Longitudinal Growth of Mandated Hearing Aid Benefits in the US

Importance: Inconsistent hearing aid coverage across US health plans poses substantial barriers to essential care. Prior research has examined private insurance and Medicaid mandates separately, leaving the overall reach of coverage across all major US programs unclear. Objective: To identify mandated hearing aid coverage under private insurance, Medicaid, and federal direct-service programs and to compare coverage for US youth, adults, and older adults by coverage plan and economic indicators. Design, Setting, and Participants: This cross-sectional study used population-level policy surveillance data with nationally representative insurance data from the American Community Survey (ACS) from 2008 to 2023. ACS respondents were categorized by age (younger than 18 years, 18 to 64 years, and 65 years or older), insurance type (state-level private insurance, Medicaid, and federal direct-service insurance providers), and eligibility for hearing aid coverage. Data were analyzed from February 2024 to August 2026. Exposures: Mandated health coverage for hearing aids through private insurers, Medicaid, US Department of Veterans Affairs, TRICARE, and Indian Health Service. Main Outcomes and Measures: Annual estimates of the proportion of US individuals with mandated coverage for hearing aids across insurance types, classified into coverage groups. ACS measures included are age, annual household income, and home ownership status. Results: Among 50 203 993 ACS respondents from 2008 to 2023, mandated hearing aid coverage increased from 34.1% (95% CI, 34.0-34.2) to 52.5% (95% CI, 52.4-52.6) among youth younger than 18 years. Among adults aged 18 to 64 years, coverage rose from 10.2% (95% CI, 10.1-10.2) to 19.2% (95% CI, 19.2-19.3), with Medicaid the largest contributor. Mandated coverage for adults 65 years and older declined from 18.5% (95% CI, 18.4-18.6) to 16.9% (95% CI, 16.8-17.0), with Medicaid the primary source. Mandated hearing aid coverage grew 1.03 percentage points (95% CI, 1.02-1.04; P < .001) faster per year among youth younger than 18 years than among adults 65 years and older, largely reflecting consistent Medicaid coverage through the long-standing Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit and the adoption of private insurance pediatric mandates. In 2023, renters and individuals in households below the federal poverty level threshold were more likely to hold mandated coverage than homeowners and those at or above the threshold in every age group. Conclusions and Relevance: In this cross-sectional study, despite gradual improvements, substantial gaps remained in mandated hearing aid coverage, particularly for older adults and adults with limited economic resources. Policy reforms, including expanded Medicaid coverage and mandates requiring hearing aid benefits in private insurance and Medicare, could improve access and health outcomes.