Update on 2024 Federal BCBS Hearing Aid Coverage Changes

Academy staff met with representatives from the Blue Cross Blue Shield Association (BCBSA) to gain additional clarity on the recent coverage changes that went into effect for federal employees/retirees on January 1, 2024. 

Federal Blue Cross Blue Shield (BCBS) plans now specify a hearing loss of greater than 40 dB and prior authorization for coverage. BCBS representatives indicated that the prior authorization requirement was predicated by concerns regarding certain “bad actors” who were using misleading marketing materials and actively soliciting beneficiaries at the precise time when replacement hearing aids would be covered under the plan. Government watchdogs recommended implementing the prior authorization requirement as a response to this situation.

BCBSA representatives emphasized that the 40 dB threshold is not intended to serve as a “hard” line and that they strive to respect the clinical judgement of providers. In other words, if a patient does not technically meet the dB threshold, but would benefit from hearing aids, the provider should provide documentation detailing their rationale for coverage.

Currently, there is not a standardized process for prior authorization as each participating plan can dictate that process. BCBSA is also aware of the current issue in which certain devices are not being covered due to confusion on the part of individual plan representatives.

At this time, these Federal Employee Program (FEP) plans do not provide coverage for over-the-counter (OTC) devices and individual plans have been checking FDA databases to ensure that the prescribed devices do not fall into this category. However, some plans have not been checking the appropriate FDA resources for this information.  BCBSA is currently drafting FAQ documents for all the plans to address all these issues to help alleviate some of the ongoing confusion.

If you are experiencing issues regarding the prior authorization process or are receiving coverage denials, please send details to the Academy.