What is Employer Sponsored Health Insurance?

Employer‑sponsored health insurance (ESI) refers to health coverage that an employer purchases for its employees and often extends to their dependents. [1]  In the United States, ESI remains the most common form of private healthcare: approximately 165 million people receive coverage through their employer, compared with around 16 million through ACA Marketplace plans. [2]

However, many do not know that hearing care may be included in your employer-sponsored health insurance, and many miss out on benefits for hearing because of this assumption.  In this article, we’ll examine the nuances of employer-sponsored health insurance and how this benefit can help lower costs and improve the quality of life for those who take advantage of it.

Employees should be made aware that hearing insurance can be included in employer-sponsored health insurance. Many workplaces, especially those in manufacturing, construction, or loud office environments, expose employees to noise levels that can contribute to long-term hearing damage. Over time, untreated hearing loss can lead to communication difficulties, social isolation and depression. That’s why forward-thinking employers are adding hearing benefits to their health plans.

Employer-sponsored hearing insurance helps reduce the financial burden of hearing tests, devices, and ongoing care—making it easier for employees to take action early. Hearing aids, which can be costly out-of-pocket, may be partially or fully covered under these plans. With proper use, hearing aids have been shown to improve both physical health (reducing fatigue and falls) and mental well-being (reducing depression and improving cognitive focus).

Currently, 35 states require health insurance to provide hearing insurance for adults. If you live in one of these states, your employer may be required to cover hearing aids, subject to certain conditions for exclusions. Check and see if you live in a state that qualifies.

Read on for more information on other common hearing insurance questions.

Although the benefits of employer-sponsored health insurance plans are plentiful and clear, employees may still wonder about the differences between private insurance plans and employer-sponsored plans. Here’s a quick look:

• Premium Structure & Taxes
  ESI premiums are paid pre-tax and often subsidized by the employer. At the same time, private Marketplace plans are fully paid post-tax by individuals. [7] Did you know that hearing aids and certain hearing expenses can be tax-deductible? Learn more about hearing aid tax deductions.

• Plan Affordability & Coverage
  Employer plans generally have lower total premiums and lower deductibles. For instance, employer plans often cost less to enroll in and have lower deductibles than equivalent Marketplace plans, even though employee contributions may be higher due to generous coverage. [8]

• Eligibility and Enrollment Windows
  With ESI, coverage is available only to those individuals the employer designates, and enrollment typically occurs annually or after qualifying events. Marketplace plans have annual open enrollment and can be accessed by anyone, regardless of employment status.

If you don’t have health plan coverage, there are still options to get the hearing health care you may need. Take a look at Amplifon Hearing Health Care’s financing options.   

If you’re wondering if you can leave your employer-sponsored health insurance at any time, the unfortunate answer is that generally, you can’t. ESI plans are annual, with enrollment during the open enrollment period. Coverage can only be changed during open enrollment or after a qualifying event for employer-sponsored health insurance, such as:

• Marriage
• Birth
• Death
• Job Change

If you leave your job, you may elect COBRA continuation coverage for up to 18–36 months, but you must pay the full premium plus a 2% administrative fee. COBRA premiums are often costlier than active employee rates. [9]

Let’s take a look at some noticeable trends that have developed in employer-sponsored health insurance:

• Growth of high-deductible, consumer‑driven plans: CDHPs, including HSA-qualified high-deductible plans, now account for ~29% of employer offerings (2016 data), up from ~5% in 2007. [10]
  
  
• Smaller employers self-funding: Historically limited to large employers, self-insured plans are now being adopted by smaller firms (300–400 employees) as a cost-control strategy.
  
  
• Increased emphasis on telehealth and wellness: Following the COVID-19 pandemic, employers are incorporating virtual care, mental health benefits, and wellness incentives into their employee benefits designs, although availability varies.