Private insurance and hearing aids: state mandates, HSAs and FSAs

Private health insurance has to cover hearing aids only where state law says so, and only for plans that state law reaches. As of October 2026, 11 states require state-regulated plans to cover hearing aids for adults, and at least 18 more require it for children only ^[8]-^[35]. Everywhere else, coverage is up to your plan.

These laws cover a small share of people. A 2024 study found that in 2022 only 4.6% of privately insured adults ages 19 to 64, and 18.7% of privately insured children 18 and under, lived where a hearing aid mandate applied ^[2]. Several states have added adult coverage since then, but the bigger limit is the type of plan you have.

First, check whether state law applies to your plan

Fully insured plans are bought from an insurance company, and they must follow your state's mandates. Self-funded plans, where your employer pays claims itself and often hires an insurer only to run the paperwork, are governed by federal ERISA law instead. ERISA says a self-funded plan can't be treated as an insurance company under state insurance laws ^[3]. Maine's insurance regulator, for example, lists self-insured plans among those exempt from all state benefit mandates ^[4], and Maryland's notes that many large group plans are self-funded and so aren't fully insured plans ^[5].

Federal employees (FEHB). Federal law says FEHB contract terms on benefits supersede and preempt state and local health insurance laws ^[7]. OPM has "strongly encouraged" FEHB carriers to improve hearing benefits for adults, but encouraged is not required ^[6]. Check each plan's brochure.

How to tell which plan you have: ask HR, "Is our health plan fully insured or self-funded?" The answer is usually in your plan's Summary Plan Description too.

States that require coverage for adults

These 11 states require state-regulated plans to cover hearing aids for adults. Most set a minimum benefit, a replacement cycle, or both.

State	Who's covered	Minimum benefit	In effect
Arkansas	All ages	At least $1,400 per ear every 3 years. Insurers must offer it; the employer or policyholder can decline it [8]	2010
Connecticut	All ages	One hearing aid per ear every 24 months [9]	2020
Illinois	All ages	One hearing aid per ear every 36 months, plus related services [10]	Jan. 1, 2025
Maine	All ages	Plans may cap at $3,000 per aid, per ear, every 36 months [11]	2020
Maryland	Adults (a separate law covers children)	Plans may cap at $1,400 per aid, per ear, every 36 months [12]. Applies only to fully insured large group plans and some individual plans that began before 2011 [5]	Jan. 1, 2025
Minnesota	All ages	One hearing aid per ear every 3 years [13]	July 1, 2023
New Hampshire	All ages	At least $1,500 per aid every 60 months [14]	2011
New Jersey	All ages	One hearing aid per ear every 24 months, no dollar cap [15]	April 15, 2024
Rhode Island	All ages	$1,750 per aid, per ear [16]	Jan. 1, 2026
Vermont	All ages, large group plans only	One hearing aid per ear every 3 years [17]	2024
Washington	All ages	One hearing aid per ear every 36 months, no annual or lifetime dollar limit for plans issued or renewed from Jan. 1, 2026 [18]	2024 (large group); 2026 (all plans)

"In effect" means plans issued or renewed on or after that date. Your benefit starts when your plan renews, not on the day the law takes effect.

States that require coverage for children only

State	Ages covered	Minimum benefit
Colorado	Minor children	Initial and replacement aids, up to every 5 years [19]
Delaware	Dependents under 24	$1,000 per aid, per ear, every 3 years [20]
Georgia	18 and under	$3,000 per ear every 48 months [1][21]
Idaho	Dependent children, individual plans only	One device per ear every 36 months [22]
Kentucky	Under 18	$1,400 per ear every 36 months; $2,500 for plans issued or renewed from Jan. 1, 2027 [23]
Louisiana	Under 18	$1,400 per aid, per ear, every 36 months [24]
Massachusetts	21 and under	$2,000 per aid every 36 months [25]
Missouri	Under 18	At least what the state's Medicaid program covers for children [26]
Montana	18 and under	One device per ear every 3 years [27]
Nebraska	Under 19	$3,000 per 48 months; small-employer plans excluded [28]
New Mexico	Under 18, or under 21 if in high school	$2,200 per aid every 36 months [29]
North Carolina	Under 22	$2,500 per aid every 36 months [30]
Ohio	21 and under	$2,500 every 48 months [31]
Oklahoma	Up to 18	Benefit can be limited to once every 48 months per ear, with no dollar cap [32]
Oregon	18 and under; 19 to 25 if in school	One hearing aid per ear every 36 months [33]
Tennessee	Under 18	$1,000 per aid, per ear, every 3 years [1][21]
Texas	18 and under	One hearing aid per ear every 3 years [34]
Wisconsin	Under 18	One hearing aid per ear every 3 years, plus cochlear implants [35]

Virginia is unclear. A 2023 law required coverage for children 18 and under starting in 2024 ^[36], but the state's current code shows an amended version with different terms. Check with the Virginia Bureau of Insurance before relying on it. For Georgia and Tennessee, we relied on two professional compilers, ASHA and the American Academy of Audiology, because we couldn't open the official code text ^[1][21].

If your state isn't listed, check with your state insurance department. Laws change, and some states have bills pending.

Using an HSA or FSA for hearing aids

Both accounts can pay for hearing aids, because the IRS counts the cost of a hearing aid, plus the batteries, repairs and maintenance needed to run it, as a medical expense ^[37]. That holds whether or not your insurance covers hearing aids.

Account	2026 contribution limit	Good to know
Health savings account (HSA)	$4,400 self-only, $8,750 family, plus $1,000 if you're 55 or older [38]	Requires a high-deductible health plan. Once you enroll in Medicare, your contribution limit is zero [38]
Health flexible spending arrangement (FSA)	$3,400 per employee [39]	If your plan allows carryover, up to $680 can roll into the next year [39]

Two tips for timing. An FSA is a good fit for a planned hearing aid purchase, since you pick the amount during open enrollment. With an HSA, money left over stays in the account, and after 65 a withdrawal for non-medical use is taxed as income but no longer gets the extra 20% penalty ^[38].

Deducting hearing aids on your taxes

If you itemize, you can deduct medical and dental expenses only to the extent they exceed 7.5% of your adjusted gross income (AGI) ^[37]. You can't count expenses paid with tax-free HSA money or reimbursed by an FSA ^[37].

Example: your AGI is $50,000, so the threshold is $3,750. You spend $5,000 on hearing aids and $1,500 on other medical bills, for $6,500 total. The deductible amount is $2,750. It only helps if your itemized deductions add up to more than the 2026 standard deduction of $16,100 for single filers or $32,200 for married couples filing jointly ^[39].

Questions to ask your insurer or HR

• Is our plan fully insured or self-funded?
• Does the plan cover hearing aids for adults? What's the dollar limit and replacement cycle?
• Is the limit per ear or per pair? Does it apply to the deductible?
• Which providers are in network for hearing aids, and do I need a referral?
• Are the hearing test, fitting and follow-up visits covered separately?
• Can I buy a hearing aid rider?
• Can I use FSA or HSA money for the part the plan doesn't pay?

Before you shop, get your hearing tested so you know what you need. Our guide to hearing aid costs shows typical prices by where you buy, and our hearing provider directory lists clinics near you. If you're 65 or older, see Medicare and hearing aids. For other programs, start at the costs and coverage hub.