How much do hearing aids cost? Part 3 of our series

Filed Under: Costs, Health plans, Patients

CHCTelecoil

How much do hearing aids cost? Part 3 of our series. Part 1 is here, and Part 2 is here.

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How much do hearing aids cost? That depends.

We asked three experts to tell us their thoughts, and their e-mail interviews were so interesting that we stitched them together into this conversation.

Our experts:   Brad Ingrao, an audiologist and independent consultant, and a former consultant for the Rehabilitation Engineering Research Center (RERC) on Hearing Enhancement at Gallaudet University, and a former columnist  in Hearing Loss Magazine;  Richard Einhorn, a composer who had a sudden hearing loss, and who has developed a strong expertise in various forms of hearing aids; and Katherine Bouton, author of “Shouting Won’t Help: Why I–and 50 Million Other Americans–Can’t Hear You,” and a blogger at Psychology Today writing at “What I Hear.”

1.    What’s the best advice you can give someone looking to buy an effective hearing aid without breaking the bank?

Einhorn: If you have mild to moderate hearing loss, then go to an audiologist and get your ears

checked. You might also want to try the new personal sound amplifiers, which cost only a few hundred dollars (be sure you can return them if they don’t work out for you). The best ones that I’ve tried are by Sound World Solutions, Able Planet, and Etymotic. How good are they? In my experience, they are roughly about as good as a lower end hearing aid that costs many hundreds of dollars more but your experience may be very different. The difference is that you don’t get the custom fit (although Sound World’s CS 10 does allow customized programming via a smartphone) nor are there any assistive accessories to these devices (at least not yet). Also, many of them don’t have a tcoil option. These are all considerations if you have a really serious hearing problem. 

If you have more severe hearing problems or suspect more complicated problems, then you absolutely must go to a hearing specialist such as an audiologist as well as a good ENT or otologist (and the sooner the better). The audiologist may suggest hearing aids which will be custom fitted to your ear-shape and your hearing problems. They can be very expensive. Be sure to insist upon having a T-coil installed and be sure that the audiologist turns it on and tests to make sure it works. Hearing aids all sound different, and there is no way beforehand to tell which one will work for you. Therefore, try a few before finally deciding on one. Also, each audiologist will set hearing aids up differently and audiologists vary in their ability to do good fittings. If you are not satisfied, go to a different audiologist.

Ingrao: Ultimately, in my opinion, the conversation needs to stop being about price, and needs to become one of value.  One of the larger variables, is the professional doing the fitting, particularly their ability to help the patient find solutions for the many situations where even the most expensive hearing aids fail.  These always include settings with background noise, reverberation and when the desired signal (usually speech) is more than 6 feet from the hearing aid microphones.

Einhorn:  As Brad says, one serious problem is that all hearing aids, especially those for serious losses, need to be fitted carefully and that ability (and willingness) to do so varies widely. The hearing aid industry is trying to respond to this by simplifying and computerizing the testing procedures,  hoping thereby to standardize testing procedures. Even so, fittings can be tricky. Again, if you try a few aids and they are not working well for you, it might be best to try a different audiologist. A second audiologist might very well set up an aid that hasn’t worked for you in such a way that it will, in fact, work quite well. 

The other thing is to manage expectations. Once again, the hyperbole of the hearing aid companies’ advertising creates expectations that simply cannot be met given the laws of acoustics and existing digital technology. While essential for anyone with a serious hearing loss, hearing aids cannot “cure” hearing problems; however, they can make it easier to hear in many situations and this is extremely important for maintaining connections to other people and possibly even for cognitive health.

Bouton: I agree with all that Richard and Brad say, when referring to serious hearing loss.

I think you probably want to include hearing aids for mild to moderate hearing loss as well. In that case, if money is the issue, I think there are alternatives to a $2,000-6,000 hearing aid.

Anyone with hearing loss, however, should begin by having their hearing tested by an audiologist. There may be underlying health issues, or their loss may not show up on a standard pure-tone test but would show up in an audiologist’s test using background noise.

2.    We hear a lot about Costco as a good supplier. Any thoughts?

Einhorn: Sorry, the only thing that I know about Costco is that several people I know have used it and have had a good experience. I can’t confirm that as I have never used them.

Bouton:  Start with an audiologist and then move on to the internet if you have to, but beware of the fact that it often takes two or three tries to find the right hearing aid. In my opinion, for mild to moderate loss where cost is an issue, Costco or another reputable store with audiologist on staff is probably the best bet. 

3.  We are also talking about telecoil or T-coil — anything else we should mention?

Einhorn: A T-coil is, I believe, essential if you have serious hearing problems. It’s useful for listening on the phone and also if there are hearing loops installed. You can install a personal hearing loop for your television very easily and inexpensively.

