Led by Dr. Michelle Arnold, an associate professor in the Department of Communication Sciences and Disorders at the University of South Florida (USF), the investigation spanning from 2008 to 2023 charted a complex trajectory of coverage evolution. While mandated hearing aid benefits saw substantial increases for children and more modest gains for working-age adults during this period, a stark and troubling finding emerged: coverage for adults aged 65 and older actually experienced a slight decline. This nuanced picture suggests that despite some policy advances, systemic inequities continue to create significant barriers for the populations most affected by hearing loss.
Uneven Progress: A Closer Look at Age-Related Disparities
The study’s findings illuminate considerable differences in how hearing aid coverage requirements have shifted across various age demographics. For children, the expansion of mandated benefits was most pronounced, reflecting increased advocacy and policy focus on early intervention for pediatric hearing loss. However, even with these significant gains, nearly half of all children in the U.S. still lacked guaranteed hearing aid coverage by 2023, underscoring that the battle for universal access is far from won. This gap leaves many families grappling with substantial out-of-pocket expenses for a critical developmental need.
Working-age adults (ages 18-64) also saw a modest uptick in mandated coverage, largely attributable to the expansion of Medicaid programs and, in some states, new requirements for private insurers. However, this progress often varied significantly by state, creating a patchwork system where an individual’s access to benefits can depend heavily on their geographic location and specific insurance plan. The lack of uniform standards across the nation means that many working adults, particularly those in jobs that do not provide comprehensive health benefits or who live in states with less robust mandates, remain vulnerable to the high costs associated with hearing aids.
In stark contrast to the gains observed in younger populations, adults aged 65 and older experienced a slight reduction in mandated hearing aid coverage over the 15-year study period. This demographic is critically important, as the prevalence of hearing loss dramatically increases with age. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), approximately one in three people between the ages of 65 and 74 has hearing loss, and nearly half of those 75 and older have difficulty hearing. Given these statistics, the decline in guaranteed coverage for older adults represents a significant public health challenge, exacerbating existing health disparities and placing an undue financial burden on a demographic often living on fixed incomes.
The Role of Medicaid and the Medicare Blind Spot
Medicaid emerged as a primary driver of mandated coverage, particularly for children and working-age adults. Its role in providing essential healthcare services to low-income individuals and families has been pivotal in expanding access to hearing aids for these groups. However, the study highlighted a crucial caveat: the scope of hearing aid benefits for adults under Medicaid programs varies widely from state to state. This variation creates a "postcode lottery" for access, meaning that eligible individuals in one state might receive comprehensive benefits, while those in an adjacent state could be left with minimal or no coverage. Such disparities undermine the principle of equitable healthcare access and contribute to significant health outcomes differences based on residence.
The situation for older adults is further complicated by the design of traditional Medicare. Historically, traditional Medicare has not covered routine hearing exams or hearing aids, viewing them as elective rather than medically necessary. While Medicare Advantage plans (privately offered plans approved by Medicare) often include some hearing-related benefits, the extent of this coverage is highly variable and depends entirely on the individual plan selected. This creates a confusing and often inadequate system where many older adults, despite the high prevalence of hearing loss in their age group, find themselves without guaranteed assistance for devices that can cost thousands of dollars. The absence of comprehensive hearing aid coverage in traditional Medicare is a longstanding policy gap that continues to disproportionately affect seniors, forcing them to choose between their health and their financial stability.
Lower-Income Adults: Persistent and Profound Coverage Gaps
Beyond age, the research also meticulously examined how mandated coverage differed based on household income and housing status, revealing profound inequities. In 2023, individuals residing in households below the federal poverty level were found to have a higher likelihood of possessing mandated hearing aid coverage compared to those in higher-income brackets. Similarly, renters were more often covered than homeowners across all three age groups studied. These findings strongly underscore the critical role that Medicaid plays as a safety net, extending benefits to some of the nation’s most economically vulnerable populations.
However, despite Medicaid’s crucial contributions, the study painted a sobering picture of persistent and significant gaps among adults experiencing poverty. A staggering 63.5% of adults aged 18-64 living below the federal poverty level lacked mandated hearing aid coverage. For adults aged 65 and older in similar economic circumstances, the situation was even more dire, with 71.3% having no guaranteed benefits. These statistics starkly differentiate between incremental improvements in insurance protection and the broader, more urgent need for truly affordable and accessible hearing healthcare for all.
Dr. Michelle Arnold articulated the gravity of these findings, stating, "Adults covered by Medicare and those living in households experiencing poverty are largely left out of gains in hearing aid insurance coverage that we’ve seen over the past 20 years." This statement highlights a systemic failure to protect the most vulnerable segments of the population from the prohibitive costs associated with hearing loss. With out-of-pocket expenses for prescription hearing aids ranging from approximately $2,000 to $7,000 per set, as estimated by USF, this financial barrier is often insurmountable for individuals without adequate insurance, effectively denying them access to a vital health technology.
The Perilous Transition from Pediatric to Adult Coverage
Another critical concern identified by the researchers involves the precarious transition from pediatric to adult insurance coverage. Children often qualify for hearing aid benefits through federal Medicaid protections or specific state requirements imposed on private insurers. These mandates are designed to ensure that children receive necessary amplification during critical developmental periods. However, the study found that these crucial protections do not necessarily extend into adulthood.
