I Have a Disability. How About You?

Katherine Bouton #HLAA., Americans with Disabilities Act (ADA), hearing loss, Hearing Loss as a Disability, Smart Hearing, stigma of hearing loss

December 3rd (that’s today) is National Disability Day, a United Nations recognized event also known worldwide as the International Day of People with Disability.

National Disability Day promotes education about the needs of people with disabilities as well as compassion and understanding of the challenges they face.

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Some disabilities are visible at a glance. People dependent on wheelchairs for mobility may have different degrees of severity of physical impairment but if they need a wheelchair, for whatever reason, they are eligible for accommodations under the Americans with Disabilities Act.

Hearing loss, on the other hand, is not only invisible but not everyone with hearing loss is disabled. Mild hearing loss is not usually a disability. Severe to profound hearing loss is, and these people are entitled to accommodations under the ADA. But many who have severe and even disabling hearing loss refuse to acknowledge it, fearful of stigma and discrimination. In order to get accommodations under the ADA, you must acknowledge disability. Many are unwilling to take that step. That complicates advocacy for all of us with hearing loss.

Deputy Inspector Daniel Carione of the New York City Police Department put this eloquently in a talk he gave at a meeting of HLAA’s New York City Chapter last spring. Carione was a 22-year much-decorated veteran of the NYPD when he was forced to take early retirement in 2011. The reason? He wore hearing aids. He decided to fight the ruling. Before he had any legal ground to stand on, he told the audience, he had to make an important admission to himself.

“The Americans with Disabilities Act is not this heroic shield that falls from the sky and protects each and every person who may or may not be disabled,” he said. “You have to be disabled. That was very difficult for me to accept.”

Dan Carione does not look disabled. He was—and is—a powerful physical and intellectual presence. To use the word disabled about himself defied the visible reality. But his attorney knew that admitting disability was essential. “One of the first things she taught me was to use the word disabled. It’s counter-intuitive. It hit me in the head like a dart because I didn’t want to use the word disabled. But if you’re not disabled, the ADA can’t protect you.”

As a hidden disability, and one with stigma attached, hearing loss is often not acknowledged. This harms not only those who refuse to acknowledge it but it also makes getting accommodations for the rest of us even harder. If a movie theater thinks you’re the only person in the audience who needs captions, that makes it easy to say it’s an expense they can’t afford. I go to a movie theater in the small town where I live part time. The audience is preponderantly gray. Statistics tell us that many have hearing loss that is severe if not disabling. Half of those in the United States 75 and over have disabling hearing loss, according to the NIDCD. But you’d never know it because you can’t see it and they aren’t talking about it.

So on this National Disability Day, if you have hearing loss and can’t hear a speaker at a lecture or at your place of worship, can’t hear at a movie, can’t hear that airline announcement, speak up. Ask for a hearing assistive device. Ask for captions. Ask for accommodations. Speak up for yourself, and you will be speaking up for all of us.

 

For more about hearing health, my book “Smart Hearing.” will tell you everything I know about hearing loss, hearing aids, and hearing health.Smart Hearing Cover final

You can get it online at Amazon or Barnes & Noble, in paperback or ebook for Kindle or Nook. You can also ask your library or favorite independent bookstore to order it.

 

 

 

 

 

“Affordable” Hearing Aids

Katherine Bouton #hearingaids, #HLAA., affordable hearing aids., Healthy Hearing

There’s a lot of talk about “affordable” hearing aids, much of it in anticipation of the Food and Drug Administration’s final approval of an over-the- counter hearing aid. We don’t know the specifics of the future OTC hearing aid but some have speculated that the cost will probably be around $1000.

Comparatively speaking, that is affordable. The cost of high-end hearing aids is approaching $4000 (for one). $3000 is not unusual. Costco’s least expensive hearing aid is $999.  There are less expensive devices, many available online, some of which use the term “hearing aid”, but buyer beware. For some people, they may work well out of the box. Others may end up with hearing aids that aren’t really right for them. As for hearing-aid like devices, PSAP’s or hearables, for some they will be adequate but for others not so good. And if they are too cheap, a 2016 Consumer Reports survey found, they can actually damage your hearing.

But these low-cost alternatives are still a major expense for many Americans, especially older Americans.  Earlier this year a Federal Reserve Board survey found that 40 percent of Americans could not cover a $400 emergency expense without selling something or borrowing.  A $1000 affordable hearing aid is not “affordable” for 40 percent of our population.

