Ally’s Act
Ally’s Act would require private health insurance plans and group health plans to cover a broad set of hearing devices and related services for individuals determined to need them by a physician or qualified audiologist. The coverage would include implants (such as cochlear and bone-conduction implants), external sound processors, maintenance, upgrades every five years, repairs, comprehensive hearing assessments, preoperative assessments, surgical procedures, postoperative and activation visits, and aural rehabilitation. The bill also requires that cost sharing and coverage limitations for these items be no more restrictive than those for other medical benefits, and it prohibits plans from denying or limiting coverage when medical necessity is established. The act would apply across PHSA, ERISA, the Internal Revenue Code, and the ACA, with a phased effective date for plan years beginning on or after January 1, 2026. It also addresses grandfathered health plans by extending the coverage requirement to plans that maintain grandfathered status after the enactment date.
Key Points
- 1Mandatory coverage scope: The bill requires coverage for all aspects of hearing devices and systems listed, including implants, external processors, maintenance, upgrades every five years, adhesive adapters, repairs, and a range of associated medical and rehabilitation services.
- 2Non-discriminatory coverage requirements: For items and services covered, plans must ensure cost sharing and treatment limitations are not more restrictive than those for most medical/surgical benefits and may not impose separate limitations just for hearing devices.
- 3Medical necessity protections: Plans may not deny or limit coverage for items or services that have been deemed medically necessary by a physician or qualified audiologist.
- 4Cross-cutting applicability: The coverage mandate would apply to private group health plans and health insurance issuers offering group or individual coverage under PHSA, ERISA, and the IRC, aligning federal health laws with a unified hearing device coverage standard.
- 5Effective date and grandfathered plans: The new requirements take effect for plan years beginning on or after January 1, 2026. The bill also changes ACA grandfathering rules to recognize this new benefit, affecting plans that retain grandfathered status.