Health care coverage: hearing aids

The law expands pediatric hearing-aid coverage in large-group insurance while limiting out-of-pocket costs. It sets a minimum package of related hearing services and replacement access.

What the law does ​

• Requires large-group health plans and insurance policies issued, amended, or renewed on or after January 1, 2028, to cover medically necessary hearing aids and related services for enrollees and insureds under 21.
• Requires coverage of medically necessary services from qualified audiologists experienced with children.
• Includes assessments, earmolds, fittings, adjustments, auditory training, maintenance, and replacement hearing aids at least every three years, or sooner when existing devices no longer work or meet medical needs and cannot be adjusted.
• Allows plans and insurers to cap coverage for each hearing-aid device at $3,000 and require use of network providers.
• Bars deductibles, caps coinsurance at 10 percent, and prohibits other financial or treatment limits except as allowed by the law.
• Excludes Medicare policies, specialized health coverage, and Medi-Cal managed care plans.

Who it affects ​

• Children and young adults under 21 enrolled in large-group health plans or insured through large-group health policies.
• Large-group health care service plans and health insurers.
• Qualified audiologists providing pediatric hearing services.

Context ​

The requirements apply to qualifying large-group coverage beginning January 1, 2028.