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Since its implementation in 1965, Medicare has excluded coverage for hearing aids and related audiology services despite the large numbers of older Americans that have hearing loss. It is increasingly well-documented, however, that untreated hearing loss often leads to a variety of serious health problems and injuries. This means the cost of not treating audiology problems must be measured when considering the value and cost of adding coverage.

In conjunction with the National Committee to Preserve Social Security and Medicare and Dr. Frank Lin from Johns Hopkins, the Center for Medicare Advocacy is working to advance legislation introduced by Congresswoman Debbie Dingell to consider new medical evidence and Medicare coverage for audiology and hearing aids.

Who is At Risk?

Why are audiology resources so important to the Medicare population? Hearing loss affects:

  • More than 40% of people over 60 years old
  • More than 60% of those over 70 years old
  • Almost 80% of those over 80 years old[1]

A total of nearly 30 million Americans are affected, with numbers expected to increase as the average age of the population climbs.[2]

Medicare coverage gaps affect women disproportionally – and women make up 67% of the population over 85 years old and are more likely than men to live in poverty. African American and Latina women are affected at an even higher rate.[3] Gaps in benefits and cost-sharing requirements, together with spending for premiums for Medicare and supplemental coverage, result in high out-of-pocket expenses for many people on Medicare. This is particularly troublesome given the low incomes of Medicare beneficiaries. In 2014, for example, half of all Medicare beneficiaries had incomes below $24,150 per person.[4]  Further, older women spend more on health care (including premiums) than older men ($5,657 for women, versus $5,031 for men.).[5]

More hearing screenings are needed. Although the number of adults who reported receiving a hearing screening during a physical exam is higher than in previous years, it is still only 23% among adults.[6]  Compared to people who had their hearing tested 5-9 years ago, those with more recent hearing tests were more than 2-3 times as likely to be a current hearing aid user.[7] 

Risks Associated with Untreated Hearing Loss

Currently only 1 in 5 Americans diagnosed with hearing issues use a hearing aid.[8] Unfortunately, untreated hearing loss in older adults can lead to physical and mental health issues, such as:

  • Higher risk of dementia. Mild hearing loss was shown to double the risk of dementia. Moderate hearing loss tripled the risk. Severe hearing loss showed a five-fold increase.[9]  With dementia projected to double every twenty years, this link should be studied further to determine whether treating hearing loss slows the increase of dementia.
  • Higher risk of falls. Hearing loss has been significantly associated with the odds of reported falls. Even mild hearing loss was associated with triple the number of falls.[10]
  • Depression. Studies show a strong relationship between hearing problems and depression.[11]
  • Other negative effects. In addition, untreated hearing loss may also cause increased social isolation, lower quality of life, reduced cognitive function, and lost productivity in the workplace.[12],[13],[14]  

Cost appears to be the greatest barrier to hearing aid adoption. A 2014 survey found that the average price of one hearing aid was $2,363; most individuals need two hearing aids, doubling the cost.[15] Most hearing aid users pay for the devices completely out-of-pocket, as traditional Medicare and most private insurance plans do not cover the cost of hearing aids or their fitting. The lack of Medicare coverage is widely cited as a major barrier to access. One survey found that 50% of consumers identify lack of insurance coverage as a barrier to acquiring a hearing aid.[16] One survey found that 64% of people with the most serious hearing loss reported that they could not afford a hearing aid, and over 75% identified financial factors as a barrier.[17]  

Links to Chronic Conditions Found in Medicare Patients

In 2010, beneficiaries in traditional Medicare were found to have the following rates of chronic conditions, which may be linked to hearing loss:

  • Depression in people under 65 with a disability – 27%
  • Depression in people over 65 – 12%
  • Alzheimer’s/dementia in people under 65 with a disability – 3%
  • Alzheimer’s/dementia in people over 65 – 13%[18]

These patients with chronic conditions, especially those with multiple chronic conditions, have a much higher usage rate of home health visits, more physician office visits, and more emergency room visits when compared to all FFS beneficiaries. Hospital readmission rates were also much higher than average for this group.

The expense of treating chronic health conditions among Medicare beneficiaries has huge implications for the health care system. In 2010, Medicare spending was over $300 billion. Care for the third of Medicare beneficiaries with either zero or one chronic condition cost Medicare  $20 billion. Those with six or more chronic conditions (about 14% of beneficiaries in traditional Medicare) had Medicare costs of over $140 billion.[19

Shrinkage of the brain, which occurs in natural aging, seems to occur more rapidly in older adults with hearing loss. Studies found that those with hearing loss had a higher probability of developing dementia, and that this probability increases with the severity of the hearing loss. According to researchers, there is a striking relationship between hearing loss and development of dementia.[20]

If treating patients’ hearing loss helps reduces instances of depression and slows the onset of dementia, costs associated with treating these conditions would be reduced, resulting in significant Medicare savings.

Help with Hearing Aid Costs

As has been the case with prescription drug costs, a lack of competition keeps hearing aid costs too high for most older and disabled people.  It is possible to negotiate lower prices, however, as is shown by the US Department of Veteran Affairs (VA). The VA spends an average of only $369 per hearing aid.[21] In addition, other countries, such as the UK, Denmark, and Switzerland, all pay significantly less than the American market.

The limited incomes of Medicare beneficiaries together with the lack of Medicare coverage greatly reduces the likelihood of people obtaining hearing aids. Of individuals needing hearing aids, only one-third reported current use of hearing aids. Significantly, there is a 28-66% greater prevalence of hearing aid use among older adults in the upper four-fifths of the income-to-poverty distribution compared to those in the bottom one-fifth.[22]

Conclusion

Medicare coverage for audiology services and hearing loss would help diminish the number of beneficiaries injured by falls, debilitated by dementia, and suffering from depression. It would improve the socialization and well-being of older people, people with disabilities and their families. Audiology coverage would help beneficiaries avoid the consequences, complications and expensive care that hearing-impaired people frequently require. While an exhaustive cost-benefit analysis is not currently available, Medicare would likely achieve savings by covering audiology care.

