We all want hearing aids to be more affordable. That’s the impetus behind the Over-the-Counter Hearing Aid Act of 2017. Although signed into law by President Trump, it is still not active, though it’s been on the FDA’s schedule a few times. In July, President Biden signed an executive order on Promoting Competition in the American Economy, which included a call for the FDA to issue regulations for OTC hearing aids in the next 120 days.
The need for affordable hearing aids is also behind the movement for Medicare to cover hearing aids, which would likely have a trickle-down effect on private insurers. President Biden called for Medicare coverage for hearing services in his budget request for fiscal 2022, and it is part of the $3.5 trillion social-policy package that Senate Democrats just approved, along party lines. (This is nowhere near the last step, don’t expect any changes in Medicare soon.)
Affordable hearing aids are also behind the consumer-electronics push to issue devices. Two good devices are already available: The Bose Sound Control Hearing Aids, which go for $849.95 a pair. They are considered hearing aids by the FDA, but not OTC hearing aids even though you can buy them without an audiologist. They are the only hearing aid in their category. They’re so popular that Bose limits purchase to two pairs per customer.
The Apple Airpods Pro ($249 a pair on the Apple website) also have many of the features found in hearing aids. Apple does not advertise them as hearing devices, but experts like Abram Bailey at HearingTracker.com have praised their features and called them hearing aids in all but name.
Affordability is also behind Costco’s popularity as a hearing-aid retailer. Costco sells its own Kirkland brand as well as discounted aids from the major manufacturers. Costco has hearing professionals on staff. Consumers might want to buy at Costco and have their hearing aid services, like programming and cleaning, provided by their audiologist.
Changes in all these areas could result in widespread availability of less expensive hearing aids, but there’s another problem, which is less often discussed. Audiologists aren’t reimbursed for services that may be needed with these devices.
Writing on StatNews.com, a highly regarded medical website, three prominent specialists in the hearing field, addressed the issue. Frank Lin, Charlotte Yeh, and Cristine Cassel* urged Congress to distinguish between Medicare coverage for hearing aids and Medicare coverage for the hearing-care services of an audiologist.
Audiologists aren’t needed to purchase OTC hearing aids or any of the consumer-electronics devices. But audiological care can be crucial in ensuring that you’re buying something appropriate for your hearing loss, or that you don’t have an underlying condition that is causing the loss. They can also fit those OTC hearing aids, offer advice on how best to benefit from them, and repair them if necessary – for a fee, of course. The authors call these “essential support services” in maximizing the benefit of these devices.
Those who have more severe hearing loss will still need traditional audiologist-fitted hearing aids. FDA-approved hearing aids should be covered by Medicare. The authors are not arguing that OTC hearing aids be covered, just that audiological services should be. Distinguishing these audiological services from the cost of the hearing aid helps ensure that older adults with hearing loss can safely and optimally benefit from these new technologies.
So perhaps in addition to OTC hearing aids and other FDA alternatives, we need to change the way audiologists are reimbursed. This would be good for people with less severe loss, or not enough money to buy FDA approved hearing aids. But it would be good for audiologists as well. It’s clear that the hearing aid sales model is changing. Separating coverage of hearing aids from coverage of audiological services would seem to benefit everyone.
* The authors of the STAT article: 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.
For more about living with hearing loss, read my books “Smart Hearing: Strategies, Skills and Resources for Living Better With Hearing Loss” and “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You.” Both are available as ebook and paperback on Amazon.com.