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If you or someone you know has been displaced, needs medical or behavioral health support, or is navigating interruptions to health coverage or services, resources are available to help.
Adult hearing benefit
Hearing aids and cochlear implants are covered for clients age 21 and older.
What happened?
The Washington State Legislature passed ESSB 5179 requiring Apple Health (Medicaid) to cover hearing instruments (hearing aids) when medically necessary. The passing of ESSB 5187 added coverage for adult cochlear implants as of January 1, 2024.
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.
- Cochlear implants.
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 hardware benefit is located in the hearing hardware billing guide and fee schedule. Other related hearing services are listed in the Physician-related/professional services billing guide and fee schedule.
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.