Ally’s Act
- Bill Number
- H.R. 4606
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-07-22: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-06-30T08:07:22Z
AI-Generated Summary
Purpose of the Legislation
The Ally's Act (H.R. 4606) aims to ensure that certain private health insurance plans cover hearing devices and related services for people with hearing loss. It does this by updating key federal laws to mandate coverage, making it easier for individuals to access these treatments without excessive out-of-pocket costs.
Key Provisions
- Required Coverage Items and Services: Health plans must cover auditory implant devices (such as bone conduction implants and cochlear implants), their external sound processors, and related support. This includes:
- Maintenance and repairs.
- Upgrades or replacements every 5 years.
- Accessories like adhesive adapters and softband headbands.
- Comprehensive hearing assessments, preoperative medical evaluations, necessary surgery, postoperative medical and audiological visits, and aural rehabilitation (therapy to improve hearing use).
- Coverage Standards: Financial requirements (like deductibles, copays, or coinsurance) and treatment limits (such as visit frequency caps) for these services cannot be stricter than those for most other medical or surgical benefits. No separate cost-sharing or limits can apply only to hearing-related items.
- Medical Necessity Rule: Plans cannot deny or limit coverage if a doctor (physician) or qualified audiologist determines the item or service is medically necessary. A "qualifying individual" is someone diagnosed with hearing loss (one or both ears) needing these devices.
- Scope of Application: Applies to group health plans (employer-sponsored) and individual health insurance. Coverage is added to laws like the Public Health Service Act (PHSA), Employee Retirement Income Security Act (ERISA, which governs employer plans), Internal Revenue Code (IRC, for tax-related plan rules), and Patient Protection and Affordable Care Act (ACA).
- Grandfathered Plans: Existing plans that predate the ACA and are exempt from some new rules must comply starting with plan years on or after January 1, 2026.
Significant Changes to Existing Law
- New Mandates in Core Laws: Adds specific sections to PHSA (new Sec. 2799A-11), ERISA (new Sec. 726), and IRC (new Sec. 9826) requiring hearing device coverage, which was not previously mandated at this level in private insurance.
- Extension to Grandfathered Plans: Amends ACA Sec. 1251 to include this coverage for "grandfathered" plans (older plans kept for continuity), closing a gap where these plans might otherwise avoid new requirements. (Grandfathered plans are those not significantly changed since the ACA's 2010 enactment.)
- Clerical Updates: Adjusts tables of contents in ERISA and IRC for easy reference to the new sections.
- No changes to Medicare, Medicaid, or short-term plans; focuses on private market coverage.
Potential Impacts
- On Citizens: Improves access to hearing aids and implants for millions with hearing loss, potentially reducing financial barriers (e.g., devices can cost $20,000+ without insurance). Could enhance quality of life, communication, and employment opportunities, especially for children and adults with unilateral or bilateral hearing issues.
- On Health Insurers and Plans: May increase costs for covering surgeries, devices, and follow-ups, possibly leading to higher premiums or adjustments in plan designs. Insurers lose discretion to deny based on their own medical necessity reviews.
- On Government Agencies: Minimal direct impact; the Department of Health and Human Services (HHS), Labor, and Treasury would enforce via existing ACA mechanisms, potentially adding administrative workload for compliance oversight.
- On International Relations: None apparent; this is a domestic health policy focused on U.S. insurance markets.
Main Stakeholders Affected
- Individuals with Hearing Loss: Primary beneficiaries, including children and adults needing implants or processors.
- Health Insurers and Group Health Plans: Must expand benefits, affecting for-profit insurers, self-insured employers, and plan administrators.
- Healthcare Providers: Physicians, audiologists (hearing specialists), and surgeons gain clearer authority in determining coverage without insurer overrides.
- Employers: Those sponsoring group plans may face higher costs or need to update benefits.
- Advocacy Groups: Organizations for the hearing impaired (e.g., those focused on cochlear implants) stand to benefit from broader access.
Notable Legal, Constitutional, or Political Implications
- Legal Implications: Strengthens patient protections under the ACA by treating hearing devices like other essential medical benefits, reducing disputes over denials. Aligns with disability rights laws (e.g., Americans with Disabilities Act) by promoting equitable healthcare access. Enforcement would follow existing complaint processes, with potential for lawsuits if plans violate rules.
- Constitutional Implications: None significant; does not infringe on free speech, privacy, or state powers, as it regulates interstate commerce in insurance (a federal authority upheld in ACA cases).
- Political Implications: Bipartisan sponsorship (Democrats and Republicans) suggests broad appeal as a targeted expansion of healthcare without overhauling the system. Could set precedent for mandating coverage of other assistive devices, influencing future debates on insurance mandates versus costs. As an introduced bill (July 22, 2025, 119th Congress), its passage depends on committee reviews in Energy and Commerce, Education and Workforce, and Ways and Means.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (98)
Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Pocan, Mark [D-WI-2], Rep. Rutherford, John H. [R-FL-5], Rep. Veasey, Marc A. [D-TX-33], Rep. Takano, Mark [D-CA-39], Rep. Cohen, Steve [D-TN-9], Rep. Moskowitz, Jared [D-FL-23], Rep. Deluzio, Christopher R. [D-PA-17], Rep. Pettersen, Brittany [D-CO-7], Rep. Chu, Judy [D-CA-28], Rep. Matsui, Doris O. [D-CA-7], Rep. Salinas, Andrea [D-OR-6], Rep. Sherrill, Mikie [D-NJ-11], Rep. Evans, Dwight [D-PA-3], Rep. Mullin, Kevin [D-CA-15], Rep. Stanton, Greg [D-AZ-4], Rep. McIver, LaMonica [D-NJ-10], Rep. McBride, Sarah [D-DE-At Large], Rep. Amo, Gabe [D-RI-1], Rep. McClain Delaney, April [D-MD-6], Rep. Schakowsky, Janice D. [D-IL-9], Rep. Barragán, Nanette Diaz [D-CA-44], Rep. Dingell, Debbie [D-MI-6], Rep. Kim, Young [R-CA-40], Rep. Escobar, Veronica [D-TX-16], Rep. Khanna, Ro [D-CA-17], Rep. Grothman, Glenn [R-WI-6], Rep. Lawler, Michael [R-NY-17], Rep. Swalwell, Eric [D-CA-14], Rep. Doggett, Lloyd [D-TX-37], Rep. Tonko, Paul [D-NY-20], Rep. Budzinski, Nikki [D-IL-13], Rep. Ryan, Patrick [D-NY-18], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Tlaib, Rashida [D-MI-12], Rep. Frost, Maxwell [D-FL-10], Rep. Mannion, John W. [D-NY-22], Rep. Bresnahan, Robert P. [R-PA-8], Rep. Craig, Angie [D-MN-2], Rep. Sewell, Terri A. [D-AL-7], Rep. Watson Coleman, Bonnie [D-NJ-12], Rep. Van Drew, Jefferson [R-NJ-2], Rep. Houlahan, Chrissy [D-PA-6], Rep. McGovern, James P. [D-MA-2], Rep. Lynch, Stephen F. [D-MA-8], Rep. Thompson, Mike [D-CA-4], Rep. Carter, Troy A. [D-LA-2], Rep. Fields, Cleo [D-LA-6], Rep. Ross, Deborah K. [D-NC-2], Rep. Harder, Josh [D-CA-9] and 48 more
Recent Actions
- 2025-07-22: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-22: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-22: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-07-22: Introduced in House
- 2025-07-22: Introduced in House
Bill Versions
- Ally’s Act — issued 2025-07-22 — PDF (12 pages)