Hearing aid pricing and weak insurance – older adults lose out

You may have seen that rechargeable hearing aid commercial.   What was most striking about the commercial to a hearing industry outsider is the upfront commentary on what sounded like the predatory price of hearing aids – providers “charge whatever they can get.”   Several interesting aspects to that commercial – but the most interesting was that comment.  Who is ‘they’, how much can they ‘get’, and is there insurance that pays for them?  This is in an era where hearing aids have evolved to incorporate embedded AI, fall detection, direct connections for phone calls, and numerous other features and functions.

‘They’ are audiologists.  The field may be, according to some projections, growing, no doubt in parallel to the aging baby boomer population, but it is a very small field that may produce only 3100 new jobs by 2026.  The position needs a 4-year doctor degree which can follow any bachelors undergraduate education. Much of the writing about the cost and types of hearing aids appears to be produced by hearing aid resellers and intermediaries, by audiologists or the manufacturers themselves.  There are few surveys (Pew has nothing!). AARP recently surveyed the health impact (that’s good), but not the cost of correcting hearing loss. Another survey (Hearing Tracker) of 2000 hearing aid users was conducted (led by an audiologist) last year that reported what users typically pay ($2372 per hearing aid.)

Looking at the Hearing Tracker survey demographics. There is a disconnect between the responders in this survey and the general population in their age ranges. The majority of responders in the Hearing Tracker survey were older, mostly 55-74, though a quarter were 75+.  The majority of responders were women, though in the general population hearing loss affects twice as many men as women – one study in 2011 attempted to figure out why men are less regular users – concluding that poor handling of the devices was a factor.  Half of the Hearing Tracker responders were retired, and more than half of the responders had incomes north of $50K per year.  Contrast that with general population income age 65+ in which half of this older adult population has received less than $40,000 per year from all sources, with women receiving an income of $18K from all sources.

Insurance coverage – a nightmare patchwork of options.   So let’s see – uncorrected hearing loss is correlated with poorer health outcomes, one of which could be fall risk, another dementia.  ‘Coverage’ of hearing aids amounts to a patchwork of discounts and various forms of organizational assistance plus pay-over-time options.  The audiologist price for assessing and configuring hearing aids is bundled as part of the hearing aid price. A commenter in a NY Times article about hearing aid cost noted that the opthomalogist charge is separate from the eyeglasses sold in their office. Why isn’t that true of hearing aids? Which of course has led to the effort to sell hearing aids directly to consumer (remember that commercial?) despite lobbying efforts funded by hearing aid manufacturer Starkey.

The government steps tentatively in. FDA regulations are to be delivered by August, 2020, though Bose was permitted to offer a product that will likely be the first officially FDA-approved on the market, though this audiologist’s article makes that prospect seem worrisome.  But the FDA-plus-CMS is doing nothing about insurance coverage of hearing aids, leaving it to Medicare Advantage plans that began in 2018 to provide coverage of some types of hearing aids and in some states. What is really worrisome is that hearing aids, which correct a condition that can cause substantial health issues, including fall risks and dementia, which are costs to Medicare, are considered an ‘elective’ device.   Seriously? A wheelchair or scooter can be covered by Medicare with a doctor’s note. Ditto prosthetics.  Are these uses elective? And 25% of the nation’s 65+ population are affected by Type 2 diabetes, noted as at least partly resulting from lifestyle choices, yet diabetes supplies and insulin are covered by Medicare. Finally, only 30% of Medicare beneficiaries are on Medicare Advantage plans today -- perhaps the growth in their use will coincide with the decline of price for the highest functionality hearing aids.