Medicare Coverage Could Help Older Adults Maximize Hearing

Marcia Frellick

January 07, 2019

A law that increases access to hearing aids may have the unintended harm of decreasing access to hearing services, such as fitting and counseling, that could facilitate optimal hearing and adherence in using the devices, authors of a new report say.

The Over-the-Counter [OTC] Hearing Aid Act of 2017 will soon allow people to buy certain kinds of hearing aids without first going through an audiologist or hearing aid dispenser, currently the only route to getting the devices.

The law was intended to increase access to hearing aids, which cost an average of $4700 a pair, according to a research team led by Amber Willink, PhD, from the Department of Health Policy and Management and the Cochlear Center for Hearing and Public Health, both at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

The law also calls for regulation of the OTC devices and the setting of standards for them, which would set them apart from the personal sound amplification products that are currently available OTC but are not regulated and only amplify sound.

The researchers, however, say the law will have harmful effects, particularly felt by low-income seniors, if services are not part of hearing aid purchases.

"Hearing care is a continuous, daily adjustment," they write in the article, published online today in the journal Health Affairs.

The authors note prices of hearing aids range from $2200 to $7000, in part because of varied technology and the services traditionally bundled with them.

Making them available over the counter will likely decrease costs, but if the devices are made available in areas where access to services do not exist or are not coupled with purchase of the devices, older adults who cannot afford hearing care services will go without them and will be more likely to have trouble hearing, the authors write.

The law will exacerbate the income gap that already exists in seniors getting help with hearing, the authors say.

To see how older adults have been using hearing aids, the researchers obtained data from the Medicare Current Beneficiary Survey Cost and Use file and focused on the 11% of Medicare beneficiaries ages 65 and older who reported using hearing aids in the previous 12 months.

Those included in the 11% differed from the Medicare population at large, the authors write. They were more likely to be white, male, and have higher education and income.

Beneficiaries eligible for both Medicare and Medicaid were 41% less likely to use hearing care services and were twice as likely to say they had substantial trouble hearing with their aids, compared with high-income Medicare recipients (at or above 400% of the poverty level).

Steven P. Wallace, PhD, associate director with University of California Los Angeles Center for Health Policy Research, told Medscape Medical News he does not see the new law as making the income gap worse.

Already, he said, people who are low income are often not getting the audiologist services and can't afford the hearing aids, so being able to buy hearing aids at a lower cost over the counter will not likely increase the gap.   

"They'll get some relief, which seems to me better than getting no relief," said Wallace, who was not involved with the study.

Also, if more people are using hearing aids with more access to them over the counter, there may be less stigma around them, he said, and perhaps better adherence.

Proposed Solutions

The authors suggest two solutions to reduce financial barriers to obtaining hearing care services.

One is by making hearing services mandatory under Medicaid. Currently, only 28 state Medicaid programs now provide some form of coverage for hearing aids or hearing services, the authors note.

The other is ending the Medicare exclusion that says services that support fitting and management of hearing aids are not covered. Expanding Medicare would be the better option, they argue, because poor hearing is not limited to people dually eligible for Medicare and Medicaid.

Wallace said the basic call for Medicare coverage of hearing services is a "no-brainer."

"The fact that we don't provide hearing aid services through Medicare is a throwback to the 1960s when Medicare was first started and didn't cover prescription drugs," he said. "We've learned over the years what services are necessary to deal with health issues and this is one [that] Medicare hasn't caught up with."

Untreated hearing loss can be very costly to the healthcare system as it is linked with higher risk for cognitive decline, falls, depression, incident dementia, and more hospitalizations, the authors note.

The OTC Hearing Aid Act requires the US Food and Drug Administration (FDA) by 2020 to develop a system for regulating the devices for perceived mild-to-moderate hearing loss. Implementation is currently awaiting the FDA's specifics on the regulations.

The article was supported in part by funding from the Cochlear Center for Hearing and Public Health at the Johns Hopkins Bloomberg School of Public Health and from the Commonwealth Fund. One author is on the Scientific Advisory Board for Clearwater Clinical and Shoebox Audiometry. One author is on the advisory board for Boeringher-Ingelheim and Autifony, Inc and is a consultant for Cochlear Ltd and Amplifon. Dr Wallace reports no relevant financial relationships.

Health Affairs. Published online January 7, 2019. Abstract

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