Implications of the Lack of Hearing Coverage in Medicare

A vital sensory perception will be in jeopardy for many aging Americans within the next 40 years: hearing. The National Institutes of Health estimates that a third of adults between 65 and 74 experience hearing loss, and half of adults who are at least 85 experience hearing loss. In the year 2060, one in four adults will be at least 65 years old and therefore at high risk. Setting precedence for protecting hearing health now is necessary for the preservation of both the psychological and social wellbeing for older adults currently and for decades to come.

Research has suggested a positive correlation between prolonged presbycusis, a type of sensorineural hearing loss caused by natural aging, and risk of cognitive decline. Current studies link prolonged untreated hearing loss with onset of dementia. A 2018 longitudinal study of 38,000 men found the 18.3 percent of participants (n = 6948) with hearing impairment displayed increased risk of dementia compared to the remainder of the healthy-hearing participants. Furthermore, having a hearing impairment can lead to an overloaded mental capacity. This can make it more difficult to meet multiple task demands, like attending to a conversation while completing a crossword puzzle simultaneously.

On top of the cognitive risks, prolonged untreated hearing loss can significantly contribute to loss of income and social isolation and loneliness, the latter a danger already threatening the older adult population at large. A survey from the National Council on the Aging suggested that hearing-impaired older adults are more likely to experience paranoid thoughts and withdraw from activities with loved ones. An explanation for this behavior pattern is the decreased enjoyment of social interactions that can result from impaired communication. Likewise, older adults living with this condition are at a 40 percent increased risk of depression. Social determinants of health can play a contributing factor to these poor health outcomes. While original Medicare does not allocate funding to hearing exams, aids, or hearing aid fittings, private Medicare Advantage plans do; Medicare Advantage costs about 6 percent more.

In more urgent matters, several states have mandated facial coverings in response to the COVID-19 pandemic. While these coverings are helpful to slow the spread of the virus, they add further obstruction to speech perception, and remove the ability to lip read, as some people with hearing impairments prefer to do. As older adults are now isolated from their families due to the pandemic, home health aides or other care staff are sometimes their only face-to-face contacts; protective face masks now inhibit this communication as well. Today, the risk of social isolation and loneliness may be at an all-time high for hearing-impaired older adults who are now self-isolating due to COVID-19 while combating these negative feelings.

Research supports hearing aid use as a solution to the above problems. Studies within the last 5 years found that American older adults with hearing loss experienced a significant decline in perceived loneliness following 4 to 6 weeks of hearing aid use. Additionally, studies on hearing aids associated use of the device with maintained cognitive ability, and increased listening enjoyment and reduced listening effort, the latter self-reported by participants.

There is an unmet need for hearing aids in the United States health care system due to their enormous out of pocket costs. Currently, Medicare considers hearing loss to be a typical symptom of aging, and therefore does not cover preventative hearing exams or hearing aids; one hearing aid ranges between $2,300 to $7,000 on average, and many require two. A combination of lack of insurance and perceived stereotypes (e.g., “I heard hearing aids are difficult to use” and “Wearing hearing aids means I am old”) are two of the largest barriers to hearing aid use; at this time, out of the 27 million Americans aged 50 and over with hearing loss, only one in seven use a hearing aid. Meanwhile, the psychological and cognitive effects of prolonged exposure to social isolation and loneliness may have financial implications like increased Medicare spending. Researchers have associated social isolation and loneliness among older adults with an estimated $6.7 billion in additional federal spending annually.

It seems all the pieces of the puzzle are lying out on the table – the projected growth of the older population, prevalence of hearing loss, risk factors that can develop into serious cognitive disturbances if left unattended – but no one is around to put them together (i.e., the lack of funding for hearing health, if my metaphor landed successfully). While more research is needed on effective strategies for transitioning patients from diagnosis of hearing loss to treatment, it only makes sense for Medicare to cover routine hearing exams, hearing aids, and fittings for hearing aids. Addressing hearing health today is critical to maintain the cognitive abilities and emotional wellbeing of the older adult population tomorrow.