Almost two-thirds of Americans over age 70 have meaningful hearing loss, experts say, and I probably will be among them. I should do something about it.
One reason I haven’t is the average price for hearing aids: roughly $2,500, often more — and most of us need two. That helps explain why only 20 percent of those with hearing loss use hearing aids.
Medicare declines to cover a number of products and services that older beneficiaries need. Dental care ranks high on my personal list of exclusions that make the least sense, but the fact that the 1965 Medicare law specifically prohibits the national insurance program from paying for hearing aids is also a strong contender. So it’s heartening to notice some recent developments that might lead to more rational policies and more affordable and accessible devices.
- An October report* by the President’s Council of Advisors on Science and Technology recommended federal actions to “simultaneously decrease the cost of hearing aids, spur technology innovation and increase consumer choice options.”
The council suggested, for example, that the Food and Drug Administration permit a “basic” hearing aid, for mild to moderate age-related hearing loss, to be sold over the counter — something every state now prohibits.
The report also urged the Federal Trade Commission, whose rulings enabled consumers to comparison shop for eyeglasses and contact lenses, to treat hearing devices more like visual ones. “It should be like a prescription for eyeglasses,” said Dr. Christine Cassel, co-chairwoman of the council’s hearing technologies working group.
The hearing aid itself represents only about a third of what audiologists charge. (Medicare does cover testing with a physician’s referral.)
After an audiologist or physician provides an audiogram assessing your hearing, Dr. Cassel said, you should be able “to take it with you and shop around for the best prices” on devices.
- In June, the Institute of Medicine will issue a report on hearing health that tackles key questions like federal regulation, insurance and price. A number of major players — among them the Centers for Disease Control and Prevention, the National Institute on Aging and the Pentagon — have sponsored the yearlong effort.
- The F.D.A., acting on recommendations by the president’s council, will host a public workshop next month to consider whether its hearing aid regulations “may hinder innovation, reduce competition, and lead to increased cost and reduced use.”
The agency has also reopened public comments on proposed regulation of so-called personal sound amplification products and their marketing.
Reports, comments, workshops — we can be forgiven for rolling our eyes and wondering if anything useful will emerge. Still, these actions represent a greater national focus on hearing loss and rehab than we have seen in decades.
What’s driving this interest, apart from the demographic bulge that means the hearing-impaired population is about to get much larger, is a wave of new research.
Congress barred Medicare coverage of hearing aids 50 years ago because “people thought hearing loss was just a normal part of aging,” said Dr. Cassel, one of the authors of a recent JAMA editorial on hearing health policies. “They didn’t see it as a disability or a medical problem.”
But we’re learning that, however normal, hearing loss can have significant consequences.
Older adults with poor hearing report a greater number of falls than those with normal hearing, a Finnish study found. American researchers have demonstrated a similar association in those aged 40 to 69.
Older adults with hearing loss are also more apt to report periods of poor physical and mental health, and to be hospitalized.
Perhaps most disturbing, studies also show a relationship between hearing loss — mild, moderate or severe — and accelerated rates of cognitive decline. Older people with hearing loss also are more likely than those with normal hearing to develop dementia.
How can aging ears affect so many other aspects of our health? Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins University who has led many of these research efforts, points to several possible causes. With diminished hearing, “your brain is constantly having to work harder to process garbled sounds” — a concept called cognitive load — and may have less capacity for other mental tasks.
Alternatively, hearing loss may lead to changes in brain structure. In one of Dr. Lin’s studies, M.R.I.s showed greater brain atrophy among those with poor hearing. A struggle to hear can also lead to isolation, and “we’ve known for years that social connectedness is important for cognitive health,” Dr. Lin added. Technology put the Internet in our pockets, but hasn’t done much to affordably improve our hearing.
“In every other aspect of our lives, advances in electronic technology have made things cost much, much less,” Dr. Cassel said. “That hasn’t happened with hearing aids.”
Almost annually, she noted, “some congressperson gets energized about this and tries to pass legislation” to remove Medicare’s hearing aid restriction. Last year, it was Representative Debbie Dingell, Democrat of Michigan, with six Democratic co-sponsors. The bill stalled in committee, but “we are not giving up the fight,” Representative Dingell said in an email.
Driving down the cost of the devices could make them more widely available in several ways.
“If it’s $200 instead of $2,000, more people could pay out of pocket,” Dr. Cassell said. “And that also means Medicare might cover it” — unlikely at current prices.
It’s clearly possible to provide good devices for far less than we now pay. The Department of Veterans Affairs, which negotiates with manufacturers for lower prices, provided comprehensive hearing care to more than 900,000 veterans in 2014 and dispensed almost 800,000 hearing aids without copays. The average cost per device: $400.
Price isn’t the only obstacle to wider use. In European countries where insurance does cover hearing aids, they’re still underused. Clearly, our discomfort with age-related disability plays a role.
So do the shortcomings of hearing aids. Though they’re improving, “no technology will ever correct hearing loss like glasses correct vision,” Dr. Lin said.
As hearing declines with age, the cochlea, the part of the inner ear that receives and transmits sound, sustains irreversible damage.
Still, the way we acquire hearing aids, or don’t, has costs beyond the obvious. Daunted by the multiple visits, the adjustments and especially the expense, people often delay for years while their mild or moderate hearing loss worsens.
Over that time, “you’ve lost some of the neural pathways from the ear to the brain,” Dr. Lin said. “With longstanding hearing loss, rehabilitation is much harder. The earlier you address it, the easier it is and the more successful you can be.”