Hearing Aids Can Run $500 or $3,400 — Here’s How to Choose Wisely

Over-the-counter hearing aids have cut prices by thousands, but researchers say the lower cost comes with a downside many shoppers miss.

If hearing aids have been on hold because of the price, the new over-the-counter market may feel like a break.

The average OTC device now costs about $500, while a prescription hearing aid averages $3,400, according to data cited in a JAMA Viewpoint by two University of California, San Francisco professors, health economist Kathryn A. Phillips and physician Christine K. Cassel.

That difference leaves roughly $2,900 in your pocket — enough for a new refrigerator or a lot of groceries.

Consumers have noticed. The authors report that 70% of first-time hearing-aid buyers chose an over-the-counter device.

But there is a catch: one in five OTC users said they received no professional help at all, and only 51% got the full package of support, which can include an evaluation, help selecting a device and fitting it properly.

One study cited by the authors also found that only about a quarter of OTC hearing-aid listings on Amazon could be confirmed as legitimate FDA-regulated hearing aids.

“Changing a regulation can create access,” Phillips said in a UCSF news release. Her point, which I agree with, is that access does not automatically mean people can easily navigate the system.

If you are enrolled in Original Medicare, you will pay the full amount yourself. Traditional Medicare does not cover hearing aids or the exams used to fit them.

In other words, the market opened the door and left buyers to figure things out on their own. Here are six ways to help make sure your $500 actually improves your hearing.

1. Decide whether OTC is appropriate for you

According to the Food and Drug Administration, OTC hearing aids are intended for adults 18 and older who believe their hearing loss is mild to moderate. They are not meant for severe or profound loss.

Notice who makes that judgment: you. There is no required exam, no prescription and no audiologist fitting.

The FDA lists warning signs that should prompt a doctor visit — ideally with an ear, nose and throat specialist — before you buy. Two examples are sudden hearing changes within the past six months or blood or fluid coming from the ear in that same period.

If an OTC device does not help enough, the FDA says you should see a hearing professional.

You are far from alone if you need help. The National Institute on Deafness and Other Communication Disorders says 22% of people ages 65 to 74, and 55% of those 75 and older, have disabling hearing loss.

Even so, fewer than one in three adults 70 and older who could benefit from hearing aids have ever used them, according to the institute.

2. Make sure you are buying a hearing aid, not an amplifier

The Amazon finding should be a warning sign. If only about a quarter of listings were verified, buying the wrong product is a real possibility.

The FDA says a genuine OTC hearing aid package should clearly display two terms: “OTC” and “hearing aid.” If both are not on the box, keep looking.

Do not be swayed by official-looking labels, either. The FDA warns that phrases like “FDA Registered” or “FDA Certified,” along with an FDA logo on OTC hearing-aid packaging, can be misleading.

There is also a category called personal sound amplification products, or PSAPs. The FDA says these are designed to boost sound in certain situations for people with normal hearing. They are regulated as consumer electronics rather than medical devices, and the agency says they are not substitutes for hearing aids.

A cheap amplifier you do not need is not a deal. It is just wasted money.

3. Get one hearing test before you buy

Medicare may help cover this step.

Medicare Part B pays for diagnostic hearing exams when a doctor or other provider orders them to determine whether medical treatment is needed.

You can also see an audiologist on your own without a doctor’s order once in any 12-month period, but only in limited situations, including non-acute hearing conditions.

After you meet the Part B deductible, you generally pay 20% of the Medicare-approved amount, plus a copayment if the visit takes place in a hospital outpatient setting.

Keep in mind that while the test may be covered, the hearing-aid fitting is not. You are paying for the information, not the device.

I would gladly pay a modest share for an exam to understand the problem rather than spend $500 on a guess. Phillips and Cassel also suggest that audiologists could offer one-time consultations for OTC buyers. It is worth asking whether a provider near you does that.

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4. Ask for your audiogram and device settings

Your audiogram is the chart showing the results of your hearing test. If a professional programs a device for you, there is also a record of those settings.

One of the authors’ ideas is to let patients leave with their test results and device programming details, similar to walking out with an eyeglass prescription and shopping wherever you want.

That is not standard practice yet. But there is nothing stopping you from asking for both before you leave.

With your results in hand, you can compare options instead of being tied to a single seller.

5. Read the return policy before paying

The FDA requires OTC hearing-aid packaging to state the manufacturer’s return policy, or to say that no returns are allowed. Read that before you buy.

Do not assume there will be a warranty. The FDA’s OTC hearing-aid rules do not require manufacturers to provide one.

And do not assume there will be a trial period. If the package says no returns, you are making a $500 gamble on a device you have never worn.

6. Use pretax money and review your Medicare Advantage options

The IRS treats the cost of a hearing aid — along with batteries, maintenance and repairs — as a medical expense.

That matters in two ways. If you itemize deductions, you can deduct the portion of your medical and dental costs that exceeds 7.5% of adjusted gross income.

Because health savings accounts follow the same tax-law definition of medical care, hearing aids are generally eligible for HSA funds. They are also generally eligible for health flexible spending accounts, depending on the plan.

That can add up. If your money would otherwise be taxed at 22%, paying for a $500 device with pretax dollars saves you $110 in federal income tax.

If you have Medicare Advantage, check the extras. Some plans provide benefits that Original Medicare does not, so contact your plan for details.

Do that before Medicare’s open enrollment period, which runs each year from Oct. 15 to Dec. 7, so you can make changes for the following year.

Extras can shift from year to year, as explained in “Your $0 Medicare Advantage Plan Just Got Worse. Check These 5 Things Before Dec. 7.”

If you are shopping plans anyway, it pays to look closely because Medicare choices can change.

The bottom line

Lower-cost hearing aids are a real benefit. But a $500 device that does not fit your needs, or cannot be returned, is still $500 wasted.

Get tested, inspect the packaging, read the return policy and use pretax dollars when you can. That is how a lower price becomes better hearing.