- Maryland: Up to $1,400 per ear every 36 months until the child reaches age 18.
- Connecticut: Up to $1,000 per ear every 12 months for children aged 12 and younger.
- Oklahoma: Children up to age 13 are covered, subject to their policy's standard co-payment schedule. Unlike Maryland and Connecticut, Oklahoma has established no limits on the amounts insurers must spend for hearing aids or how frequently they may be replaced.
- Rhode Island: Insurers must offer an optional rider for hearing aids, with the consumer liable for higher premiums.
By Kathleen Phalen
Special to The Washington Post
Page HE01 Under a groundbreaking law that takes effect this week, health insurers in Maryland must pay up to $1,400 for hearing aids for children. But the law, intended to increase access to treatment for hearing loss in infants before it leads to developmental delays and other serious problems, will cover less than half of the state's insured population -- and a carefully negotiated clause relieves insurers of having to directly inform members that they may qualify for the benefit.
Untreated hearing problems can permanently impede a child's development, but often the impact can be minimized if the deficits are diagnosed and treated early. Maryland, Virginia and the District all require that newborns be given hearing tests, which generally occur before babies leave the hospital. All three jurisdictions require insurers to cover the cost of these exams, estimated at $25 to $40 per child. Of the three, only Maryland now requires insurers to pay for hearing aids prescribed as a result of this screening.
'This is certainly one of the very first laws of its kind,' said John Flanders, children's rights advocate at the Washington-based Alexander Graham Bell Association for the Deaf and Hard of Hearing. 'It is precedent-setting. Maryland is leading the way.'
The mandate, approved earlier this year by the Maryland General Assembly, applies to new policies written after Oct. 1 and to older policies as they come up for renewal over the next 12 months. Insurers must cover up to $1,400 per hearing aid every 36 months for children with hearing loss that is diagnosed by a licensed audiologist.
Exceptions include plans written by insurers based in other states, plans covering federal employees and self-funded plans, which are typically sponsored by large employers. Also exempt are the state's small-group plans, which cover about 475,000 people, though the Maryland Health Care Commission is scheduled to decide in late October whether to extend the mandate to these plans under its jurisdiction.
Given all these exclusions, Gerard Petrik, chief of standard benefits for the commission, estimates that less than half of Maryland's insured population will be protected by the new mandate.
A consultant retained by state insurance officials found that hearing aids average $1,400 each, a cost that has usually been handled out-of-pocket by families. 'We felt very strongly that we needed to help these parents,' said Sen. Paula C. Hollinger (D-Baltimore County), who sponsored the legislation along with Del. Sheila Ellis Hixson (D-Montgomery). 'With screening newborns, we were picking up hearing loss, but there was no way to help parents with hearing aids, and they can be very expensive.'
The National Institute on Deafness and Other Communication Disorders says that about two or three of every 1,000 children in the United States are born with a hearing impediment, which puts them at risk for delayed or inadequately developed speech, language, cognitive and social skills. Treatment of hearing problems in the first six months of life can significantly improve long-term language outcomes, said James Battey, the institute's director, who estimated that as many as six infants per 1,000 have such problems. Research has shown that children whose hearing loss is identified in the first six months of life demonstrate superior language skills over those identified later.
According to Donna Sorkin, executive director of the Bell Association, children with even mild hearing loss that goes untreated have a one-in-three chance of failing at least one grade in school. 'We recommend parents have babies fitted for hearing aids within the first month of life, but putting the financial burden on families is wrong,' she said. 'If they get the follow-up they need, kids can be on par with their normal hearing peers by the first grade.'
The Hollinger-Hixson bill initially called for insurance companies to mail notices to their customers that hearing aids were available for children up to 18 years of age, but this requirement was dropped. 'It was a compromise with the insurance companies,' says Ben Dubin, national treasurer of the Bell Association.
The proposed notification did little more than add cost for the insurers, said Fran Doherty, vice president of government affairs for CareFirst BlueCross BlueShield, one of the large health insurers in Maryland. 'Come Oct. 1, and as contracts are renewed, the benefit will be prominent in contracts and it is part of our notification to providers,' she said last month.
Gilbert R. Herer, director of the Children's Hearing and Speech Center at Children's National Medical Center in Washington, said he does not believe the legislative compromise on notifying parents will be a problem, because health care providers are aware of insurance and other funding sources for hearing aids. For example, Medicaid covers hearing aids. And for families without insurance coverage for these devices, the Bell Association has some funds available. Herer said he also has private funding for parents of hearing-impaired infants born at Holy Cross Hospital in Silver Spring.
In addition, Maryland is establishing a hearing aid loaner bank to serve children under age 3 whose parents can't afford to buy one immediately. While the bank is intended to provide temporary hearing aids for children up to age 3, the standard six-month loans may be extended in some cases, said Deborah Metzger, a manager for the Maryland Infants and Toddlers Program, which is run by the state education department.
While Maryland's law is less than comprehensive, 'this is really a new movement to get hearing aids covered,' says Sorkin. 'Health systems in Europe all cover hearing aids. We need to understand as a society that hearing loss is a health issue.'
How the States Compare
While 34 states and the District require that newborns be screened for hearing loss, only four states insist that insurers help cover the cost of hearing aids. Here's how those four standards compare, based on information from the Alexander Graham Bell Association for the Deaf and Hard of Hearing:
- Maryland: Up to $1,400 per ear every 36 months until the child reaches age 18.
- Connecticut: Up to $1,000 per ear every 12 months for children aged 12 and younger.
- Oklahoma: Children up to age 13 are covered, subject to their policy's standard co-payment schedule. Unlike Maryland and Connecticut, Oklahoma has established no limits on the amounts insurers must spend for hearing aids or how frequently they may be replaced.
- Rhode Island: Insurers must offer an optional rider for hearing aids, with the consumer liable for higher premiums.
SOURCE: 2001 The Washington Post Company
