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Insurance Expansions to Cover Hearing Aids

Mahmoudi, Elham, PhD

doi: 10.1097/01.HJ.0000544479.65268.58
Editorial

Dr. Mahmoudi is a health economist and an assistant professor in the department of family medicine at the University of Michigan. Her research interests include evaluating health care policies, reducing disparities in health care access, and optimizing care management for older adults and patients with disabilities and multiple chronic conditions.

Hearing loss is the third most common chronic condition among adults 60 or older, and is associated with a host of preventable adverse events. Untreated hearing loss has been linked to more frequent falls, cognitive or functional declines, worse physician-patient communication, social isolation, and more frequent hospitalization (JAMA. 2013 Jun 12;309(22):2322). However, in our visually oriented-society, treatment of hearing loss does not seem to be a priority. For example, despite the high prevalence of hearing loss, particularly among older adults, physicians do not routinely examine their older patients’ hearing or refer them to audiologists. Furthermore, Medicare, which is the primary source of insurance coverage for older adults, does not cover routine hearing tests or the cost of hearing aids. Finally, perhaps owing to the underestimated risks associated with hearing loss, people with hearing difficulty usually delay treatment or forgo it entirely.

Our recent study examining the connections between hearing aid use and health care use and costs indicates that hearing aid use among people with severe hearing loss is linked to lower chances of emergency visits and hospitalization, fewer nights in the hospital when hospitalized, and a higher probability of physician office visits compared with those with severe hearing loss who do not use hearing aids (JAMA Otolaryngol Head Neck Surg. 2018 Jun 1;144(6):498). On the other hand, the total annual health care cost was higher among people with severe hearing loss who used hearing aids compared with that of their counterparts who did not use hearing aids. Hearing aids are expensive. Considering the lower probability of using expensive health services (i.e., emergency rooms and hospitals) among people who used hearing aids, perhaps the use of hearing aids could be cost-effective over a longer period (i.e., two to five years).

For patients seeking treatment for hearing loss, financial barriers are considerable. Hearing aids are expensive, costing on average between $2,000 and $7,000. Lack of insurance coverage means no (or minimal) cost sharing for patients. The Over-the-Counter Hearing Aid Act, signed into law in 2017, made hearing aids more readily available to people with hearing difficulties by eliminating the need for a prescription. However, the passage of the act did not ameliorate the financial difficulties associated with hearing aids. The lack of a strong insurance market presence for hearing aids has negatively affected people with hearing loss. Additionally, the process of receiving treatment for hearing loss is long and complex, and involves many points of contact, including multiple visits to family physicians, audiologists, and hearing aid specialists. The low prevalence of hearing aid use may be due to these issues. In particular, hearing aid use is substantially lower among people with lower educational attainment and income and among minority subpopulations.

Research shows that hearing aid use can improve quality of life by enhancing communication, family relationships, emotional and cognitive stability, and overall physical health (Med Educ. 2013;47(5):443). Although more research is needed to examine the cost-effectiveness of hearing aids, considering the positive outcomes associated with their use, insurance companies, including the Centers for Medicare and Medicaid Services, should contemplate expanding their coverage of hearing aids.

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