Effect of Hearing Aid Insurance Coverage Requirements for Adults on Utilization
Abstract
Hearing loss affects 23% of those aged 12 and older in the U.S. More than 2/3 of U.S. adults over the age of
70 have significant hearing loss. The most efficacious management option for most individuals with hearing
loss is the use of hearing aids (i.e., a small removable electronic device that is worn in or behind the ear to
amplify sound), which can improve communication and quality of life. Hearing aids are generally not covered
by insurance and about 86% of hearing loss cases go untreated. However, Medicaid provides hearing aid
benefits in 28 states and 8 states require private insurance benefits for at least some adults. These coverage
requirements may improve hearing aid uptake by reducing costs as a barrier. The long-term goal of our
research agenda is to understand the effects of improving hearing on health. Specifically, the objective of our
current application is to use quasi-experimental (e.g., difference-in-differences) evaluation methods to estimate
the effect of coverage requirements in Medicaid and private insurance plans on hearing aid use. We will use
high quality, reproducible Anthem private insurance claims data, National Health Interview Survey (NHIS) data,
Medicaid claims-linked NHIS data, and Medicare Current Beneficiary Survey (MCBS) data to study: (i) the
effect of state private insurance coverage requirements for hearing aids on beneficiary hearing aid purchasing
and out-of-pocket payments in fully-insured health insurance plans; (ii) the effect of Medicaid and private
insurance coverage requirements on use of hearing aids in the NHIS, and Medicaid coverage requirements in
the Medicaid-linked NHIS and MCBS (for dual-eligibles); and (iii) the effect of private and Medicaid
requirements by demographic group. Our project is significant by focusing on high rates of untreated hearing
loss; by estimating the effects of state implementation of private and public insurance coverage requirements
on hearing aid adoption among U.S. adults (which provides evidence for the effects of pending national
legislation); and by providing evidence on whether hearing aid coverage requirements improve well-
documented disparities in hearing aid use for males, racial/ethnic minorities, and lower-educated individuals.
Our project is innovative by being the first to use quasi-experimental difference-in-differences methods (which
can provide causal evidence) for hearing health care research, including newer methods accounting for
heterogeneous treatment effects; leveraging powerful sources of currently under-used data to study hearing
health care access and utilization; constructing detailed coverage requirement data through original policy
research that we will make available publicly. The research team includes experts in clinical audiology, health
economics, advanced statistical modeling, insurance claims data, and health policy. The proposed project will
have a positive impact because addressing system barriers to affordable and accessible hearing health care
has the potential to reduce disparities and increase use.