Hearing loss is 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 older people’s quality of life 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, and poorer physical functioning, studies have also shown that even mild hearing loss is associated with a threefold increase in falls. Despite the prevalence of hearing loss, hearing aid use is relatively low (15 percent to 30 percent), primarily because of their high cost, which is not covered by Medicare. 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 $2,400, 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.
In 2016, The President’s Council of Advisors on Science and Technology and the National Academy of Medicine (formerly known as the Institute of Medicine) recommended policy changes that would help lower the cost and promote greater use of hearing aids. Some experts have suggested 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.
The FDA has also reduced restrictions on the sale of personal sound amplification devices, 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 over-the-counter for a few hundred dollars.
As basic hearing aids come on the market as over-the-counter devices, their cost is expected to decline to a few hundred dollars. Competition for more complex hearing aids is also likely to intensify, and prices will decrease as the FDA reduces regulatory restrictions on these devices.
Lower hearing-aid costs will be good news for consumers, especially seniors with hearing loss. Increased competition and declining costs should encourage state policymakers to expand hearing-aid coverage and may also give federal policymakers greater leeway to consider adopting Medicare coverage for these devices which would be of great benefit to current and future beneficiaries.
HEARING AIDS: Policy
Access to hearing assessments and hearing aids
Policymakers and regulators should make necessary changes to help lower the cost and promote greater adoption of hearing aids.
The Food and Drug Administration 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
The Food and Drug Administration should carefully review the safety and efficacy of new hearing aids before allowing them on the market.
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 also Chapter 10, Utilities: Telecommunications, Energy, and Other Services—Telecommunications, Cell Phones, and Hearing-Aid Compatibility).
The Federal Trade Commission 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.