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Bill

S 5789

Requires insurance policies to provide coverage for medically necessary hearing aids purchased from hearing aid dispensers

2025 Regular Session Introduced by Joe Addabbo and 1 co-sponsor

Requires insurers to cover medically necessary hearing aids purchased from hearing aid dispensers, reducing patient costs and standardizing benefits.

REFERRED TO INSURANCE
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WeVote Research Nonpartisan
Bill Summary · S 5789

Summary of Bill S 5789

Overview

Bill S 5789 would require insurance policies to provide coverage for hearing aids that are medically necessary and purchased from hearing aid dispensers. The bill is currently in the referral stage, having been referred to the Insurance committee on March 3, 2025. The primary sponsor is Luis R. Sepúlveda.

Purpose and Intent

  • Expand insurance coverage to include hearing aids when medically necessary.
  • Ensure coverage applies specifically to hearing aids purchased from hearing aid dispensers.
  • Align insurance benefits with the medical need for assistive hearing devices, potentially reducing out-of-pocket costs for patients.

Key Provisions (as inferred from the bill’s title and status)

  • Insurance policies offered in the state would be required to cover hearing aids deemed medically necessary.
  • Coverage would apply to purchases made from hearing aid dispensers (as opposed to other retail outlets or sources), integrating the dispensing channel into the coverage framework.
  • The bill’s text (not provided here) would likely address eligibility criteria for medical necessity, scope of coverage, and any relevant exclusions or limitations. Specifics such as copays, deductibles, coverage limits, or timelines are not detailed in the available information.
  • Administrative or regulatory requirements for insurers to implement the coverage are not specified in the provided summary.

Affected Parties

  • Insured individuals who require hearing aids for medical reasons.
  • Hearing aid dispensers and related audiology providers.
  • Insurance carriers issuing policies in the state (including private and potentially employer-sponsored plans).
  • Members of the public who rely on eligible hearing aids and related services.

Procedural and Timeline Details

  • Status: Referred to Insurance (as of March 3, 2025).
  • The bill has two identical entries on the same date for the referral, indicating the committee assignment process.
  • Next steps typically include committee hearings, potential amendments, and a floor vote in the chamber, followed by consideration by the other chamber (if applicable) and eventual signature or veto by the executive, depending on the jurisdiction.

Related Legislation

  • S 4929 (prior-session)
  • S 8640 (prior-session)
  • A 3249 (companion) — listed twice, indicating multiple related companion versions
  • These related bills suggest ongoing interest in expanding hearing aid coverage and potential cross-chamber or cross-session refinements.

Potential Impacts and Considerations

  • Positive impacts: Improved access to medically necessary hearing aids; reduced out-of-pocket costs for patients; potential standardization of coverage across policies.
  • Potential costs: Possible premium or administrative costs to insurers; impact on coverage design, copays, and benefits structures.
  • Considerations for implementation: How “medically necessary” will be defined, the accepted sources for hearing aids (hearing aid dispensers), and any implementation deadlines or transition provisions.

Next Steps for Readers

  • Monitor the Insurance committee process for hearings, amendments, and reported bills.
  • Review the full text when available to understand definitions (e.g., “medically necessary,” “hearing aid dispensers”) and any cost-sharing or coverage limits.
  • Compare with related bills (S 4929, S 8640, A 3249) for a sense of broader legislative intent and potential consolidated provisions.

Compiled from official sources — confirm details with the bill’s official record.

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