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Federal Government Approves Expanded Coverage in Vermont’s Essential Health Benefits Benchmark Plan

August 29, 2022

Montpelier, Vt. - Governor Phil Scott today announced that starting in 2024, individual and small group health plans will cover one set of prescription hearing aids every three years and annual exams. This week, the Centers for Medicare & Medicaid Services approved expanded coverage in Vermont’s essential health benefit (EHB) for services including prescription hearing aids.

Together with the Food and Drug Administration’s recent announcement establishing a new category of over-the-counter hearing aids, the new EHB benchmark plan ensures that Vermonters will have better access to affordable hearing aids than ever before.

“Expanding this coverage is a significant step forward, and I appreciate the hard work of my teams at the Department of Health Access and the Department of Financial Regulation for their dedication in moving this forward,” said Governor Scott. “Ensuring greater access to care is a priority for my Administration.” 

“Hearing loss has a profound impact on people living with it” said Kevin Gaffney, Commissioner of the Department of Financial Regulation. “The new benchmark plan will allow consumers with hearing loss to have hearing aids should they choose to use this technology to support their communications with family, friends, and co-workers.”

A 2018 report from the Vermont Department of Health found that approximately 6% of Vermonters experience serious difficulty hearing and the Governor’s Deaf, Hard of Hearing and DeafBlind Advisory Council indicate that up to 70,00 Vermonters identify as hard of hearing. Current research demonstrates that mild to moderate hearing loss doubles the risk of dementia, can increase the risk of falls, and contribute to depression.

According to a 2015 presentation from the President’s Council of Advisors on Science and Technology, a single hearing aid typically costs approximately $2,400, which most consumers pay completely out-of-pocket. For Vermonters covered by health insurance marketplace plans, these costs will be covered by insurance rather than entirely paid out-of-pocket.

Vermont’s new EHB benchmark plan was approved following a public comment period, review by the Green Mountain Care Board, and collaboration with a diverse array of stakeholders. In Vermont, insurance coverage for hearing aids is already available for individuals enrolled in Medicaid. The new benchmark plan was proposed by the Department of Financial Regulation and Department of Vermont Health Access in accordance with the Affordable Care Act.

“This result shows how agencies across state government can come together with outside stakeholders to address coverage needs in our system of care,” said Emily Brown, deputy commissioner of insurance at the Department of Financial Regulation.

“Vermont can be proud that we are expanding coverage for hearing aids and reducing cost pressures for Vermonters who are deaf or hard of hearing,” said Andrea De La Bruere, commissioner of the Department of Vermont Health Access. “We are committed to ensuring Vermonters have access to comprehensive, affordable health care services that improve health and well-being.”
Vermont’s new EHB benchmark plan will also increase access to nutritional counseling and rehabilitative services. The new changes will take effect for qualified health plans Vermonters can buy through Vermont Health Connect, for plan years starting on or after January 1, 2024.