Medicare does not cover hearing aids. Some Medicare supplement programs do, as do some other insurance policies. But that 40 percent who can’t find a quick $400 for an emergency probably do not have this level of insurance. The V.A. also provides hearing aids to veterans with service-related hearing loss.

For many, Medicaid is the only solution. Medicaid covers hearing aids for adults in 28 states, including New York State where I live. For a complete list of states and of eligibility requirements for hearing aids, based on the severity of the loss, see this recent article in Health Affairs. Coverage varies widely from state to state, as does coverage for associated services like hearing-aid batteries.

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In this map, the dark red states have the best Medicaid hearing aid coverage. The pink states have no hearing aid coverage. The other states fall in between.

As the Health Affairs article concludes: older Americans “in states lacking comprehensive hearing health care coverage have few ways to access hearing aids or the professional services associated with hearing loss and hearing aid use.” As we know, untreated hearing loss is significantly related to other adverse health outcomes, especially in the elderly.

The Health Affairs study also found that over one-fourth of adults skipped necessary medical care in 2017 because they were unable to afford the cost.

So when we talk about “affordable” hearing aids, let’s remember that that is a relative term.

 

For more about hearing health, read my new book, which will tell you everything I know about hearing loss, hearing aids, and hearing health!Smart Hearing Cover final

You can get it online at Amazon or Barnes & Noble, in paperback or ebook for Kindle or Nook. You can also ask your library or favorite independent bookstore to order it.

 

 

 

 

 

 

 

Will Your Health Insurance Cover Hearing Aids?

Katherine Bouton #HLAA., FDA and hearing aids, Health insurance for hearing aids, Hearing Aid Cost

The second installment of Hearing Tracker’s survey of 2000 hearing aid users has just been published, and it includes some interesting facts and figures.

Paying for Hearing Aids with Medical Insurance, the new Hearing Tracker report,  is based on a survey of 2000 hearing aid users conducted earlier this year by Hearing Tracker and its founder, Abram Bailey.

The news is that 25 percent of hearing aid buyers received some insurance reimbursement. The coverage ranged from $1226 (partial coverage) to $2131 (full coverage). Bailey warned readers that these figures are based on recollection and that people should go to their provider to get an exact figure.

There are two ways of looking at the fact that 25% of hearing-aid users received help in paying for hearing aids. The good news is that this figure is up from 13% in 2008. The glass is half full: the number of people with insurance has doubled in the past decade. Or it’s half empty: three quarters of hearing aid users are paying out of pocket, including Medicare recipients.

Here’s a breakdown of reimbursement by insurance provider. Before you decide to change insurance companies, take heed of Hearing Tracker’s caveat: Please remember that the dollar figures below represent recollections and guesses of hearing aid consumers, and may not accurately depict differences among companies. Screen Shot 2018-10-29 at 8.17.14 PM

The comments accompanying the article show that coverage is hugely variable, with many readers writing in to tell their own experiences. There seems to be no definitive answer to what insurance covers what, even in the same state with the same insurance company. This is not unusual in the health-insurance field, as followers of Jeanne Pinder’s ClearHealthCosts.com know.

Three states mandate hearing-aid coverage for adults. Arkansas requires coverage of $1400 per aid every three years. New Hampshire $1500 per aid every 60 months (every five years). Rhode Island $800 per aid every three years. As Bailey wrote: “If you live in one of these states, consider yourself lucky.”

This survey got its start last spring,  when I asked Bailey whether the discussion of over-the-counter hearing aids and non FDA-approved “hearables” had had an effect on the market. I was also curious about insurance coverage, partly because a friend of mine had just gotten two high-end hearing aids, fully covered by his insurance. As far as I can recall, I have never received reimbursement for a hearing aid, so I was surprised.

Bailey responded with the idea of a survey,  which he created. It was sent to those who subscribe to his website, those who follow my website, and to HLAA members. The  respondents represented an experienced and committed group of hearing aid users, and their responses may not be representative of hearing aid users as a whole.

The first report on the survey was published in June 2018 and focussed on the cost of hearing aids. You can read that report here.

I said above that there is no definitive answer to what insurance covers, even in the same state with the same insurance company. Actually, there is one question with a definitive answer: Does Medicare cover hearing aids? The answer is a categorical No.

 

For more about hearing health, read my new book, which will tell you everything I know about hearing loss, hearing aids, and hearing health!Smart Hearing Cover final

You can get it online at Amazon or Barnes & Noble, in paperback or ebook for Kindle or Nook. You can also ask your library or favorite independent bookstore to order it. 

