Hearing Aids Denied by Insurance? What You Can Do

Hearing loss affects more than 48 million Americans, yet health insurance coverage for hearing aids remains inconsistent, fragmented, and often inadequate. If your insurer denied coverage for hearing aids — for yourself or your child — you are not alone, and in many situations, you have grounds to appeal.

This guide explains the coverage landscape for hearing aids, the legal protections that exist at the federal and state levels, and how to build an effective appeal.

The Coverage Landscape: Adults vs. Children

The starting point for understanding hearing aid denials is recognizing that the rules are fundamentally different for children and adults.

Adults and the ACA

The Affordable Care Act (ACA) does not require adult hearing aid coverage as an essential health benefit. As a result, most employer-sponsored and individual market health plans legally exclude hearing aids for adults. This is why so many adults receive straightforward denials: the plan genuinely does not cover the benefit, and no federal law requires it to.

However, adult coverage may exist through:

• State mandates — Several states require insurers to cover hearing aids for adults (see below)
• Medicare Advantage — Some Medicare Advantage plans have added hearing aid benefits, though Traditional Medicare does not cover hearing aids
• VA benefits — Veterans with service-connected hearing loss may be eligible for hearing aids through the VA
• Employer plan riders — Some employers voluntarily add hearing coverage to their plans

Children and EPSDT

Children are in a much stronger legal position. Under federal Medicaid law, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program requires state Medicaid programs to cover any medically necessary treatment for children under 21 — including hearing aids. If your child is on Medicaid or CHIP and needs hearing aids, the coverage denial is almost certainly wrongful.

Additionally, most state insurance mandates for hearing aids focus specifically on children. These mandates apply to fully insured commercial plans (but not self-funded ERISA plans) and typically require coverage up to a specified dollar amount per ear, per hearing aid replacement cycle.

State Mandates for Hearing Aid Coverage

As of 2026, more than 25 states have passed some form of hearing aid coverage mandate. The requirements vary widely:

• Arkansas — Coverage for both children and adults
• Connecticut — Coverage for children up to age 18
• Delaware — Coverage for children
• Illinois — Coverage for children and adults; up to $2,500 per hearing aid for children
• Maryland — Coverage for children up to age 18
• Massachusetts — One of the strongest mandates; coverage for children and some adult requirements
• New Hampshire — Coverage for children
• New Jersey — Coverage for children up to age 15
• New York — Coverage for children up to age 18
• North Carolina — Coverage for children up to age 22
• Oklahoma — Coverage for children
• Rhode Island — Coverage for children
• Tennessee — Coverage for children

If you live in a state with a mandate and have a fully insured plan, a denial of hearing aids for a covered child is likely a violation of state law.

Medicare Advantage Hearing Aid Coverage

Traditional Medicare (Parts A and B) does not cover hearing aids or hearing exams for the purpose of fitting hearing aids. However, Medicare Advantage (Part C) plans are permitted to add extra benefits beyond traditional Medicare, and many do.

If you are enrolled in a Medicare Advantage plan, review your Evidence of Coverage (EOC) carefully. Many Medicare Advantage plans now offer:

• Annual hearing exams covered
• Hearing aids covered at specific benefit amounts (often $500–$2,500 per ear)
• Access to national hearing care networks (e.g., UnitedHealthcare Hearing, Humana Hearing)

If your Medicare Advantage plan's denial contradicts the benefits listed in your EOC, you have the right to appeal through the Medicare Part C appeals process.

The Rise of OTC Hearing Aids

In 2022, the FDA finalized a rule creating a new category of over-the-counter (OTC) hearing aids for adults with mild to moderate hearing loss. OTC hearing aids are available at retail stores and online without a prescription or audiologist fitting. Prices range from under $200 to over $1,500.

If your insurer denied prescription hearing aids, OTC hearing aids may be a practical interim option — though they are not appropriate for severe or profound hearing loss, or for children. Insurance does not typically cover OTC hearing aids.

How to Appeal a Hearing Aid Denial

Step 1 — Identify the reason for denial. Common denial reasons include: benefit exclusion (plan doesn't cover hearing aids), medical necessity dispute (insurer questions whether aids are necessary), Prior Authorization Denied: How to Appeal" class="auto-link">prior authorization failure, or out-of-network audiologist.

Step 2 — Check your state mandate. If you live in a state with a hearing aid coverage mandate and have a fully insured plan, cite that mandate in your appeal. Your state insurance department can confirm whether the mandate applies to your plan type.

Step 3 — EPSDT appeal for children. If your child is on Medicaid or CHIP and was denied hearing aids, file a Medicaid fair hearing appeal. The EPSDT mandate is clear: medically necessary hearing aids for children must be covered. Include your child's audiological evaluation and the prescribing audiologist's letter of medical necessity.

Step 4 — Internal appeal for commercial plans. Submit a written appeal with:

• Your audiologist's evaluation documenting the degree of hearing loss
• The audiologist's letter of medical necessity explaining why hearing aids are appropriate
• Documentation of how hearing loss affects your daily functioning, communication, work, or education
• Reference to any applicable state mandate or plan benefit

Step 5 — Escalate to your state insurance department. If your insurer denies your appeal and you believe a state mandate was violated, file a complaint with your state insurance department. This is particularly effective for child hearing aid denials in states with clear mandates.

Step 6 — External Independent Review: Complete Guide" class="auto-link">External review. If your denial was based on medical necessity (rather than a pure benefit exclusion), you may be entitled to external review in your state.

When the Denial Is an Exclusion, Not a Dispute

If your plan has a clear blanket exclusion for hearing aids and you are an adult in a state without a mandate, the appeal pathway is limited. In this case:

• Advocate with your employer to add hearing coverage to your plan
• Look for a Medicare Advantage plan with hearing benefits during open enrollment
• Explore hearing aid financing programs and manufacturer assistance programs
• Consider OTC hearing aids if your loss is mild to moderate

Fight Back With ClaimBack

For children with hearing loss, for adults in states with mandates, and for Medicare Advantage members with hearing benefits — a hearing aid denial is often worth fighting. ClaimBack helps you identify the right appeal strategy, build the necessary documentation, and challenge the denial on legal or clinical grounds.

Start your hearing aid appeal with ClaimBack.

Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity and Why Does It Matter?
• Common Reasons Insurance Claims Are Denied