Medicare Coverage of Hearing Care and Audiology Services

Since its implementation in 1965, Medicare has excluded coverage for hearing aids and related audiology services despite the large numbers of older Americans that have hearing loss.

The exclusion of some hearing aids is specified in the Medicare statute itself, which states that payment is prohibited for:

routine physical checkups, eyeglasses . . . or eye examinations for the purpose of prescribing, fitting, or changing eyeglasses, procedures performed . . . to determine the refractive state of the eyes, hearing aids or examinations therefore,… (emphasis added)

Despite the use of the word routine int he section quoted above, the Medicare regulations do not actually limit the exclusion of hearing aids. Coverage is excluded broadly, for: 

(d) Hearing aids or examination for the purpose of prescribing, fitting, or changing hearing aids.

The Medicare policy manual, which controls initial decisions on coverage that are made by the Medicare claims processing contractors, also excludes coverage of all hearing aids. It states:

Hearing aids are amplifying devices that compensate for impaired hearing.  Hearing aids include air conduction devices that provide acoustic energy to the cochlea via stimulation of the tympanic membrane with amplified sound.  They also include bone conduction devices that provide mechanical energy to the cochlea via stimulation of the scalp with amplified mechanical vibration or by direct contact with the tympanic membrane or middle ear ossicles.

Despite these long-time exclusions, it is increasingly well-documented that untreated hearing loss can lead to a variety of serious health problems and injuries. This means the cost of not treating audiology problems must be measured when considering the value and cost of adding coverage.

Why this Matters: Risks Associated with Untreated Hearing Loss

Currently only 1 in 5 Americans diagnosed with hearing issues use a hearing aid.[1] Unfortunately, untreated hearing loss in older adults can lead to physical and mental health issues, such as:

• Higher risk of dementia. Mild hearing loss was shown to double the risk of dementia. Moderate hearing loss tripled the risk. Severe hearing loss showed a five-fold increase.[2]  With dementia projected to double every twenty years, this link should be studied further to determine whether treating hearing loss slows the increase of dementia.
• Higher risk of falls. Hearing loss has been significantly associated with the odds of reported falls. Even mild hearing loss was associated with triple the number of falls.[3]
• Depression. Studies show a strong relationship between hearing problems and depression.[4]
• Other negative effects. In addition, untreated hearing loss may also cause increased social isolation, lower quality of life, reduced cognitive function, and lost productivity in the workplace.[5],[6],[7]  

Cost appears to be the greatest barrier to hearing aid adoption. A 2014 survey found that the average price of one hearing aid was $2,363; most individuals need two hearing aids, doubling the cost.[8] Most hearing aid users pay for the devices completely out-of-pocket, as traditional Medicare and most private insurance plans do not cover the cost of hearing aids or their fitting. The lack of Medicare coverage is widely cited as a major barrier to access. One survey found that 50% of consumers identify lack of insurance coverage as a barrier to acquiring a hearing aid.[9] One survey found that 64% of people with the most serious hearing loss reported that they could not afford a hearing aid, and over 75% identified financial factors as a barrier.[10]  

Links to Chronic Conditions Found in Medicare Patients

In 2010, beneficiaries in traditional Medicare were found to have the following rates of chronic conditions, which may be linked to hearing loss:

• Depression in people under 65 with a disability – 27%
• Depression in people over 65 – 12%
• Alzheimer’s/dementia in people under 65 with a disability – 3%
• Alzheimer’s/dementia in people over 65 – 13%[11]

These patients with chronic conditions, especially those with multiple chronic conditions, have a much higher usage rate of home health visits, more physician office visits, and more emergency room visits when compared to all FFS beneficiaries. Hospital readmission rates were also much higher than average for this group.

The expense of treating chronic health conditions among Medicare beneficiaries has huge implications for the health care system. In 2010, Medicare spending was over $300 billion. Care for the third of Medicare beneficiaries with either zero or one chronic condition cost Medicare  $20 billion. Those with six or more chronic conditions (about 14% of beneficiaries in traditional Medicare) had Medicare costs of over $140 billion.[12]

Shrinkage of the brain, which occurs in natural aging, seems to occur more rapidly in older adults with hearing loss. Studies found that those with hearing loss had a higher probability of developing dementia, and that this probability increases with the severity of the hearing loss. According to researchers, there is a striking relationship between hearing loss and development of dementia.[13]

If treating patients’ hearing loss helps reduces instances of depression and slows the onset of dementia, costs associated with treating these conditions would be reduced, resulting in significant Medicare savings.

The Costs of Hearing Care

The limited incomes of Medicare beneficiaries together with the lack of Medicare coverage greatly reduces the likelihood of people obtaining hearing aids. Of individuals needing hearing aids, only one-third reported current use of hearing aids. Significantly, there is a 28-66% greater prevalence of hearing aid use among older adults in the upper four-fifths of the income-to-poverty distribution compared to those in the bottom one-fifth.[14]

As has been the case with prescription drug costs, a lack of competition keeps hearing aid costs too high for most older and disabled people.  It is possible to negotiate lower prices, however, as is shown by the US Department of Veteran Affairs (VA). The VA spends an average of only $369 per hearing aid.[15] In addition, other countries, such as the UK, Denmark, and Switzerland, all pay significantly less than the American market.

Conclusion

Medicare coverage for audiology services and hearing loss would help diminish the number of beneficiaries injured by falls, debilitated by dementia, and suffering from depression. It would improve the socialization and well-being of older people, people with disabilities and their families. Audiology coverage would help beneficiaries avoid the consequences, complications and expensive care that hearing-impaired people frequently require. While an exhaustive cost-benefit analysis is not currently available, Medicare would likely achieve savings by covering audiology care.