When Medicare was signed into law in 1965, it did not include any coverage for hearing aids. They were considered “routinely needed and low in cost” and most Americans didn’t live long enough to actually need them. Even though the costs are now high and the need great, Medicare still doesn’t cover hearing aids.
Today, hearing loss affects one-third of adults over the age of 65 and has a significant impact on health. Those experiencing it are at increased risk for depression, loneliness, and dementia, and may become socially isolated. Hearing loss also affects physical health, putting individuals at higher risk for falls and disability and possibly causing functional limitations such as reduced mobility or balance.
Hearing aids are a relatively simple solution to such a common and harmful problem, especially since hearing aid technology has evolved substantially over the years and continues to advance. Only in the 1950s did hearing aids become small enough to be worn in or behind the ear. Today’s devices are often digital, customized to the user, and automatically adjust to the auditory environment.
Unfortunately, hearing aids aren’t accessible to many people because of cost and limited insurance coverage. On average, a single hearing aid costs $2,400; most people need two, bringing the total treatment costs close to $5,000. Insurance coverage is unpredictable: Medicare offers no coverage, Medicaid coverage depends on the state, and private insurance coverage depends on the insurer. So most people end up paying for hearing aids out of pocket — if they can afford them at all.
The Over-the-Counter Hearing Aid Act of 2017 may provide some help. Sponsored by Sens. Elizabeth Warren (D-Mass.) and Chuck Grassley (R-Iowa), it allows individuals to buy certain types of hearing aids over the counter without prior approval from a health care provider. The Food and Drug Administration has until 2020 to propose new regulations for the law, and the devices likely won’t be available to the public until 2021.
Will over-the-counter hearing aids actually help address the unmet need for these devices? That remains to be seen. It will depend on how much they cost and how good they are. They likely won’t replace the prescription hearing aid market — nor should they — much like how drugstore reading glasses don’t fully substitute for prescription lenses. Nevertheless, over-the-counter products serve an essential purpose: They provide immediate, low-cost relief to health problems that may not need more advanced treatment.
One concern with the over-the-counter approach is that some consumers may believe these hearing aids address their problems when they really should be seeking professional help.
Another approach that could make prescription hearing aids more accessible is through insurance coverage. The Seniors Have Eyes, Ears, and Teeth Act has been introduced in Congress for several years in an attempt to include hearing aids and, as the law’s name suggests, vision and dental services, in Medicare coverage.
In a speech on the House floor, this year’s sponsor, Rep. Lucille Roybal-Allard (D-Calif.), referenced research from The Commonwealth Fund showing that only one-quarter of Medicare beneficiaries who need a hearing aid actually receive one. The barrier for the others? Cost. If Medicare covered hearing aids, the cost barrier would be reduced for many beneficiaries. (Some already have hearing aid coverage through Medicare Advantage or a Medicare supplemental plan.)
The Seniors Have Eyes, Ears, and Teeth Act is simple: It reverses the exclusion of these services from Medicare coverage as currently dictated by law. What it does not do is spell out future pricing, cost sharing, or premiums that may be associated with this additional coverage.
Medicare would likely reimburse manufacturers at prices lower than they currently receive, as it does for other health care goods and services. The Department of Veterans Affairs has had success paying just $400 per hearing aid, about $2,000 less than the private market. Further research is needed into how the VA policy affects veterans’ access and health outcomes, as well as manufacturer contracts. This policy could go two ways: lower prices could slow innovation in hearing aid technology, or an expanded market could increase innovation because it raises potential revenue even at Medicare prices.
Medicare coverage for hearing aids could be structured in several ways. For example, The Commonwealth Fund proposes that Medicare beneficiaries pay a $25 monthly premium for bundled vision, hearing, and dental services. Others may recommend the services simply be added under the umbrella of Medicare Part B. Should Roybal-Allard’s bill pass, the regulations that emerge from it will greatly influence the law’s impact on access.
The Eyes, Ears, and Teeth Act doesn’t address Medicaid or private insurance coverage for hearing aids. But changes to Medicare coverage might prompt other types of insurance to reassess their own coverage of these necessary devices.
Our understanding of the effects of hearing loss and the technology for addressing it have both come a long way in the past 50 years. Considering these advancements, the lack of simultaneous improvement in access to hearing aids is beginning to look antiquated.
Elsa Pearson, M.P.H., is a policy analyst at Boston University School of Public Health. Austin Frakt, Ph.D., is the director of the Partnered Evidence-Based Policy Resource Center at VA Boston Healthcare System; an associate professor at Boston University School of Public Health; and an adjunct associate professor at Harvard T.H. Chan School of Public Health.