Hearing Aids

Background

Hearing loss represents a substantial problem, affecting more than 30 million Americans.

It affects more than 40 percent of Americans older than 60 years, more than 60 percent of those older than 70 years, and nearly 80 percent of people older than 80 years. Left untreated, hearing loss can negatively affect quality of life for older persons by preventing them from engaging with others, leading to social isolation and limiting ability to work. Hearing loss also has been associated with depression, dementia, cognitive decline, poorer physical functioning, and falls with injury. Studies have shown that even mild hearing loss is associated with a threefold increase in falls.

Hearing aid use is low among adults with hearing loss (15 percent to 30 percent). Cost is a major barrier to getting assessment and treatment for hearing loss in the form of hearing aids. The average price for a hearing aid is $2400, and most people need two. The majority of people would have to pay the full cost of hearing aids out-of-pocket due to lack of insurance coverage. Some state Medicaid programs cover hearing aids, however, Medicare expressly excludes coverage for hearing assessments and hearing aids.

The President’s Council of Advisors on Science and Technology (PCAST) and the National Academy of Medicine (formerly known as the Institute of Medicine) have recommended policy changes that would help lower the cost and promote greater use of hearing aids. For instance, these advisory organizations have recommended that the FDA establish a new classification for basic hearing aids and allow these devices to be sold over the counter at drug stores for the treatment of mild to moderate hearing loss—similar to what is allowed for reading glasses. These recommendations would not alter FDA regulation of more complex hearing aids.

These organizations also advocate that the FDA should reconsider its regulation of personal sound amplification products, which are a type of generic hearing aid, that can be helpful in situations in which amplification and noise cancellation are all that is needed. These devices are generally available for a few hundred dollars.

Hearing Aids: Policy

Access

In this policy: Federal

AARP supports policy changes that would help lower the cost and promote greater adoption of hearing aids, such as the PCAST recommendations. For example, FDA should allow over-the-counter sale of basic hearing aids and audiologists should offer more standardized prescriptions that patients can use to compare products.

Safety and efficacy

In this policy: Federal

The FDA should carefully review the safety and efficacy of new hearing aids before allowing them on the market.

Compatibility

In this policy: Federal

The Federal Communications Commission should ensure full and prompt implementation of its hearing-aid compatibility rules to increase the number of wireless phones that can be used effectively with hearing aids and cochlear implants (see Chapter 10, Utilities: Telecommunications, Energy, and Other Services—Telecommunications, Cell Phones and Hearing-Aid Compatibility).

Sales tactics

In this policy: FederalState

The FTC and state consumer protection agencies should investigate complaints of high-pressure sales tactics that inhibit older people from getting professional counseling before purchasing a hearing aid.

States should regulate hearing-aid dealers and sales practices, including direct response and mail-order solicitations; require that advertising mention bonding of sellers; and require adequate consumer protections.