Sponsors (90)
The bill expands guaranteed, comprehensive coverage and long-term support for people with qualifying hearing loss—improving access and reducing out-of-pocket device costs—while likely raising insurance costs and creating transitional delays and administrative complexity for plans and employers.
People with qualifying hearing loss will have guaranteed coverage starting in 2026 for auditory implants, processors, surgery, rehabilitation, and follow-up care, improving access to medically necessary treatment and long-term hearing outcomes.
Covered individuals gain regular device maintenance, repairs, and upgrades or replacements (every 5 years) without separate higher cost-sharing, reducing out-of-pocket costs for long-term device use.
Clinicians (physicians or qualified audiologists) can secure coverage when they determine medical necessity, lowering barriers from prior-authorization denials and speeding access to needed care.
Employers and insurers may face higher costs to cover implants and ongoing device services, which could raise premiums for workers, families, and small-business owners.
Members of grandfathered plans that remain exempt through January 1, 2026 may experience delayed access to these benefits until later plan years, leaving some people without new coverage initially.
Requiring plans to align cost-sharing and treatment limits with predominant medical/surgical benefits could create administrative complexity and disputes over what qualifies as 'predominant,' increasing compliance burden for plans and employers.
Based on analysis of 2 sections of legislative text.
Introduced July 22, 2025 by Joseph Neguse · Last progress July 22, 2025
Requires group health plans and health insurance issuers to cover auditory implant devices (including cochlear and osseointegrated bone conduction implants), external sound processors, and related services for people who meet clinical eligibility. Coverage must include evaluation, surgery, postoperative care, aural rehabilitation, maintenance/repairs, and upgrades or replacements every 5 years, and financial limits cannot be more restrictive than those for most medical/surgical benefits; the rule applies to plan years beginning on or after January 1, 2026 (except for certain grandfathered plans).