• Wiser Medicare

Access to Affordable Hearing Aids: This Summer or Later?

Hearing aids can undoubtedly improve many seniors’ quality of life. But at a price of thousands of dollars, they can be too costly for many. The question today is whether some of the legislative efforts in Congress can force the long-overdue changes to all the industry restrictions and bring prices down to where people can afford them.

The statistics on the need for hearing aids

According to the U.S. Food and Drug Administration (FDA), nearly 38 million Americans over 18 have trouble hearing. That’s 15% of the adult population. And only about one in five of those people have and use a hearing aid.


The statistics get worse with age: one in four people between 65 and 74 could benefit from hearing aids, which increases to one in two for people over 75. Whether the hearing loss is slight-to-moderate or permanent-and-total, it can profoundly impact someone’s daily communications, relationships, emotional well-being and overall quality of life.


So why do so few people have hearing aids? Primarily because of their cost.

What is the cost of hearing aids?

The reason for the high cost is that hearing aids are considered medical devices controlled by the FDA – which so far has protected the category from competitive forces which would bring prices down.

The cost of hearing aids depends on the hearing loss being corrected, the quality of materials used in the device and the technology used. On the lower end, a hearing aid can cost $1,000-4,000. (The reported average is around $2,300 per ear.) Premium hearing aids can cost above $6,000 per ear.


So the next question is, “How can someone with hearing loss get hearing aids paid for by insurance?” Since we’re looking primarily at older Americans, let’s look at the different forms of Medicare.


Does Original Medicare (Part A and Part B) cover hearing aids?

Original Medicare does not cover hearing aids or routine exams for filling hearing aids. You will have to pay 100% for both.


However, Medicare Part B (Medical Insurance) will cover diagnostic exams for hearing and balance if your health care provider prescribes the test to see if you need medical treatment (and doesn’t mention hearing aids). Medicare will also cover surgically implanted devices like cochlear implants that don’t work like standard hearing aids.


Once you have met that year’s Part B deductible, you will pay the 20% of the Medicare-approved amount left after Medicare pays 80%. You will also pay a hospital copayment if the testing is in a hospital outpatient setting.


Suppose you have reinforced your Original Medicare coverage with a Medicare Supplement Insurance (Medigap) plan. In that case, your supplement will pick up the remaining 20% balance of Medicare-approved expenses, but it will not cover hearing aids or the exams for filling hearing aids.


Does Medicare Advantage cover hearing aids?

Most Medicare Advantage (Part C) plans offer extra benefits that Original Medicare does not. “Hearing” is one of them (along with vision, dental, prescription drugs and wellness).


Up to 97% of Medicare Advantage plans offered hearing plans of some kind in 2021, but not all of them covered hearing aids. The coverage is very individual to these private Medicare Advantage plans.


There’s often a maximum annual dollar cap or a frequency limit on how often the plan covers the service. Some plans designate what brands are available. Does the plan offer analog or digital? Inside or outside the ear? And are earmolds, fitting exams and batteries included. If not, the out-of-pocket cost of getting hearing aids can be considerable.


Takeaway action step: You will want to contact the plan before signing up for it or renewing (during the next enrollment period) to define precisely what is covered.


The legislative journey

Seniors have complained for decades about the high cost of hearing aids. So Congress passed a law – which President Trump signed in August 2017 -- allowing over-the-counter (OTC) sales of hearing aids in hopes of increasing competition and lowering costs. These hearing aids could be sold in stores without a prescription or a medical exam by an audiologist or hearing specialist.


Four years later, federal regulators still hadn’t issued the rules to implement the law. While the FDA did publish proposed regulations for public comments, no products could be legally marketed over the counter. Instead, hearing aids continued to be restricted devices that had to follow federal and state requirements.


In July 2021, President Biden had issued an executive order, part of which addressed the rules on the classification of OTC hearing aids. The U.S. Department of Health and Human Services (HHS) was given 120 days to issue its proposed rules. Unfortunately, that deadline was not met either, but the expectation is that it could take effect sometime in the summer of 2022.


Meanwhile, in April 2022, the “Delivering Over-the-Counter Hearing Aids Now Act” was introduced in Congress. The bill – in the first stage of the legislative process – instructs the HHS to issue regulations regarding the OTC hearing aids. The bill must be considered by committee before possibly being sent to the House or Senate.


The hearing aid market today

The FDA’s delay in issuing regulations has created a void being filled by direct-to-consumer marketing. Some products are hearing aids and others are “personal sound amplification products” (or PSAPs which amplify sound without addressing issues such as distortion).


Some leading technology brands and smaller manufacturers are joining major retailers in selling to consumers at prices well below those charged through audiologists and hearing specialists. Others are selling through TV and online advertising. Quality and advertiser claims are not benefiting from FDA regulations, but people with mild to moderate hearing loss are finding more affordable solutions.


Some options for free or discounted hearing aids

If you are interested in accessing hearing aids through the regulated channels (but cannot pay the average $2,300 bill per ear) – and if your Medicare Advantage plan has too many restrictions to make that benefit valuable – several other avenues exist.

  • The Veteran’s Administration provides free hearing aid products and services to people enrolled in its VA Health Care program.

  • In some states, Medicaid may be available for special, one-time needs such as hearing aids if you are elderly or have health issues, even if you don’t qualify for their full coverage.

  • The Office of Vocational Rehabilitation in some states may help working people get free hearing aids if needed for them to work.

  • Some private foundations help eligible people with free devices.

  • Some manufacturers offer support programs.


It may take some research and dedication, but it could be worth your while if you want regulated products. Either that – or wait for the FDA’s regulations to be issued.

 




63 views0 comments