Despite extravagant claims in their advertising, hearing aids work well only in situations where the noise is relatively controlled, and at short distances (they are not like eyeglasses – they do not correct hearing, they simply help you hear better in certain circumstances). What is often very helpful in some situations are assistive listening devices. These can be expensive and proprietary.

That is, Oticon works only with Oticon, Widex with Widex, etc. However, if your hearing loss is serious enough, then for specific situations, hearing aids will not be adequate and if you really want to watch TV or speak on the phone, you may find these additional devices essential.

4.    We hear a lot about iPhones as a terrific solution. We know this doesn’t work for everybody, but Richard, you’ve been quoted as saying it’s a great solution for you. Best ideas, best tools?

Einhorn: I’ve attached an article with some information about how to use the iPhone. Using an iPhone is NOT A substitute for a hearing aid, but I have found it helpful in situations which are difficult for hearing aids. (Here’s a passage from the article he wrote for Hearing Loss magazine, May-June 2012).

“After a lot of experimenting, I finally came up with a very useful set-up that I use when I’m at a restaurant or party. It consists of:
1. an iPhone
2. a pair of high quality in-ear earphones (from a company like Shure, Etymotic, or Sennheiser)
3. a directional mic called the Blue Mikey which clips onto the iPhone and is available at music stores and online
4. a hearing assistance app like soundAMP R

“I plug the earphones into the earphone jack on the iPhone. I snap the Blue Mikey onto the power jack of the iPhone. I open up soundAMP R, the hearing assistance app. I take my hearing aid out and insert the earphone into my ear. Then, I simply point the Blue Mikey/iPhone at the person I want to listen to and raise the volume of the mic by adjusting the fader in soundAMP R. When someone else talks, I simply point the device at that person. When a lot of people are talking, I try to find a spot for the mic that includes as many of them as possible. I move the device around as needed.”

Bottom line: if you are not comfortable with technology and don’t know how to operate a smart phone, an iPhone is simply too hard to use for hearing assistance. If you are comfortable with tech, an iPhone can be very useful in noisy situations, such as restaurants – but only if it is properly set up with good earphones (not the awful Apple earbuds). Incidentally, I have never used any other smartphone than an iPhone so I have no information about how well an android, for example, will work for hearing assistance.

5.    You mention that “the health problems associated with serious hearing problems” are becoming clearer. Can you explain?

Einhorn: I’m referring specifically to Frank Lin’s work at Johns Hopkins documenting a clear association between severity of hearing loss and severity of dementia. In addition, there has been an association found, I believe, between hearing loss and heart disease. There are also many very well-known psychological and interpersonal problems connected with serious hearing losses. These have a profoundly negative impact on quality of life. Hearing loss is a very serious disability.

Bouton: The Framingham Heart Study found an association between low frequency loss and cardiovascular disease.  If you have your hearing tested and find low-frequency loss, you might want to take preventative measures against cardiovascular disease. Frank Lin’s study shows a statistical correlation between hearing loss and early onset dementia, but whether there is a cause and effect remains to be studied. One thing is certain though, and that is that untreated hearing loss often leads to isolation, and isolation itself is a risk factor for dementia. Finally, hearing loss is a symptom of many autoimmune diseases, and may be the first symptom to appear. Again, knowing that you have the hearing loss can help you take preventative measures.

As for cost, it’s vitally important that insurance companies — including Medicare and Medicaid — begin to cover the cost of hearing aids. Untreated hearing loss leads to unemployment, isolation, depression, and — as mentioned above — may be an early indication of preventable medical problems. The risk of early onset or more severe dementia, whatever the cause, is an enormous public health issue as well as a personal issue. The costs in the long run of not treating hearing loss far outweigh the cost of reimbursing for hearing aids.

6.   Let’s move on to insurance/Medicaid/Medicare. Who covers hearing aids?

Einhorn: What I do know is that most don’t, which makes less and less sense as the health problems associated with serious hearing problems become clearer.

Ingrao: Medicare provides no coverage at all for hearing aids.  Most Medicaid programs (state by state) provide coverage, but the criteria, including how much they will pay, vary by state.  Historically, the reimbursements have been very low, so there aren’t many providers willing to accept Medicaid patients for hearing aids.  Also variable by state is the availability of hearing aid benefits through the department of Vocational Rehabilitation.  The Veterans Administration also provides hearing aid benefits for many vets, but again, “it depends” applies as they are quite taxed with the current volume and complexity of service personnel returning with more complex and extensive injuries.  Always worth looking at for a Vet.  Wait times and limited service center options are common.

