Ally’s Act
This bill requires private and employer-sponsored health insurance plans to cover auditory implants—such as cochlear implants and bone-conduction devices—for people diagnosed with hearing loss. Coverage must include the necessary surgeries, medical exams, rehabilitation, device maintenance, and upgrades or replacements every five years. In addition, insurers cannot charge higher out-of-pocket costs for these treatments than for standard medical care, nor can they deny coverage if a doctor or audiologist determines it is medically necessary.
What this bill touches.
Who it helps · who it burdens.
Who it helps
- Individuals with hearing loss qualifying for auditory implantsGains mandatory health insurance coverage for auditory implant devices (including cochlear and bone-conduction implants), external sound processors, maintenance, repairs, 5-year upgrades or replacements, related surgeries, fittings, and rehabilitation services without extra cost-sharing or treatment limits (Sec. 2(a)–(d)).
- Physicians and qualified audiologistsGain binding authority over coverage determinations for auditory implants and related care, as health plans and insurers are barred from denying or limiting coverage once these providers determine medical necessity (Sec. 2(a)–(c)).
Who it burdens
- Group health plans and health insurance issuersMust cover auditory implant devices, replacement processors, maintenance, surgeries, and related rehabilitation services, cannot apply cost-sharing or treatment limits more restrictive than general medical/surgical benefits, and are prohibited from denying coverage once a physician or audiologist determines medical necessity (Sec. 2(a)–(d)).
The provisions, in plain language.
Requires group health plans and health insurance issuers to cover auditory implant devices (including cochlear and bone-conduction implants), external sound processors, maintenance, repairs, upgrades or replacements every five years, and associated surgical, fitting, and rehabilitation services for qualifying individuals.
Prohibits health plans and insurers from applying cost-sharing rules or treatment limits to covered auditory devices and services that are more restrictive than those applied to general medical and surgical benefits.
Bars health plans and insurers from denying or limiting coverage for auditory implants and related care if a treating physician or audiologist determines they are medically necessary.
Extends these auditory device and service coverage requirements to grandfathered health plans beginning with plan years on or after January 1, 2026.