AARP Eye Center
Millions of older adults in the U.S. suffer from hearing loss and the heavy social, emotional, and health tolls that come with it. Yet many are unable to afford the hearing care they need. But that could soon change, thanks to a pair of developments.
First, for those whose hearing loss is mild to moderate, hearing aids will soon be available over-the-counter at retail stores and online, putting them within reach and bringing down costs to consumers. And for people with more severe hearing loss, relief may come through the Build Back Better Act that recently passed the U.S. House of Representatives and is under consideration by the U.S. Senate. If it becomes law, traditional Medicare will start covering hearing benefits for people with more severe hearing impairment for the first time in the program’s history.
Here's a look at why access to hearing care is critical for older adults and their families, some of the upcoming changes and what remains to be done.
Hearing Loss: A Significant Burden Among Older Adults
An estimated 44 million people 20 years and older in the U.S. have hearing loss. Although hearing loss can occur at all ages, the risk increases significantly as people grow older, doubling with every decade of life. In fact, roughly nine out of ten people with hearing loss are adults ages 50 and older. That’s 40 million older adults. The highest prevalence of hearing loss is among those 80 years and older. Eighty percent of people in this age group have hearing loss, compared to 10 percent among those in their 50s. Other demographic factors can also influence hearing loss risk. For instance, the likelihood of hearing loss is greater among men than women and lower among non-Hispanic Black individuals than people from other racial and ethnic groups.
For older adults, hearing loss is usually permanent and progressive. Typically, it starts with difficulty hearing soft spoken people (mild hearing loss) and gradually worsens to not being able to perceive regular speech without hearing aids (severe hearing loss) or even hear very loud sounds (profound hearing loss).
When left untreated, hearing loss can have significant impacts on people’s lives. For many who experience it, hearing impairment can bring a sense of insecurity, lead to social isolation, and reduce overall quality of life. It can also lead to serious health issues. Compared to people with normal hearing, older adults with hearing loss have a higher risk of developing dementia, depression, or functional disabilities. Falls, a serious health risk among older adults, are also strongly associated with untreated hearing loss.
Costs Are a Significant Barrier to Accessing Hearing Care
Yet despite the negative impact on health, many older adults who have lost the ability to hear well do not get the care they need. For instance, only 13 percent of Medicare beneficiaries who report having hearing troubles have a hearing aid. Use of hearing devices is especially low among women, racial and ethnic minorities, and low-income individuals.
While there are many reasons why older adults with hearing loss do not access the care they need, the high cost of hearing technologies and services is a leading cause. Because hearing aids must be customized to the severity of the hearing loss, people often face these high costs more than once, as hearing loss increases. With the average cost of one hearing aid ranging from $1,000 to $4,000, and some premium models costing as much as $6,000, hearing care is a heavy financial burden for many older adults.
In general, insurance coverage of hearing care for older adults is limited. Many commercial health insurance plans do not cover hearing services or aids. Traditional Medicare does not cover hearing exams, except in limited circumstances. Nor does the program pay for hearing aids or fitting services. People with Medicare who opt for Medicare Advantage plans have some coverage for hearing care but that too is often limited and enrollees can face large out-of-pocket costs.
A Step in The Right Direction, And More Possibly on the Way
This reality is exactly why the Food and Drug Administration’s (FDA) proposed rule to allow the sale of over-the-counter hearing aids is so significant for older adults with mild to moderate hearing loss. Once the rule is finalized, consumers will be able to directly purchase hearing aids in retail stores and online, an option that was never previously available.
Currently, people typically need a hearing exam, a prescription from a doctor for a hearing aid, and a visit to an audiologist to get their device fitted to their ear. In addition, hearing aids can only be purchased through a hearing care professional’s office or in specialized stores. While this approach may still be necessary for some, having the option to purchase over-the-counter hearing aids will lower barriers to access and encourage greater availability of more affordable options through increased competition in the hearing aid market.
Yet for many older adults with more severe hearing loss, most of whom tend to be in their 70s and 80s, an over-the-counter solution isn’t enough. For them, the Build Back Better Act is critical to meeting their needs: It would expand traditional Medicare coverage to include a new hearing benefit under Medicare Part B (outpatient coverage), starting in 2023.
If the Build Back Better Act becomes law, traditional Medicare would cover hearing exams, management, and treatment by audiologists. In addition, the new benefit would include coverage of hearing aids for people diagnosed with moderately severe, severe or profound hearing loss. Medicare would help pay for one hearing aid for each ear, every five years. Only hearing aids prescribed by a physician or qualified hearing care professional would be covered, and consumers would be responsible for Part B cost-sharing. As with other Medicare-covered benefits, Medicare Advantage plans would be required to cover the same hearing benefits.
Call it a one-two punch, two halves making a whole, or filling the gap. While the impending availability of over-the-counter hearing aids is a significant step forward, it does not address some crucial needs. Passing the Build Back Better Act will ensure those with severe hearing loss get the care they need. The ability to hear well is critical to each person and their family's well-being, regardless of the extent of their hearing loss. Older adults deserve nothing less.