Opinion: Making hearing aids affordable isn’t enough. Older adults also need hearing care services

When Anne Madison noticed her hearing was declining at age 66, she struggled. She had always prided herself on being a savvy health care consumer, but when it came to hearing loss, what were her options? Ads for hearing aids seemed predatory, visits to an audiologist for objective professional advice about how to address hearing loss weren’t covered by Medicare, and since Medicare also didn’t cover hearing aids, the price tag was far out of her reach.

This story, which Anne told one of us (F.L.), is a common one. Hearing loss affects over 40 million Americans, including two-thirds of all adults over 70, and is understood to be the leading risk factor contributing to the development of dementia. Because a pair of hearing aids costs a prohibitive $4,700 on average, less than 20% of people who would benefit from hearing aids actually have them. Millions of Americans could potentially improve their health and lead better lives if hearing aids and related hearing care services were more affordable and easily accessible.

There’s good news: In 2017, Congress passed a bipartisan bill instructing the Food and Drug Administration to make certain hearing aids available over the counter, and the White House recently issued an executive order instructing the FDA to release the long-delayed regulations for these new aids within the next 120 days. Once finalized, these regulations will encourage consumer technology companies already producing innovative hearing technologies such as Bose and Apple to enter the hearing aid market, increasing competition in a stagnant marketplace currently dominated by just five manufacturers and making these life-changing devices drastically more accessible.

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But there’s also bad news: While consumers may soon be able to directly purchase more affordable hearing aids, many still won’t have access to the audiological support services needed to ensure they can fully benefit from these devices. Such support services are often essential to help individuals overcome a poor understanding of their hearing loss (a common refrain from such individuals is “My hearing is fine! My wife just mumbles at me all the time.”) or without the technological savvy to learn how to use a hearing aid on their own.

At present, Medicare provides coverage for hearing tests but not for such hearing treatment or hearing aid-related services, leading to the sad paradox that an older person could see an audiologist to be diagnosed with hearing loss but not receive the hearing aids or essential treatment services needed to address it.

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Current efforts in Congress spurred by President Biden’s budget request for the 2022 fiscal year calling for Medicare coverage for hearing services — along with coverage for vision and dental services — would address this anachronism. That would be important not only for seniors with traditional Medicare but also for anyone with private health insurance or Medicare Advantage plans, which often follow the cues of Medicare policy.

Hearing care services and hearing aids are distinct and important components in the treatment of hearing loss. The right type of policy would allow Medicare to cover hearing care to meet the needs of America’s older population, be fiscally sustainable, and leverage the paradigm shift in the hearing aid marketplace that will come about with over-the-counter hearing aids.

The framework for hearing care coverage previously passed by the House in 2019 as part of the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3) and some other proposals that are being actively considered by Congress for the fiscal year 2022 budget would do this.

Under H.R. 3 as passed by the last Congress, hearing treatment services provided by audiologists to help older adults effectively use their hearing aids would be routinely covered by Medicare. Individuals with mild to moderate hearing loss could buy an OTC hearing aid on their own — possible soon in a revamped hearing aid marketplace where these devices are widely expected to cost on par with now-ubiquitous wireless earbuds for under $200 — but could then still receive essential support services from an audiologist to learn how to best use them. Individuals with greater levels of hearing loss who would not be helped by over-the-counter devices would be eligible for more customizable “prescription” hearing aids covered by Medicare.

Distinguishing between Medicare coverage for hearing aids versus Medicare coverage for the hearing care services of an audiologist, as in the framework of last Congress’ H.R. 3, is essential to ensuring that Medicare can best leverage the competitive over-the-counter hearing aid marketplace while also ensuring that older adults have access to audiologists to provide the support services needed to get the most from these technologies.

The bipartisan congressional effort in 2017 and recent White House executive action will soon set in motion a sea change that will open access to affordable hearing aids for millions of Americans. Congress now has the opportunity to act on the president’s budget request to ensure that older adults with hearing loss can fully benefit from these technologies through Medicare coverage of the care services they also need.

Frank Lin is an otolaryngologist and professor and director of the Cochlear Center for Hearing and Public Health at the Johns Hopkins Bloomberg School of Public Health. He was a member of the National Academy of Medicine consensus study on hearing care that recommended the FDA create rules for OTC hearing aids. Charlotte Yeh is an emergency medicine physician and chief medical officer of AARP Services, Inc. Christine Cassel is a geriatrician and adjunct professor of medicine at the University of California, San Francisco. She was a member of President Obama’s Council of Advisors on Science and Technology which recommended that the FDA create rules for OTC hearing aids. The views expressed here are the authors and do not necessarily reflect the opinions of their organizations.

Source: STAT