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Vermont Essential Health Benefits Benchmark

Under the Affordable Care Act, individual and small group health plans are required to cover ten categories of Essential Health Benefits (EHB). Each state is authorized to develop state-specific EHB benchmark plans detailing the specific services required to be covered under each broad EHB category. In August 2022, the Centers for Medicare & Medicaid Services (CMS) approved expanded coverage in Vermont’s essential health benefit (EHB) for services including prescription hearing aids. Starting in 2024, individual and small group health plans hearing will cover one set of prescription hearing aids every three years and annual exams. It also increases access to nutritional counseling and rehabilitative services.

 

Vermont’s new EHB benchmark plan was approved following a public comment period, review by the Green Mountain Care Board, and collaboration with a diverse array of stakeholders. Coverage for hearing aids is also available for individuals enrolled in Medicaid.

 

Materials related to Vermont’s EHB Benchmark Plan may be found on this page. Materials related to Vermont’s 2014-2022 EHB-benchmark plans and associated materials can be found on the CMS website here.