 

 

My New Book

Katherine Bouton #HLAA., Cochlear Implants, dizziness, FDA and hearing aids, Global Hearing Loss, Healthy Hearing, Hearing Aids, hearing loss, Smart Hearing

SMART HEARING: Strategies, Skills and Resources for Living Better with Hearing Loss. Smart Hearing_Cover_highres

You can get it online at Amazon or Barnes & Noble, in paperback or ebook for Kindle or Nook.

If you’re one of the the millions of Americans who have experienced hearing loss, whether newcomer or longtime veteran, this book is for you. It’s also for your friends and family, employers, counselors, clergy. Hearing loss is much misunderstood.

If you follow my blog, you’ve read some of this, but there’s much much more. Smart Hearing is an easy-to-read, comprehensive look at a big, confusing field. I hope you’ll read it, and share it with others who don’t seem to fully get what it is like to have hearing loss.

The opening chapters are about the basics: how to find an audiologist, how to buy a hearing aid, and how pay for it. Later chapters guide you through the world of assistive listening technology, CART captioning, hearing loops, and telecoils. Find out what a cochlear implant is, and who can benefit from one. Chapters on tinnitus and vertigo offer suggestions for prevention and treatment. (In the case of vertigo, some of the suggestions are from personal experience.)

The past year has been a tumultuous time in the hearing-health field. Smart Hearing untangles the confusion about over-the-counter hearing aids, PSAPs, the FDA and what it approves and what it doesn’t.

Everyday experiences are often frustrating for those with hearing loss: dinner parties, travel, work, restaurants. There’s a chapter on managing each of these challenges.

Finally, Smart Hearing urges reader to take note of the sometimes significant health costs of not treating hearing loss.

I hope you’ll read it and share it, and maybe even get your library to order it.

FDA Approves an OTC Hearing Aid

Katherine Bouton Bose, Healthy Hearing, OTC Hearing Aids

For the past year or so since the Over-the-Counter Hearing Aid Act of 2017 was passed, I and other hearing-loss advocates have patiently explained time and again that right now there are no OTC hearing aids. That’s because the FDA approval process includes a three-year comment period before it publishes its final regulations. And until that time, only hearing “devices” can be sold over the counter.

Or at least that was what we thought. Last Friday (October 5), the FDA took almost everyone by surprise when it announced that it had approved a Bose hearing aid that consumers will fit and program themselves.

The Bose Hearing Aid, the FDA announcement said, is intended for adults over 18 with perceived mild to moderate hearing loss. “This is the first hearing aid authorized for marketing by the FDA that enables users to fit, program and control the hearing aid on their own, without assistance from a health care provider,” the announcement said. The wireless device processes sound through an earphone in the ear canal, and the user programs the aid on a smart phone.

The FDA does require compliance with sales regulations, “including state laws that might require hearing aids to be purchased from or dispensed by a licensed hearing aid dispenser.”  I’m not sure how many states have that regulation. Would welcome enlightenment.

The Bose Hearing Aid is not yet available, nor has the price been set, but Bose has landed a huge coup. As Abram Bailey at Hearing Tracker noted, “Bose has effectively been granted a very unique position by the FDA.”

The Bose Hearing Aid will be a new product, according to Sandy Weiss at Bose, rather than an adaptation of Bose’s Hearphone, which is a PSAP. As for when they will be available, Ms Weiss said in an email, there is as yet no new product announcement or distribution plan. She added that while details about future pricing are confidential, Bose does “expect to offer more affordable solutions than traditional hearing aid solutions currently on the market.”

So what made the FDA decide to approve this particular hearing aid? After reviewing data from clinical studies of 125 patients the FDA found the results persuasive enough that it approved the Bose Hearing Aid under its De Novo premarket review pathway. The De Novo pathway allows expedited approval of “low- to moderate-risk devices that are novel and for which there is no prior legally marketed device”. (Click here to see a list of other devices approved under the De Novo pathway so far in 2018.) Not only were the results of self-fitting comparable with those of a hearing professional, the FDA noted, but participants in the trial generally preferred their own settings over those selected by a hearing aid professional.

The announcement was made after the close of the European stock markets on Friday but by 10 AM Eastern time on Monday, the shares of the Danish companies GN Store Nord and William Demant Holding had each fallen by 13 percent, with Switzerland’s Sonova dropping 10 percent The American markets saw a similar drop. Obviously Bose, a privately held company, is seen as a threat to conventional hearing aid sales.