Hearing management

17 January 2019

Why hearing aid upkeep is often out of reach for the poor

A US study has revealed how the high cost of hearing aids, along with their upkeep, makes it difficult for people with a low-income to enjoy the benefits of the devices.

If you're poor, you'll likely have less success with your hearing aid, a new study finds.

A survey of more than 1 100 Medicare recipients with hearing aids found that 27% of low-income users still had a lot of trouble hearing. That compared with just 11% of the wealthiest users.

The reason, the study authors suggested, is that poorer seniors have insufficient access to ongoing care to keep the devices functioning properly.

Ongoing maintenance and counselling

While 42% of the wealthiest hearing aid patients sought out expert audiology advice each year, only about 30% of the poorest users did so, the study found.

"As Medicare does not cover hearing aids or hearing care services, beneficiaries must therefore pay for them out of pocket," said study lead author Amber Willink. "The cost of these services is a significant barrier to access, particularly for low-income beneficiaries."

But even for patients of means, "the value of hearing care services is not widely known or appreciated," said Willink, an assistant scientist at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Given the complexity of hearing aid use, hearing care services provide "a necessary value-add". They offer proper fitting and device customisation as well as ongoing maintenance and counselling to ensure continued use, she explained.

Two-thirds of Americans over the age of 70 have some degree of hearing loss, which affects their quality of life, the researchers noted. But most don't use hearing aids, often because of the price.

New law

Willink's team pegs the expense at about $2 000 (±R28 000) for a single unit. But a study published last July placed the overall figure at about $7 000 (±R98 000). That report, led by Dr Michael McKee of the University of Michigan, suggested that high prices (alongside hearing loss shame) keep many seniors from seeking hearing devices.

Some low-income seniors can obtain partial Medicaid coverage, but it's only available in 28 states, the researchers reported.

The situation might ease somewhat in 2020 when a new law takes effect allowing consumers to buy hearing aids directly from approved manufacturers instead of an audiologist or licensed dispenser.

However, while hearing aids may become more affordable, McKee cautioned that "this may also exacerbate hearing health disparities among those who can't afford them in the first place, or may not be as technologically savvy as others".

It will be important for audiologists to help guide consumers on these choices, he said.

Jackie Clark, past president of the American Academy of Audiology, said that getting Medicare to cover costs in full would go a long way to ensuring that those at all income levels get the devices and continuous care they need.

Optimal performance

"It would certainly be a whole new ballgame if Medicare would cover hearing aids," said Clark, who is also a clinical professor at the University of Texas at Dallas.

Willink and her colleagues also suggested that the federal government expand Medicare and/or Medicaid coverage of hearing care services.

But with or without such a major funding change, Clark said hearing aid users must be educated about the importance of regular consultations.

The audiologist is critical in determining what technology is best, and knowing how to programme the device to ensure optimal performance, she explained.

Study participants were aged 65 and older, and drawn from a 2013 survey pool of nearly 9 100 Medicare recipients.

The report was published in Health Affairs.

Image credit: iStock


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Hearing Expert

Minette Lister graduated with a Bachelor of Communication Pathology (Audiology) from the University of KwaZulu-Natal, Westville in 2015. Thereafter, she completed her compulsory year of community service at Phoenix Assessment and Therapy Centre in Durban. In 2017, Minette started working for Thompson and Hoffman Audiology Inc. She is passionate about working with children and adults to diagnose and manage hearing loss using state of the art technology. Minette offers hearing screening programmes for newborn and high-risk babies, as well as school-aged children, in order to decrease the incidence of late or unidentified hearing loss.

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