Regarding the recently passed and enacted legislation related to 24-A M.R.S. § 2762, a law which requires health insurance carriers in Maine to provide hearing aid coverage in all individual and group health plans, the Maine Bureau of Insurance in the Department of Professional and Financial Regulations has published the following Frequently Asked Questions (FAQ) documentation:
New Hearing Aid Mandate, Effective January 1, 2020
Q: I have insurance and I need hearing aids. Does this new law mean my insurance will cover the cost now?
A: It depends on several factors:
Type of Insurance
The following types are required to provide the benefit:
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- Fully funded major medical policies, including ACA coverage;
- Short-term limited duration policies
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These types are exempt from all State health insurance benefit mandates:
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- Medicare products, including Medicare Supplement and Medicare Advantage plans (federally exempted by Social Security/Medicare);
- Self-insured plans, except state or municipal governmental and multiple-employer welfare association (MEWA) plans;
- Plans other than comprehensive major medical or short-term limited duration: accidental injury; specified disease; hospital indemnity; dental; vision; disability income; long-term care; other limited benefit health insurance.
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Benefit Details, Deductibles, Cost, Networks, and Renewal Dates
Coverage amount:
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- Up to $3,000 per hearing aid for each hearing-impaired ear; and
- Available every 36 months.
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Deductibles: You should be aware that you could still be responsible for all or part of the cost if you have not yet met your annual deductible at the time you purchase a hearing aid.
Cost: If you purchase a hearing aid that costs more than $3,000, you should assume you will need to pay the amount over the $3,000 out of your own pocket, even if you have met your deductible – unless your policy specifically provides a greater benefit.
Network: You could also be responsible for all or part of the cost if you use a provider who is not part of your plan’s network.
Renewal dates: If you have a group plan that is required to provide this benefit, but it renews later in the year, the benefit will not be included in your coverage until that time.
Q: I know I have hearing issues. Do I need to go to my primary care office before going to see a hearing specialist and getting a prescription for hearing aids?
A: Whether you are able to self-refer to a specialist and whether pre-authorization is required to purchase a hearing aid would depend on your policy contract. Check with your insurer and/or your employer’s benefits department.
Q: Will my insurance cost more because of this mandate?
A: The cost of providing the new benefit is built into the premium and should be very minimal (the Bureau’s 2014 report estimated that the cost per policyholder could be $.47 per month).
If you have questions beyond this FAQ, please contact the Maine Bureau of Insurance