As Dr. Arnold explained, "Children may benefit from federal Medicaid protections or state laws requiring private insurers to cover hearing aids, but those protections may not continue as they age into adult coverage." For individuals with permanent hearing loss who rely on amplification throughout their lives, this abrupt cessation of benefits can create immense uncertainty and hardship. The prospect of losing coverage for future hearing aid replacements, ongoing maintenance, and related audiological services poses a significant threat to their long-term hearing health and overall well-being. This "coverage cliff" can lead to periods of untreated hearing loss, impacting educational attainment, employment opportunities, and social engagement.
Broader Context: The Unseen Costs of Untreated Hearing Loss
The implications of these coverage gaps extend far beyond the direct financial burden. Untreated hearing loss is a significant public health issue with wide-ranging consequences for individuals and society. According to the World Health Organization (WHO), over 5% of the world’s population – or 430 million people – require rehabilitation for disabling hearing loss. In the U.S., the CDC estimates that 15% of American adults (37.5 million) aged 18 and over report some trouble hearing. The lack of access to hearing aids can lead to a cascade of negative health, social, and economic outcomes.
Research has increasingly linked untreated hearing loss to an elevated risk of cognitive decline, dementia, depression, anxiety, social isolation, and an increased likelihood of falls, particularly in older adults. A landmark study by Dr. Frank Lin at Johns Hopkins University has repeatedly highlighted these connections, underscoring that hearing aids are not merely quality-of-life devices but essential tools for maintaining overall health and cognitive function. The societal economic costs are also substantial, including lost productivity, increased healthcare expenditures for co-morbid conditions, and the indirect costs of caregiving for individuals whose health has deteriorated due to untreated hearing loss. Estimates from various organizations, including the Hearing Loss Association of America (HLAA), suggest that the economic burden of untreated hearing loss in the U.S. could be in the hundreds of billions of dollars annually.
Historically, hearing aids have often been classified as elective medical devices rather than durable medical equipment, contributing to their exclusion from many insurance plans. Efforts to change this classification and expand coverage have been ongoing for decades, with advocacy groups like the HLAA and AARP consistently pushing for legislative reforms. While some states have mandated coverage for children, and a growing number now require it for adults in private plans, federal action on a broader scale, particularly concerning Medicare, has remained elusive.
The recent introduction of over-the-counter (OTC) hearing aids, following the FDA’s 2022 ruling, was intended to address affordability and access by allowing certain types of hearing aids to be purchased without a prescription or an audiologist’s fitting. While this development offers a new, potentially lower-cost option for some adults with mild to moderate hearing loss, the JAMA study underscores that it does not fully resolve the systemic issues of insurance coverage and access to comprehensive hearing healthcare, especially for individuals with more complex needs, severe hearing loss, or those requiring professional audiological services. The study focuses on mandated insurance benefits, highlighting that even with OTC options, many still face barriers to guaranteed coverage for the devices and associated professional care that might be most appropriate for them.
Charting a Path Forward: Policy Recommendations
The authors of the JAMA study not only identified critical gaps but also outlined several potential policy approaches to address these persistent challenges and foster more equitable access to hearing healthcare. These recommendations include:
- Expanding Adult Hearing Aid Benefits Through Medicaid: Standardizing and broadening Medicaid coverage for hearing aids and related services for adults across all states would significantly reduce disparities for lower-income populations.
- Establishing Additional Private Insurance Coverage Requirements: Implementing federal or more widespread state mandates for private insurers to cover hearing aids would ensure a baseline level of protection for working-age adults.
- Providing Guaranteed Hearing Benefits Through Medicare: The most impactful change for older adults would be the inclusion of comprehensive hearing aid coverage within traditional Medicare, recognizing hearing aids as essential medical devices. This would alleviate the significant financial burden on seniors and align Medicare benefits with the healthcare needs of an aging population.
These findings are particularly timely and relevant as policymakers, healthcare professionals, and advocacy groups continue to debate and explore solutions for improving the affordability and accessibility of hearing technology. The research serves as a robust evidence base for calls to action, emphasizing that while the availability of OTC hearing aids is a step towards broader access, it does not negate the fundamental need for robust insurance protection and integrated hearing healthcare across all age and income groups.
It is important to reiterate that this research meticulously examined mandated insurance coverage rather than the actual ownership or use of hearing aids. Therefore, its findings precisely delineate the extent of guaranteed insurance benefits available to Americans, providing a clear picture of the structural barriers to access, rather than measuring the proportion of individuals who ultimately obtain hearing aids. This distinction is crucial for understanding the policy landscape and identifying where legislative and regulatory changes are most urgently needed.
The collaborative research effort involved investigators from a consortium of leading institutions, including the University of South Florida, University of Missouri, Georgia State University, University of California, Irvine, and the University of Texas at San Antonio. Financial support for this vital study was provided by the National Institute on Deafness and Other Communication Disorders, a key component of the National Institutes of Health, underscoring the national significance of addressing hearing health disparities. The study’s rigorous methodology and compelling findings provide an invaluable resource for shaping future policy decisions aimed at ensuring that essential hearing healthcare is not a luxury, but a right for all Americans.
Reference:
Arnold ML, Tonti L, Phillips S, et al. Longitudinal Growth of Mandated Hearing Aid Benefits in the US. JAMA Otolaryngol Head Neck Surg. Published online October 15, 2026. doi:10.1001/jamaoto.2026.3143
Source: USF, JAMA Oto
