Aetna Denied Hearing Aids? Your Options Including CVS Hearing and Pediatric Mandates

Hearing aid denials from Aetna are nearly universal for adult members — but that doesn't mean you're completely without options. Between pediatric ACA mandates, CVS Health's hearing benefit add-on, Medicare Advantage hearing coverage, and state-level mandates, there may be more coverage available than your denial letter suggests.

Why Aetna Denies Most Adult Hearing Aid Claims

Aetna, a CVS Health subsidiary covering approximately 23 million medical members, explicitly excludes hearing aids from most standard commercial health plan benefits. This is a coverage exclusion, not a medical necessity denial — which means standard medical necessity appeals have limited effectiveness for adult hearing aid claims.

The rationale is historical: hearing aids have traditionally been classified as assistive devices rather than medical treatments, and most commercial health insurance was designed around acute medical care. However, this classification is increasingly being challenged as hearing loss is linked to dementia, depression, and social isolation — conditions that are expensive to treat.

When Aetna Does Cover Hearing Aids

Pediatric ACA Mandate: The Affordable Care Act requires most health plans to cover essential health benefits (EHBs) for children under 19. In many states, the pediatric EHB benchmark includes hearing aids. If your child (under 19) was denied hearing aids by Aetna on a fully insured commercial plan, check whether your state's EHB benchmark includes pediatric hearing aids. States including California, New York, Illinois, and Massachusetts require pediatric hearing aid coverage.

Medicare Advantage hearing benefits: Aetna Medicare Advantage plans vary but many include hearing aid benefits — typically an allowance of $500–$2,500 per year or per pair. The specific benefit depends on your plan. If you have Aetna Medicare Advantage, review your Evidence of Coverage for hearing benefits.

Employer add-on riders: Some employer-sponsored Aetna plans include optional hearing aid benefit riders. Check your Summary Plan Description and Benefits Summary — if a hearing benefit is listed, a denial for lack of coverage may be incorrect.

State mandates for adults: A growing number of states are enacting adult hearing aid coverage mandates. Check your state's Department of Insurance for current requirements that may apply to fully insured Aetna plans in your state.

CVS Health Hearing Benefit

As part of CVS Health's integration of Aetna, CVS has developed hearing benefit programs including partnerships with hearing aid retailers and discount programs. While these are not insurance coverage, they can reduce the cost of hearing aids significantly. Check your member portal at my.aetna.com or contact 1-800-537-9384 to ask about any hearing benefit or discount program associated with your plan.

CVS has also partnered with hearing care providers to offer hearing aids through CVS Health's network at negotiated rates — available to Aetna members even when insurance coverage is excluded.

How to Appeal a Hearing Aid Denial

If you have a pediatric hearing aid mandate claim:

• Request your state's current EHB benchmark and confirm hearing aids are included
• Verify your plan is fully insured (not self-funded — self-funded plans are exempt from state mandates)
• Submit an audiologist's evaluation documenting hearing loss severity and hearing aid prescription
• Include your child's age documentation confirming under-19 status
• Cite your state's mandate statute and the ACA EHB requirement

If you have a plan benefit rider:

• Obtain written confirmation of your plan's hearing benefit from your HR department
• Submit audiologist documentation with the appeal
• Note the specific benefit language from your Summary Plan Description

If you are appealing a Medicare Advantage hearing benefit denial:

• Request the specific MA plan Evidence of Coverage hearing benefit section
• Appeal to Aetna citing the specific benefit language

Contact for all appeals:

• Phone: 1-800-537-9384
• Online: my.aetna.com
• Written: Aetna Appeals, P.O. Box 981106, El Paso, TX 79998

When a Coverage Exclusion Cannot Be Appealed

If your plan genuinely excludes hearing aids and no mandate applies, the appeal process will not change the outcome — the issue is a plan design decision, not a medical necessity determination. In this case:

• Ask Aetna for documentation of the plan exclusion from your actual plan document
• Contact HR to request that hearing aid coverage be added to your employer's plan at next renewal
• Explore HSA/FSA funds (hearing aids are HSA/FSA eligible)
• Check manufacturer financing and discount programs (Phonak, Starkey, Oticon all have assistance programs)
• Consider over-the-counter hearing aids under $1,500 made legal by the 2022 OTC Hearing Aid Act

Fight Back With ClaimBack

If you have a pediatric hearing aid mandate claim, a Medicare Advantage hearing benefit, or a plan rider that should cover hearing aids, ClaimBack can help you build the documentation-backed appeal that gets your claim processed correctly.

Start your Aetna hearing aid appeal at ClaimBack

Related Reading

• How to Write an Insurance Appeal Letter
• Common Reasons Insurance Claims Are Denied
• Internal vs. External Insurance Appeals