Author's note: This post was created a fair few years ago, so some of this data is out of date, but still holds true today. In addition, the numbers cited in this post have been updated to 2019 numbers.

So, I briefly touched on the subject of how much a hearing aid costs in Part One. I did not discuss the subject of why a hearing aid is expensive.

I will discuss that subject below in this post, now.

Why are hearing aids so expensive? Why aren't they covered by insurance? And why don't they ever get any cheaper, while computers and cell phones are constantly getting cheaper?

The How

Let's talk about numbers of how many people have some form of hearing loss in the US for a moment.

• In 2019, 13.0% of adults aged 18 and over had some difficulty hearing even when using a hearing aid and 1.6% either had a lot of difficulty hearing or could not hear at all, even when using a hearing aid.
• Hearing difficulties increased with age with 26.8% of those aged 65 and over having some difficulty and 4.1% having a lot of difficulty or could not hear at all.
• Among adults aged 45 and over, men were more likely than women to have had some or a lot of difficulty or could not hear at all.
• Non-Hispanic white adults aged 45–64 had higher rates of some difficulty, a lot of difficulty, or being unable to hear at all, compared with other race and Hispanic-origin groups.
• In 2019, 7.1% of adults aged 45 and over used a hearing aid; use was higher among men than women in all age groups.

The source for that statistic is from the CDC page, which cites several sources as well. Now, with that sort of number, you'd think hearing aids would be cheap, right? Wrong. Let's move on to the reason why hearing aids are so bloody expensive.

The Why

Electronic devices go through a predictable price cycle. The first release is expensive, often clunky, and for early adopters only. The first iPod had a physical hard disk inside, worked only with the Mac, had no wireless networking, held 1000 songs, and cost $400. I won't insult your intelligence by describing today's iPod models. Like music players, the best hearing aids keep getting better. But they also keep getting more expensive.

Why?

In economic terms, they suffer from cost disease. (Yes, this is a real term. I didn't make it up.) Prices go down when we figure out a way to make goods and services more productively. If Apple can make more iPods with the same amount of human labor, they can sell iPods at lower prices. Some industries, however, are resistant to productivity gains. The classic example, given in the paper that coined the term cost disease, is string quartets (if you play them faster or with fewer musicians, it's really not the same), but other examples include dentistry and college education, though this may be changing with the advent of online open courses. We'll see.

But wait a minute. If we can make iPods faster and more cheaply relatively speaking, why can't we do the same with hearing aids, which are also small computers?

We can, but most of the cost of the hearing aid isn't in the actual device. It's the rest of the process: a professional audiologist gives you a hearing test and produces an audiogram (kind of like your eyeglass prescription, but for ears), takes molds of your ear canals, fits and adjusts the devices, and readjusts them as needed. We're talking hours of work by skilled professionals, and that means cash money. (Note: In my experience, audiology tests take no more than 30 minutes, but there are others that have stated theirs took longer.)

Some retailers particularly Costco have shaved hundreds or thousands of dollars off the price of fitted hearing aids through high volume sales.

Even at Costco, however, a pair of in-ear devices costs up to $3000.

Now, there's also the...

Stigma. As a society, we associate hearing impairment with stupidity and associate hearing aids with old people who are hard to deal with. These attitudes are common, and easy to fall into, and unfair. Finally,

Cost. Discreet, top-quality hearing aids, molded to your ear canal, tuned to your hearing loss, and outfitted with the latest digital technology, cost up to $3000. Per ear.

**In most states, adult hearing aids aren't covered by insurance, and states that do cover them never pay for more than a fraction of the cost of the best models. Worse yet, hearing aids have to be replaced every three to five years and are easily lost or broken.

So, there's your why and how.

Who pays?

So how are you going to pay for that audiologist-fitted hearing aid? Not, in most cases, through insurance. Health insurance typically covers only the hearing test. Most states don't require insurers to cover hearing aids at all. California covers hearing aids at $1,400 per ear. New Hampshire, one of the more generous states, covers $1500 per ear, once every five years. (The HL maintains a list of coverage by state.) Edit: It appears Hearing Loss broke the page, so I've updated the link to a Google cached one. NEW page: Hearing Aid Reimbursement

And the Affordable Care Act doesn't affect hearing aid coverage.

Why? That doesn't make sense!

I looked into it, and I just can't figure it out. Because hearing loss is so common and so expensive to treat, private insurance companies can't make money insuring it. But that doesn't explain why Medicare doesn't cover hearing aids for adults, but they do for children below 18-21 and it doesn't explain why insurance companies cover other expensive assistive devices like motorized carts.

Will custom-fitted hearing aids get cheaper or more subsidized any time soon?

Unlikely. I've monitored this for the past five years as an adult, anxiously waiting for prices to go down. It has not. In the meantime, the cheapest place to get a pair of them is at Costco, which employs professional audiologists. But what about alternatives? Custom-fitted devices will always be the best and most expensive.

Ergo, chicken and egg problem. And there is now a Part Three!

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Filed under: Uncategorized - @ March 7, 2021 2:06 AM