 

 


[1] Lin FR, Niparko JK. Ferrucci L. Hearing loss prevalence in the United States. Arch Intern Med. 2011;171(20):1851-1852. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564588/ Last accessed March 2016.
[2] President's Council of Advisors on Science and Technology. Aging America & Hearing Loss: Imperative of Improved Hearing Technologies (Letter Report to the President). Washington, DC: Executive Office of the President; 2015. https://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_hearing_tech_letterreport_final.pdf Last accessed March 2016.
[3] Salganicoff, Alina. Women and Medicare: An Unfinished Agenda. GENERATIONS – Journal of the American Society on Aging. Summer 2015; Vol. 39. No. 2: 43-50. https://kaiserfamilyfoundation.files.wordpress.com/2015/06/generations-women-and-medicare-an-unfinished-agenda-salganicoff.pdf Last accessed March 2016.
[4] Kaiser Family Foundation, “The Latest Trends in Income, Assets, and Personal Health Care Spending among People on Medicare” (November 2015), available at: http://kff.org/slideshow/the-latest-trends-in-income-assets-and-personal-health-care-spending-among-people-on-medicare/.  
[5] Id.
[6] Abrams HB, Kihm J. An introduction to MarkeTrak IX: a new baseline for the hearing aid market. The Hearing Review. 2015;22(6):16. http://www.hearingreview.com/2015/05/introduction-marketrak-ix-new-baseline-hearing-aid-market/ Last accessed March 2016.
[7] Bainbridge KE, Ramachandran V. Hearing aid use among older United States adults: The National Health and Nutrition Examination Survey 2005‐2006, and 2009‐2010. Ear Hear. 2014;35(3):289‐294. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999213/ Last accessed March 2016.
[8] President's Council of Advisors on Science and Technology. Aging America & Hearing Loss: Imperative of Improved Hearing Technologies (Letter Report to the President). Washington, DC: Executive Office of the President; 2015. https://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_hearing_tech_letterreport_final.pdf Last accessed March 2016.
[9] Lin FR, Metter EJ, O'Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Arch Neuro/. 2011:68(2):214-220. http://archneur.jamanetwork.com/article.aspx?articleid=802291 Last accessed March 2016.
[10] Lin FR. Ferrucci L. Hearing loss and falls among older adults in the United States. Arch Intern Med. 2012;172(4):369-371. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518403/ Last accessed March 2016.
[11] Audiology Today, Vol. 11:4, 1999. http://www.audiology.org/publications-resources/document-library/untreated-hearing-loss-linked-depression-social-isolation Last accessed March 2016.
[12] Dalton DS, Cruickshanks KJ, Klein BE, Klein R, Wiley TL, Nondahl DM. The impact of hearing loss on quality of life in older adults. Gerontologist. 2003;43(5):661–668. [PubMed] Last accessed March 2016.
[13] Lin FR. Hearing loss and cognition among older adults in the United States. J Gerontol A Biol Sci Med Sci. 2011;66(10):1131–1136. [PMC free article] [PubMed] Last accessed March 2016.
[14] Mohr PE, Feldman JJ, Dunbar JL, McConkey-Robbins A, Niparko JK, Rittenhouse RK, Skinner MW. The societal costs of severe to profound hearing loss in the United States. Int J of Technol Assess Health Care. 2000;16(4):1120–1135. [PubMed] Last accessed March 2016.
[15] Strom KE. HR 2013 hearing aid dispenser survey: dispensing in the age of internet and big box retailers. The Hearing Review 2014;21(4):22‐28. http://www.hearingreview.com/2014/04/hr-2013-hearing-aid-dispenser-survey-dispensing-age-internet-big-box-retailers-comparison-present-past-key-business-indicators-dispensing-offices/ Last accessed March 2016.
[16] Abrams HB, Kihm J. An introduction to MarkeTrak IX: a new baseline for the hearing aid market. The Hearing Review. 2015;22(6):16. http://www.hearingreview.com/2015/05/introduction-marketrak-ix-new-baseline-hearing-aid-market/ Last accessed March 2016.

[17] Kochkin S. MarketTrak VII: Obstacles to adult non‐user adoption of hearing aids. The Hearing Journal. 2007;60(4):24‐50. http://www.betterhearing.org/sites/default/files/hearingpedia-resources/M7_Barriers_to_hearing_aid_usage.pdf Last accessed March 2016.
[18] Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD. 2012. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/chronic-conditions/downloads/2012chartbook.pdf. Last accessed March 2016.
[19] Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD. 2012. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/chronic-conditions/downloads/2012chartbook.pdf. PAGE 22 specifically
[20] John Hopkins University. School of Medicine. Hearing Loss Linked to Accelerated Brain Tissue Loss. News and Publication. John Hopkins University, 22 Jan. 2014.
[21] Office of Inspector General, US Department of Veteran Affairs (VA). Audit of VA’s hearing aid services. Washington, DC:VA. 2014. Report 12-02910-80. http://www.va.gov/oig/pubs/VAOIG-12-02910-80.pdf Last accessed March 2016.
[22] Bainbridge KE, Ramachandran V. Hearing aid use among older United States adults: The National Health and Nutrition Examination Survey 2005‐2006, and 2009‐2010. Ear Hear. 2014;35(3):289‐294. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999213/ Last accessed March 2016.

 

The Center for Medicare Advocacy thanks Brigitte Baur for her work on this article.

 

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