Stigma plus cost.
For most people the primary obstacle to wearing hearing aids seems to be the stigma of age. Even in the U.K., where hearing aids are provided free under National Health, only one in three who could benefit from a hearing aid has one. This is ridiculous on many levels but especially because most hearing aids these days are barely visible, if at all. Wearing a hearing aid doesn's make you look old. Not wearing a hearing aid when you need one does. It may make you look not only old but stupid, absentminded, aloof or bored. It's hard to look smart when you can't hear what's said.
But for many Americans a major obstacle is cost. A good hearing aid costs $2000 to $6000. There’s no question that they’re out of reach for many people.
The real scandal about the cost of hearing aids is the lack of insurance coverage for them. When I got my first pair of hearing aids, in 2002, they cost me $3000 each. My private insurance reimbursed me $500. When a got a second stronger aid for the right ear a few years later, they turned me down flat. No reimbursement.
Medicare does not reimburse for hearing aids unless the hearing loss is caused by a specific injury or disease, such a brain tumor. Medicaid reimbursement for adults varies from state to state. The Hearing Loss Association of America has an informative page on its web site about Medicaid coverage state by state: http://www.hearingloss.org/content/medicaid-regulations.
Federal law requires Medicaid coverage for hearing aids for children under the age of 21. Children who are not covered by Medicaid are often not covered by private insurers for hearing aids. The expense for parents can be enormous. Children outgrow their hearing aids rapidly. Some states maintain hearing aid loaner banks for children. In general, parents are stuck with the cost, which is considerable.
The V.A. provides hearing aids for any veteran with a service connected disability. In addition, most states have an office of vocational rehabilitation. If you need hearing aids to do your job, they will often be paid for. This of course doesn’t help children or retirees, or anyone who does a job that can be done without good hearing.
Is it a ripoff?
As I said, I was shocked by the cost of hearing aids, as are many people. Some react to this by blaming audiologists and other hearing aid dispensers. It’s easy to understand the distrust people feel about hearing aid professionals when you can buy a sophisticated smartphone for $500 or a MacBook Pro for $1300; a digital camera, an iPod that holds hundreds of thousands of songs and movies, a huge flat-screen TV — for a fraction of the price of a single hearing aid.
I was shocked but I never felt cheated. For years I’ve seen my audiologist three or four times a year, an average of one hour per visit. The cost of these follow-up visits is included in the original cost of the hearing aid, just as the costs of maintenance or repair or training with the Bluetooth or FM system are rolled into the original cost of those devices.
Despite that $2000-to-$6000 figure, the cost of hearing aids has actually decreased relatively over time when compared to the rate of inflation, according to an article in Healthy Hearing in April 2010. The article noted the factors that contribute to the high cost: research and development is primary, time spent with the audiologist to fit the hearing aids to the needs of the consumer is also part of the cost. “Averaged over the lifetime of the instruments (three to five years or more), the cost per day of a pair of hearing aids is about three dollars.” Some people would be tempted to point out that that’s cheaper than a latte at Starbucks, but most of us aren’t buying lattes at Starbucks: the daily cost takes a bite out of tight budgets.
Expense to the manufacturer.
A major part of the cost of hearing aids is research and development. They are getting better all the time, but the process is more expensive than it is for many consumer electronics. One expert pointed out to me that the market for hearing aids is about one percent of the market for, say, a new smart phone. I’ve never seen a figure for how many people in America could benefit from hearing aids but it’s not 48 million. Many people with mild to moderate hearing loss can manage well enough without them. Many more people will want new cell phones every three or four years.
When cell phone makers want to design a new phone, they will order five million transistors or chips to run it. A hearing aid manufacturer will order ten thousand, the same expert told me. “There’s just no comparison. It’s a completely different scale.”
But it's the consumers who suffer.
People who can’t afford hearing aids may opt for low cost personal amplification devices. These may work well enough for someone with a mild to moderate hearing loss who wants to hear the TV better. One danger is that if they don’t work, the user may give up on the idea of hearing aids altogether.
A lot of new technology is coming onto the market, which I’ll write about at a later point. Some of it may make hearing aids more affordable, and provide competition for todays' hearing aid manufacturers.
For now though, the fact that conventional hearing aids are not generally covered by insurance is nothing short of scandalous. It’s terrible public health policy. The cost -- in terms of unemployment, treatment for conditions and diseases that may stem from untreated hearing loss, in access to education for children whose parents can’t afford adequate hearing aids -- far outweighs the cost that public and private insurance coverage of hearing aids would incur.