.
Most employer-based health plans are either grandfathered or self-funded, which means they do not need to offer any vision or hearing services or devices. Many employers choose to offer a separate vision plan at an additional cost, but these plans typically cover only basic services, such as an optometrist examination and glasses.
Some states mandate that health insurers provide either hearing or vision services, usually just to children. States that require hearing aid coverage include Arkansas, Colorado, Connecticut, Delaware, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, Tennessee, and Wisconsin.
It is very rare for any insurer to cover vision or hearing assistance devices beyond glasses or hearing aids, such as communication devices, special phones, safety and convenience devices, basic low vision devices, Braille readers or embossers, magnifiers, or computer software. Occasionally, some of these items, especially communication devices, may be covered as durable medical equipment, but this varies widely.
Coverage through Other Programs
Other programs, typically state-based, may cover some of the necessary items and services. For example, most states have mandated programs for hearing and vision screening in babies or young children, because these have been proven to be very cost-effective in the long run.
In addition, Early Intervention programs for babies up to the age of three often cover extensive vision and hearing services. These may include vision and hearing therapy, speech therapy, low-vision devices, hearing assistance devices, and communication devices.
Each state also has a Title V program for children with special health care needs, though the programs vary considerably from state to state. These programs may cover vision and hearing screening, therapy, and assistive devices if they are not otherwise available to families.
Each state also has an Assistive Technology program that may provide assistive devices for hearing and screening. In some cases, these programs allow devices to be loaned or borrowed, and facilitate resale and trade of devices. Some may also provide devices at no charge.
Finally, most states have state-based programs for those with vision or hearing impairments. These programs often provide common necessary items, such as a TTY phone, for individuals who require them. Sometimes these programs are found under the departments that provide rehabilitative services, and in other cases they are independent programs.
Coverage in the School System
Because schools must provide any items and services required to assist a child in receiving an education, many vision and hearing devices are provided by school districts. Typically, children with vision and hearing impairments will be assessed for special education services by the school district, usually including an assistive technology evaluation. If they meet criteria, they will then have vision and hearing services and assistive devices included as part of the Individualized Education Plan (IEP). The IEP can include any and all necessary assistive technology, as well as 1:1 or group vision and hearing services provided by an expert in vision or hearing.
Items provided by schools typically include communication devices, amplifier and listening systems, computer software (such as text to speech or enlarging software), magnifiers and other optical devices, low vision devices, Braille books, and Braille readers and embossers. In some cases, items such as Braille calculators or computer systems may also be provided if they assist with accessing the curriculum. Instruction or translation using sign language can also be provided.
Unfortunately, children cannot keep items purchased by schools in most cases, as they are the property of the school. In some cases, items may not even be allowed to come home with children. There are some exceptions to this rule, usually involving communication devices that are purchased and adapted for individual students, but in most cases, devices must be returned to the school either at the end of each day, or the end of the school year.
An Ongoing Problem with No Easy Solution
Currently, coverage for vision and hearing assistive devices is patchwork at best, with policies that vary from plan to plan and from state to state. When insurance or Medicaid does not provide coverage, the methods for obtaining devices becomes even more haphazard and difficult to navigate.
Ideally, all insurance and Medicaid plans should cover basic vision and hearing screening, glasses, and hearing aids. States should also consider coverage of devices for vision and hearing that are currently only being provided in the school environment or to workers through the Americans with Disabilities Act. These items may help young adults to live and work independently, with lower levels of dependence on state and federal support, saving substantial sums of money in the long run.