Hearing Aid Coverage Could Be ‘Transformational’

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Nicolas Reed. Credit: Johns Hopkins University

According to researchers at Johns Hopkins University, about half of Americans over 60 and two-thirds over 70 have some degree of hearing loss. Many seniors cannot afford the prohibitive price of hearing aids, which can cost thousands of dollars, or are hesitant to even admit they have a hearing problem.

Medicare has never covered the cost of hearing aids, an omission that has long been a barrier for older people who would benefit from accessing these life-changing devices. But that may soon change. The $ 1.75 trillion social spending bill currently under consideration by Congress provides Medicare hearing benefit for the first time in the history of the 56-year-old health insurance program for those 65 and over . This proposed expansion follows the recent publication by the Food and Drug Administration of new regulations allowing the sale of over-the-counter hearing aids. Together, these two major policy changes would be the biggest breakthroughs in hearing care in decades.

To understand the implications for older Americans with hearing loss, The Hub spoke with Nicholas Reed, Clinical Audiologist and Assistant Professor in the Department of Epidemiology and Senior Professor at the Cochlear Center for Hearing and Public Health at Johns Hopkins. Bloomberg School of Public Health.

How important is this change? Regarding hearing, has traditional health insurance covered anything?

Nothing on the hearing aid side has been covered since the inception of Medicare in 1965. In fact, anything related to hearing aids is a legal exclusion under current Medicare. Hearing wasn’t really seen as part of healthcare, it was an afterthought. Also, at the time, it made sense not to include hearing aids because the technology was nascent and not very advanced. The old technology was not really suitable for all types of hearing loss. Today, however, modern hearing technology can treat a wide range of hearing loss in individuals. Traditional health insurance covers a hearing test if it is ordered by a doctor as part of a medical evaluation, but it does not cover hearing aids. If this legislation passes, Medicare will finally catch up with technology and thinking about the health impacts of hearing loss, both on the individual and from a public health perspective. It really is a big deal. Age-related hearing loss is a major problem for millions of Americans, and Medicare’s access to hearing aids and hearing care services would make a huge difference to them.

What was the impetus for making this change?

I think the inclusion of hearing loss in these public health policies represents a sea change in how we view all aspects of the individual, an important perspective that was not part of the previous thinking. Communication and engagement with others is a fundamental aspect of life, but for a long time society viewed hearing loss as a mild effect of aging, something popular culture often scoffs at. But it has real health consequences – falls, depression, loneliness, dementia – that we have only come to understand better in recent years thanks to public health research. I consider this change to be in line with the public health principles of American healthcare: we are moving away from models of acute care that only target specific conditions to think about maximizing the life of the individual so that they can blossom. We now understand that the ability to hear is a key component of overall health and well-being.

How many more older Americans who need hearing aids but couldn’t afford them would be covered by this proposed Medicare extension?

Details are still being worked out in the bill, but as it stands, the extended hearing benefit would only target people with [a category of hearing loss considered to be] moderate to severe or more hearing loss, which could include up to 5 million Americans. It could be life changing for this group of Americans, as many have had to pay out of pocket for it or go without hearing aids altogether.

Starting next year or perhaps sooner, Americans will have access to over-the-counter hearing aids that are likely to be less expensive than traditional hearing aids. However, these won’t be for everyone, just those with mild to moderate hearing loss. What impact will this and the change in health insurance policy have on people with age-related hearing loss?

Keep in mind that there are already amplification devices available without a prescription, but many of them are bulky, difficult to wear for a very long time, and essentially rubbish. The FDA’s new OTC regulations allow consumer tech companies like Bose and Apple to enter a whole new market, and we hope this will lower costs, increase access, and spur healthcare innovation. hearing. Importantly, the Medicare change is a complementary action that would cover those who will not benefit from over-the-counter devices. Overall, this is a huge change from our status quo and would make the United States the first country in the world to have a strong private market with accessible over-the-counter hearing aids as well as coverage for public insurance for Medicare beneficiaries with a greater degree of hearing loss.

What is the current price of hearing aids for those who need them? Do most older people give up because they cannot afford it?

The price range varies. The number you see often because the average cost is $ 4,700 for both ears. This cost also includes the accompanying professional services — adjusting them to get the most out of the device for an individual’s specific hearing needs, and for comfort and portability. This can make hearing aids, after a house and a car, the third largest purchase of equipment in a senior’s life. In addition, they should be replaced every five years or so. Cost is not the only obstacle. They are also inaccessible. You have to go through an authorized person to get them, which can mean multiple visits. That’s why over-the-counter regulations are revolutionary.

What social benefits are likely to result from improved access to hearing benefits that result in better hearing?

Hearing loss is associated with social isolation and depression. Hearing is about your connection to others. People may be surrounded by other people, such as friends, family, but the conversation is difficult to follow and even tiring, so they become isolated even in the presence of others. Additionally, hearing impaired people may be reluctant to engage in activities requiring good hearing (concerts, theaters, movies, restaurants, physical activities). They can therefore begin to withdraw from the social aspects of life, causing or exacerbating depression. Beyond social engagement, some people can still work, and not being able to hear can affect the way they do their jobs. Many people do not realize how many areas of life are affected by the ability to hear.

Moreover, hearing loss does not only affect the individual. It also affects the way people around him engage in communication. It’s a two-way communication barrier. Conversation breakdowns can cause frustration on both sides. I think the pandemic has isolated people even more. Masking, for example, makes it harder to use visual cues and can stifle speech while some standard communication platforms, such as phones and video conferencing, have their own barriers. For example, some video conferencing platforms have closed captioning but require the host to enable it. If you have hearing loss and socially estranged, you may be more isolated than ever.

Can having hearing aids improve other health conditions and increase safety?

I think so, and new research suggests it does. If you treat a person’s hearing loss, it may be possible to prevent dementia and cognitive decline. Revisiting what we talked about previously, it is very likely that this is because hearing helps older people engage with others and stay socially active, a key aspect of dementia prevention. But beyond simple communication, hearing also places us in the world around us. Your hearing is a sense that never goes out and helps you get a sense of where you are. This could, for example, help prevent falls, which are a real danger for the elderly.

Wearing hearing aids is often associated with social stigma, unlike wearing corrective glasses. Why do you think it is? And can changing Medicare help reduce this stigma? If not, what can be done?

Historically, society has been cruel to the hearing impaired. Hearing loss was considered glaring evidence of aging, and we did not have modern accommodations or treatments for a disease so common as we grew older until relatively recently – the 1950s. This stigma persisted. But attitudes towards aging are changing, and I think the combination of Medicare and OTC hearing aids making them more affordable will increase acceptance and reduce the stigma around them.

Finally, in a nutshell, can you describe what this will mean for the millions of hearing-impaired elderly Americans who, until now, could do nothing but cope as best they could?

Yes: transformational. It is a powerful change that will transform their daily lives.


13% have difficulty hearing even with a hearing aid


Provided by Johns Hopkins University


Quote: Hearing Aid Coverage May Be ‘Transformational’ (2021, Nov 15) Retrieved Nov 15, 2021 from https://medicalxpress.com/news/2021-11-aid-coverage.html

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