When it comes to private insurance, there are two basic scenarios.  A fixed maximum benefit and a “discount.”  In the former, (Blue Cross Blue Shield, Aetna, Union plans), the member has a “hearing aid benefit” that usually reported as “X dollars per ear, every Y years/months.”  Typically plans for state and federal employees offer around $1,000 per ear every 3 to 5 years, but again, “it depends.”  Deductibles, income, co-pays, all vary patient to patient.  The best advice is for them to call their carrier and as “what is my hearing aid benefit?”  The kicker is that often, they won’t be given an exact figure, but rather an “up to” number that is only revealed when the Explanation of Benefits (EOB) arrives.

I’ve seen in range from the “up to” number in total all the way to a few dollars.

The other offering is a “discounted” selection from an approved provider.  Hear USA is a large chain of hearing aid offices that contracts with several insurers to be the exclusive provider of their hearing benefits.  They provide good quality, “top 6” brand hearing aids, but anecdotal reports suggest that the “discounts” are taken off of higher than average prices, so the end result is not much of a savings in exchange for no choice in providers.

The one that looks very good on paper is hi Health Innovations, but I have not been able to get any solid data on exactly how that benefit works for folks who fall outside the range of the two products they offer.

Bouton:  The VA will pay for hearing aids for anyone with a service-related disability. Medicare will cover hearing aids if the hearing was lost as a result of a head injury. Under the Affordable Care Act, better known as Obamacare, hearing aids are exempt from the tax on medical devices (defibrillators, artificial joints and so on are taxable.)  Most states have an office of Vocation Rehab which will pay for hearing aids if you can show that you need them for work.

But that leaves a lot of people paying for their own hearing aids.

7.  So making a simple recommendation, the bottom line is ….

Ingrao: I really can’t make that kind of blanket recommendation because, you guessed it, “it depends”  Each of the “big 6” has an option that in some markets, can retail for as low as $600 each within a bundled model.  However, that same hearing aid in other markets will be $1000 or more.

The option then is the PSAP (Personal Sound Amplification Product), but there are very, very few mainstream audiologists or dispensers who will offer these.

I know that everyone WANTS an “affordable” hearing aid with all the protection and services of the “standard” system, but unfortunately, it doesn’t really exist. …

Cheap hearing aids aren’t the answer.  BETTER hearing SYSTEMS may be.  It still (and likely always will) come down to Richard’s point about finding someone to work with who is open to alternate paradigms and products.

One of the big challenges of single payor hearing aid coverage is the “bundled” model under which hearing aids are currently wholesaled and retailed.

When I buy a hearing aid for a patient from Manufacturer X, I pay for the hearing aid, the marketing, the shipping, the help desk, the 800 phone number, the local, regional and national sales team, the trainers and the janitors at the factory.

I have no choice but to then pass that “bundle” on to the patient in the form of a high price for the “hearing aid” with all the follow up (programming cleaning, troubleshooting, “rehabilitation” and repairs) included or “at no additional cost.”

With an insurance model, the parts and labor would need to be separated.  With Medicaid, this is how it works.  They either buy the hearing aid directly , or reimburse me for the “acquisition price” (invoice price minus any end-of-month discounts), and then pay me a la carte for all the services.

The model works, but, for Medicaid at least, the rates for the services are too low to keep the lights on.

If the manufacturers allowed me to opt out of the bundled services, I could then be in a better position to run the numbers on unbundling myself.

FWIW, even people with mild to moderate losses will need assistive technology beyond 6 feet, and in noise and reverberation.  They just need them a little less than those with more severe hearing loss.

Costco works for some, but if you really run the numbers and compare apples to apples, the savings are not all that great.  One Costco here in Florida tells people they offer Oticon hearing aids at a great discount.  What they actually offer are Bernafon aids, which is Oticon’s “minor league” line.  Similar, but not exactly the same.

It’s like price shopping and comparing a Toyota to a Scion.  Yes they are similar, and even have some of the same parts, but they are not the same product.

So, I don’t think it’s a good idea to make any statements in this piece specific to any brand or provider unless you know and can reveal ALL the details.  Even then, I don’t see value in that kind of approach as the availability of that specific solution set may be limited or non-existent in a reader’s area, and may not even be around in 6 months given the current climate of mergers and acquisitions.

Einhorn:  Yes, PSAPs (personal sound amplification products) are usually not offered by audiologists because (1) they are not regulated by the FDA; and (2) they are inexpensive and therefore it does not pay to support them with customized service. They are a “non-medical” solution.

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How much do hearing aids cost? This is Part 3 of our series. Part 1 is here, and Part 2 is here.