Coverage for Hearing Aids Still Leaves Major Gaps

Despite steady changes in insurance rules that require hearing aid coverage, a large number of Americans still do not have dependable access to these devices, according to a new study.

The research found wide variation in mandated coverage by age group, with the sharpest gains among children and the most enduring shortfalls among older adults.

Published in JAMA Otolaryngology–Head & Neck Surgery, the study examined coverage requirements across private insurance, Medicaid, and federal programs serving veterans and military families, using data from more than 50 million people.

Michelle Arnold, an audiologist and associate professor in the University of South Florida’s department of communication sciences and disorders, led the work with colleagues from the University of Missouri, Columbia; Georgia State University; the University of California, Irvine; and the University of Texas at San Antonio.

“Adults covered by Medicare and those living in households experiencing poverty are largely left out of gains in hearing aid insurance coverage that we’ve seen over the past 20 years,” Arnold says.

“This is problematic, because we know that hearing aids can help reduce risks for serious health conditions such as cognitive decline, falls, hospitalizations, and mental health problems.”

Without insurance, prescription hearing aids can be prohibitively expensive. Average out-of-pocket costs range from $2,000 to $7,000 per set.

Coverage improved unevenly across age groups: children and working-age adults saw increases, while older adults experienced a decline.

• The share of children under 18 with mandated hearing aid coverage rose from 34.1% to 52.5%.
• For adults ages 18 to 64, the percentage nearly doubled, increasing from 10.2% to 19.2%.
• For adults ages 65 and older, mandated hearing aid coverage fell from 18.5% to 16.9%.

Medicaid was the biggest driver of mandated coverage for both children and working-age adults, highlighting the program’s importance in widening access to hearing care. Traditional Medicare does not cover hearing aids, and Medicare Advantage benefits differ from plan to plan, leaving many older adults without assured coverage.

The findings also point to a possible gap when children become adults.

“Children may benefit from federal Medicaid protections or state laws requiring private insurers to cover hearing aids, but those protections may not continue as they age into adult coverage,” Arnold says.

The study also identified differences in mandated coverage tied to household income and housing status.

In 2023, people in households below the federal poverty level were more likely to have mandated hearing aid coverage than those with higher incomes. Renters were also more likely than homeowners to have mandated coverage across all three age groups. These patterns reflect Medicaid’s role as a major source of hearing aid benefits.

Still, relatively better access for some groups did not mean low-income adults were adequately covered. Among adults living in households below the federal poverty level, 63.5% of those ages 18 to 64 and 71.3% of those 65 and older lacked mandated hearing aid coverage.

The researchers said access could be improved by expanding adult Medicaid benefits, requiring private insurers to cover hearing aids, and creating guaranteed hearing benefits under Medicare.

The study was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health.