Medicare AdvantageCoverageMedium impact
[Ohio] Hearing Aid Coverage – Ohio House Bill 315
CareSource·OH · Audiology, ENT (Ear, Nose & Throat)·Provider Bulletin
Effective date
Apr 3, 2025
We identified it
May 9, 2026
Summary
Effective April 3, 2025, Ohio House Bill 315 requires health plans (excluding Medicaid) to cover hearing aids for individuals aged 21 and younger at up to $2,500 per impaired ear every 48 months. Coverage requires prescription from an otolaryngologist or recommendation from a licensed audiologist. Plans are not obligated to pay if the beneficiary received coverage from another plan within the past 48 months.
Action Required
By April 3, 2025: Billing team must update claim submission and adjudication systems to identify beneficiaries aged 21 and younger and apply new hearing aid coverage limits ($2,500 per ear, 48-month cycle). Update authorization workflows to require documentation that services were prescribed by an otolaryngologist or recommended by a licensed audiologist. Implement duplicate coverage check to deny claims if beneficiary received hearing aid coverage from another plan within past 48 months. Train billing staff on new age restriction and coverage parameters. Update patient eligibility verification to reflect new benefit. Failure to implement may result in inappropriate claim denials or improper payments.