That’s a lot of acronyms up there. FDA = US Food and Drug Administration. OTC = Over the counter (not a prescription).
Recently, after dragging their feet for years, the FDA made moves to allow OTC hearing aids sold in stores and online. Meaning = people can buy hearing aids without going through an audiologist. The current situation is that in order to get (real) hearing aids, you need to have a visit with an audiologist who will test your hearing and prescribe and sell you hearing aids to fit your hearing loss. If your hearing loss is more severe, you need the fancy hearing aids. Hearing aids last on average 5-7 years. I didn’t look that up, that’s my own personal experience. Hearing aids are on average $5000+ for a pair (that’s on the cheap side), and not covered by most insurances or Medicare. Why isn’t it covered by insurance? The best explanation I found is that when they were first establishing Medicare and what it covers, hearing aids were not considered technologically good enough to be valid solutions to hearing loss. Their original omission meant that all other insurance policies that were modeled after Medicare coverage also omit hearing aid coverage. The technology has greatly improved and hearing aids are now essential medical devices for millions, but the language and sentiment remains. With that omission, comes a huge deficit in access to hearing health care.
This FDA decision is a complex, controversial, and weird one. I don’t claim to know all the in’s and out’s of the policy or the economics of how they hope it will play out. My thoughts below are based on my own experience with hearing health care. Here’s the Washington Post article on it. (I’d like to note, not one person with hearing loss was interviewed for the story.)
My thoughts: It’s a step. I don’t know that it’ll do what they want it to do. It may help folks, but probably not the ones who need it most desperately.
My reasons: The argument for allowing OTC hearing aids is that it will allow people to purchase less expensive hearing aids without having to go through an audiologist, or even just less expensive hearing aids in general. The idea is that these cheaper OTC hearing aids will drive the costs of the expensive hearing aids down. I hope that happens. I’m not 100% convinced it will.
Pessimistic prediction: OTC hearing aids that are worth wearing will still be sold at a premium price, one that is just slightly lower than the fancy kind. These OTC hearing aids will be made primarily by the same small number of companies that make the fancy hearing aids, so the competition is really only a front. They’re just making a cheaper option now. People who don’t regularly wear hearing aids don’t know the difference between quality and their specific hearing needs (since they’re skipping the audiologist), they just know price difference. The FDA has offered the perfect marketing tool: slap OTC on the label, and folks think they’re buying the generic form of hearing aids: cheaper but same quality. This is not the case. Now folks purchase an only slightly cheaper option that is significantly lower quality. This will increase stigma and shorten hearing aid wearing (folks will give up quickly). There will arise many cheap and shoddy options on the market that will “prove” misconceived notions that hearing aids “don’t work” or are a “waste of money.” No one will have the patience (or guidance) to do the hard work that involves your brain re-wiring to hear through digital means. This ignorance will continue to exacerbate the stigma and stubbornness against hearing aids. Mr. Jones will buy $250 hearing aids for his moderate hearing loss that he doesn’t have an audiologist check out. He will hate the hearing aids because they aren’t powerful enough for his loss and have low-quality. He will be bitter about spending $250 and vow never to buy hearing aids again and die sad and isolated because he can’t hear shit. Ms. Smith has been hoping to get hearing aids, but she’s smart enough not to buy the $50-$250 pieces of shit on the market, and the $1500 “higher quality” OTC pair, while cheaper, is still way out of her price range. Her life has been unchanged, she will also die isolated and frustrated, but at least she didn’t waste $50 on junk. Mrs. Snow (me) needs the highest quality hearing aids still, as she has severe hearing loss, and needs an audiologist to program the hearing aids, at least until she figures out how to do that by herself. She can’t risk it with the OTC hearing aids just yet, so she goes to her audiologist, and buys the fancy hearing aids. Due to the OTC competition, her hearing aids are now $5500 instead of $6500. That’s helpful, but still $$$$$ for something that should be covered completely by insurance. Her life is only slightly improved, but it’s not much in the grand scheme of things. Insurance companies have zero incentive for covering a device that is now attainable OTC, so the few that DID cover hearing aids now don’t, and hopes of Medicare/Medicaid covering hearing aids is all but lost. The five people who can afford $2500 hearing aids but not $5500 hearing aids are happy.
Optimistic prediction: OTC hearing aid producers keep quality high and costs low to out-bid the fancy hearing aids on the market, and run a huge PR campaign that shifts public perception of hearing aids. Now people wearing hearing aids are perceived as smart like people with glasses. Audiologists also run a PR campaign and now serve as ambassadors for people and helps them navigate the OTC and prescription hearing aid world, making sure they get the device that best fits their needs. Their services are still covered by insurance. Hearing aid companies have more competition and less stigma to deal with, so they now focus on quality sound and user-friendly technology instead of trying to make hearing aids microscopic to help people hide their unfounded shame. Once everyone sees how much better the world is when everyone has a shot at hearing, insurance companies will cover hearing aids and children won’t have to go to school with only one hearing aid because the other one is broken at home (happened to me many times). Seniors on a fixed income won’t have to chose which ear they like the best to have a hearing aid for, even though both need one (witnessed this). Young adults won’t have to read lips and stay in menial jobs because they never had access to hearing aids and their entire education has been a shamble without them, significantly reducing their ability to have living-wage employment or a happy social life (witnessed this).
I want to be optimistic. I do. But I’m not sure this move is going to change much for me. I’m afraid it might short-change any future progress that would lead to open access for all to have hearing aids if they want. I’d love to be wrong. If nothing else, people now know a little more about hearing aids and the expense.
