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Adult hearing benefit

Hearing aids covered for clients age 21 and older beginning January 1, 2019.

What happened?

The Washington State Legislature passed ESSB 5179 that requires Apple Health (Medicaid) to cover hearing instruments (hearing aids) when medically necessary.

What does this mean?

Under the legislation, clients age 21 and older who meet specific hearing loss criteria may be eligible for the following:

  • One hearing aid every five years.
  • A second hearing aid when specific criteria are met.
  • Repair and replacement of hearing aids.
  • Hearing aid related services and supplies.
  • Repairs to external components of cochlear implants and bone-anchored hearing aid (BAHA) devices.

Where do I find more information on this benefit?

This page will be regularly updated. Hearing providers interested in providing health care services to Apple Health clients should bookmark this page for reference. 

Fee schedule

The adult hearing benefit fee schedule is currently being developed and will be posted here when complete. However, it will be nearly identical to the benefits for clients age 20 and younger found in the current hearing hardware fee schedule.

Training and webinars

Sign up for a provider webinar in December:

I’m interested! How do I sign up for notifications as a hearing provider?

HCA uses two systems to manage accounts and deliver information directly to providers.

ProviderOne

ProviderOne is the billing system that eligible Apple Health providers use to submit claims, request prior authorizations, and receive payment. To receive notifications through ProviderOne:

  • If you are a current Apple Health hearing provider: Log into ProviderOne.
  • If you are interested in providing Apple Health hearing services: Enroll as an Apple Health provider.

GovDelivery

GovDelivery is a free subscription email service that allows HCA to communicate directly to its providers. Visit the GovDelivery signup page to create a new account if you are not already registered, and to choose which topics you would like to stay informed on.

To sign up for hearing provider alerts:

  • Expand Apple Health (Medicaid) providers by clicking the “+” left of the description.
  • Expand Provider Alerts.
  • Scroll down and check the box for Vision-Hearing.
  • Click SUBMIT.