Hearing Aid Benefit Plan Transparency Addressed in New Illinois Law

Illinois has enacted what audiology advocates call the nation’s first law specifically targeting transparency and consumer protections in hearing care and in discounted hearing care plans.

Gov. J.B. Pritzker signed Senate Bill 2838 (SB 2838) into law on July 24. Now designated Public Act 104-0636, the measure passed without opposition—57-0 in the Illinois Senate and 108-0 in the House—and takes effect on January 1, 2027. The Illinois Academy of Audiology (ILAA) led the effort, supported by the American Academy of Audiology and several other state and national audiology organizations. 

The law does not require insurers or third-party administrators to begin covering hearing aids. Instead, it establishes rules intended to clarify what a hearing care plan actually pays for, what merely reflects a negotiated discount between an insurer and provider, and what patients may be expected to pay themselves.

Funded Hearing Benefits vs. Discounted Hearing Care

SB2838 stipulates that hearing care organizations (e.g., health insurers or third-party administrators that offer or manage hearing benefit or discount plans) must provide written information about benefits to enrollees, prospective enrollees, and participating hearing care professionals. Items and services not covered must be identified in the plan’s marketing materials, contracts, and plan documents.

The law also prohibits organizations from presenting a discounted hearing care benefit as if it were a funded insurance benefit. Plans must disclose the specific cost-sharing amounts for benefits available through in-network and out-of-network providers. Discount programs must likewise disclose the actual discounted amounts available through preferred providers.

This is important because hearing care advocates say steep discounts can pressure participating practices to reduce professional care or deviate from best practices for quality hearing care and hearing-aid fitting. Providers may limit follow-up visits, shorten appointments, charge separately for services, or offer less ongoing support than in a traditional bundled-care model. Patients who believe they have comprehensive insurance coverage may therefore discover that their “benefit” primarily provides access to a discounted product price—not necessarily the fitting, counseling, adjustments, maintenance, and long-term care they expect or need.

Employer, Medicare Advantage, and other benefit programs may use the term “hearing benefit” for arrangements ranging from a defined dollar contribution to access to negotiated prices through a third-party network.

Kim Cavitt, AuD, an audiology reimbursement and practice-management consultant who was involved in the Illinois advocacy effort, described the law on LinkedIn as a “first step in attempting to provide transparency” around how these plans are sold and administered. She also provides in her LinkedIn post a summary of key points of the new law for hearing care practices.

It’s important to note that the new law applies to prescription hearing aids and related items and services offered through hearing care plans. Over-the-counter hearing aids are expressly excluded from its definition of covered items.

New Fee Rules for Noncovered Hearing Services

SB 2838 also addresses contracts between hearing care organizations and participating audiologists, hearing aid specialists [hearing instrument specialists], and physicians.

A plan may no longer require a participating professional to accept a plan-established fee for an item or service unless the plan actually funds or discounts that item or service. In other words, a plan cannot dictate the price of care for which it contributes nothing.

Participating hearing care professionals are not required to accept a plan-established fee for items or services the plan does not cover. A professional who instead charges usual and customary fees must either post a conspicuous notice or provide the same information directly to the patient in writing. The notice needs to explain that the professional does not accept the plan’s fee schedule for specified noncovered care—including services provided before the hearing aid fitting, more than one year after the initial fitting, or after the plan’s allowed service visits have been exhausted. The professional must also provide estimated costs for each noncovered item or service. 

For hearing practices, the change could provide greater flexibility to charge appropriately for follow-up appointments, repairs, supplies, testing, and other professional services not covered by a plan. At the same time, the disclosure requirement is designed to reduce surprise bills and help patients understand when they are outside the plan’s covered or discounted structure.

Hearing Testing and Manufacturer Ownership

The new Illinois law also states that when a hearing benefit includes testing to fit or modify a hearing aid, the professional must be reimbursed—by the plan, the enrollee, or both—even if the patient ultimately decides not to purchase prescription hearing aids. 

Another provision applies when a hearing care organization is owned or operated, in whole or in part, by a hearing aid manufacturer and that manufacturer offers prescription hearing aids through the plan. The organization must disclose that ownership or operational relationship on its website, in marketing communications, and in plan documents. It must also specify which prescription hearing aids are available through the plan.

Some hearing care organizations may appear to be an independent benefits administrator even when a hearing aid manufacturer owns it or has a financial interest in it. These relationships can create incentives that favor certain brands, limit the number of available devices through the plan, or structure pricing and referrals in ways that benefit the affiliated manufacturer. The new law is designed to provide greater transparency so consumers, employers, and hearing care professionals can better evaluate whether a plan offers broad product choice or may be influenced by an affiliated manufacturer’s commercial interests.

Changes May Take Time; May Catch on with Other States

Although the law takes effect at the beginning of 2027, consumers may not notice immediate changes. Plans and administrators will need to revise contracts, benefit descriptions, marketing language, and provider procedures as policies are issued, amended, or renewed.

Cavitt cautioned that “we may not see substantial changes until open enrollment of 2027.” 

ILAA says it pursued the legislation after hearing repeated concerns from patients and audiologists about confusing plan descriptions, unclear benefit information, and unexpected out-of-pocket costs. Advocates believe the Illinois measure could now serve as a model for other states examining the growing role of third-party hearing care plans.