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.

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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.

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  • I’ve been a Family Nurse Practitioner for 16 years & have worked in a variety of clinical settings.
    I just started working for a company where I perform comprehensive in-home clinical assessments in the homes of members aged 65 and older.
    I am having a hard time actually believing that seniors who have Medicare health insurance do not have access to some basic essential health care services.
    Our government leaders should all be ashamed of themselves for allowing this type of inhumanity to exist in our country. It is absolutely ageism and abusive. There must be thousands of research studies out there that could link a positive correlation between lack of appropriate eye care/blurred vision and maybe altered depth perception in seniors to be associated with an increase in falls. We all know the healthcare costs and morbidity/mortality studies from falls in the elderly.
    What about dental care. So, when a person is finally old enough to retire & no longer is working, the federal government has decided that these individuals must pay out of pocket for any dental work they may need. Clearly, as we age, we need more work done & it is not cheap. Geriatric individuals are an easy group to take advantage of, apparently. What is the logic behind this decision making?
    Seniors with poor dentition may not chew their food adequately and are at a higher risk of choking and accidentally aspirating their food. This causes the development of an aspiration pneumonia that can be deadly.
    Aren’t we all entitled to have teeth to eat with?
    Then there is the issue of Medicare not coverage hearing aids for the many seniors whose quality of life have been significantly affected by this. Most of the members I see need hearing aids very badly, but just can’t afford them. It’s unreal. Plus, my voice is getting tired from having to speak so loudly to them in their faces. It can get very frustrating.
    How can our government desert our seniors like this? Not everyone is rich and can afford these things. To me, it makes me disenchanted about our society. All Americans have a fundamental right to be able to see to the best degree our latest technology can provide. We deserve to be able to have hearing aids so that we can hear & have a better quality of life as long as possible. Finally, we all have a fundamental right to dental care when needed. We are not a barbaric society. Unbelievable.

    • Very well put Marcie. My Mother is 92 and in fairly good health but when the family gets together and she sits at the diner table in her own little world because she can’t hear the conversation it reminds me of living in some poor country where the elderly are cast aside. It makes me sick that a system that is supposedly set up to aid the aging won’t provide the basic needs of the elderly like dental, sight and hearing. Now I hear on the news that hearing loss might lead to dementia. Its bad enough that seniors have to supplement Medicare out of there pockets but since they do, they should be covered for the 3 basics of life…eating,seeing and hearing. Some times I am ashamed to live in such a greedy country.

  • It is very true that Medicare, AND private insurers, should cover hearing aids. They really are every bit as expensive as you describe them, and quite out of reach for many family budgets.
    However, a couple of points in this article aren’t quite accurate. If “most Americans didn’t live long enough to need them”, then where on earth do I and my born-deaf/hard-of-hearing friends fit in?
    Secondly, if they “are such a relatively simple solution”, I don’t think this one friend of mine would have attempted to send hers down the toilet when she was a small child.

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