Tyrone, age 62, has rheumatoid arthritis that causes chronic pain and a mobility impairment that prevents him from walking long distances or climbing stairs. He also has a hearing loss that prevents him from understanding ordinary conversation without the assistance of a hearing aid. He is a lawful permanent resident, but not a citizen of the United States.
What are key issues for Tyrone in selecting healthcare insurance coverage?
- Is Tyrone eligible to purchase healthcare insurance through the Marketplace?
Possibly. Lawfully residing immigrants such as permanent residents who are not enrolled in Medicare are free to purchase healthcare coverage through the Marketplace. Tyrone might also be eligible for subsidized health care coverage if he meets the income level and residency requirements.
- Is Tyrone eligible for Medicaid?
Possibly. Naturalized citizens and green card holders who have been in the country for five years or more will qualify for Medicaid if they meet the income eligibility requirements. If Tyrone had refugee status he could qualify for Medicaid without waiting for five years. (For more information, click here.)
- Are hearing aids covered under the plans that are available to Tyrone?
Probably not. It depends on several factors including the state Tyrone lives in. Most states have selected benchmark plans that exclude hearing aids for adults. As of August 2013, only 7 states’ benchmark plans provided some level of coverage for hearing aids for adults without age limits. (For more information, click here.) The benchmark, selected by each state, guides the benefits and services that plans operating in the Marketplace will make available. However, the ACA prohibits disability-based discrimination in healthcare coverage, so Tyrone could try requesting hearing aids under the Essential Health Benefit category of habilitation, rehabilitation and devices, even if they are not explicitly mentioned as a covered benefit by the plans he is considering. Navigators could refer Tyrone to local advocacy organizations for assistance to pursue this option. (See Resources.)
- Would Medicaid cover hearing aids if Tyrone is eligible for Medicaid?
Possibly. About two thirds of state Medicaid programs cover some or all of the cost of hearing aids. So Tyrone’s access to coverage for some or all of his hearing aid costs depends on his state of residence.