The High Cost of Hearing
Go to a cellphone store and you can walk out with a handheld device that's a telephone, music player, digital camera and Global Positioning System mapper, all for a couple of hundred bucks.
But go to buy a hearing aid that has one job -- making things louder and clearer -- and you'll be set back $1,500 or more, and that's not counting the cost of the audiologist who fits it.
In the age of $30 DVD players, why does a good hearing aid still cost as much as a half-decent used car? And why, to add insult to injury, will Medicare and insurance companies pay for eyeglasses, contact lenses, wheelchairs and electric scooters, but not hearing aids? It's a question that isn't lost on hearing-aid users.
"You're damn right it bothers me that insurance will pay for all those things, plus prostheses for amputees, but not aids for those that do not hear well," said Eddie Neice, a Radford resident whose two pairs of hearing aids cost him a total of $10,000.
The average price of digital hearing aids, which are becoming the standard because of their small size and longer battery life, is about $1,500. More customizable devices can run $3,000 or $5,000, and top-of-the-line models, such as those worn by former Presidents Reagan and Clinton, are even more expensive.
The result is that a cellphone that lets you hear someone across the country costs less than a hearing aid that lets you hear someone across the room. And unlike cellphones or other consumer electronics, hearing aids require regular maintenance, most notably cleaning.
"Ear wax is a major, major problem with hearing aids," said Sherry Landis, an audiologist at Gill Memorial Hearing Lab in Roanoke. She should know -- one of the services she provides her clients is lifetime support, including cleaning.
To be fair, modern digital hearing aids do more than simply make things louder. A microprocessor programmed for the individual wearer tries to amplify the right sounds (voices) while lessening distractions (the air conditioner). But in an age of digital wonders, seeing a sentence like "You pay 100 percent for routine hearing exams and hearing aids" on a health insurance plan's summary of benefits throws many people for a loop. And they turn their ire to the insurer.
"The problem with the high cost of hearing aids is the insurance companies," said Joan Goodmiller of Fincastle, who is also the Virginia coordinator for the Hearing Loss Association of America. "There is no reason why hearing aids shouldn't be listed on the insurance for everyone."
There is one reason: price. Specifically, the high price for an item that some people consider a convenience rather than a necessity. After all, in a visual society bad eyesight is much more of a handicap than bad hearing. Not to mention that a pair of eyeglasses costs a fraction of what a single hearing aid does. That's because while eyeglasses come in a limited number of prescriptions, hearing aids, because they're custom-made, come in an infinite number of shapes and settings. The components -- microphone, receiver, telecoil -- are chosen by an audiologist with a specific patient in mind.
"People are thinking, 'I could get an iPod for 150 or 200 dollars, so why are hearing aids 1,500? Why can't I go to RadioShack and buy one for 50 bucks?' " said Sergei Kochkin, executive director of the Better Hearing Institute, a not-for-profit corporation that speaks on behalf of hearing aid manufacturers and promotes education about hearing loss.
But iPods are made by the millions, and they're identical. The market for hearing aids is relatively small. As Kochkin put it, "It's a simple matter of the amount of technology relative to the volume." While 14 million iPods were sold during the 2005 holiday season alone, there are, according to Kochkin, only about 2 million hearing aids in use in the United States, and of the better ones, no two are alike.
If you think impending demand of baby boomers will help the pricing, think again. Because each device is custom-made, the increased demand will have little impact on cost -- so there's even less incentive for insurers to pay for them.
Today's digital hearing aids are marvels of power and miniaturization. The digital signal processor inside -- essentially a powerful computer the size of a match head -- takes sounds from the world and analyzes them. Then, like a graphic equalizer on a stereo, it amplifies and adjusts those sounds to meet the need of the individual wearer, all so fast you can't even notice it.
While some portable music players have five-band graphic equalizers, modern digital hearing aids have eight, 10 or 12 bands. And, like many music players that have equalizer "pre-sets" for different types of music, digital hearing aids can be programmed the same way. The push of a button can switch from processing normal conversation to being optimized for use on the phone, in a restaurant or at a particular job. "Even," Landis said, "for a computer job where you're listening to the keys all day."
In comparison, yesterday's hearing aids -- and the ones you can buy over the counter or through electronics catalogs -- are simply amplifiers. They're the aural equivalent of over-the-counter magnifying reading glasses.
And while most consumer electronics are assembled by machines or, let's face it, low-wage factory workers, hearing aids are put together by hand.
"Fifty unique people are involved in making each hearing aid," Kochkin said, including 30 just to construct each microphone and receiver, which need to be built by hand under a microscope.
While the electronics of a hearing aid are similar to what you find in telephones and stereo equipment, it also has to fit into a space the size of a wad of chewing gum. According to Kochkin, hearing-aid manufacturers spend $20 million to $40 million to develop each new chip, which they do every one to two years.
Further, each hearing aid is customized for a single user -- in fact, a single ear. When someone is fitted for a hearing aid, he first takes a hearing test to determine the amount of hearing loss and in what frequencies. Then a mold of his ear is taken, and it and the test results are sent to the hearing aid manufacturer. There, technicians handcraft and program the individual device to the audiologist's specifications. It's then sent back to the audiologist, who can tweak the settings based on user feedback.
"We're all human beings, and we're all different when it comes to what we like to hear and what we don't want to hear," said Landis. So besides the results from the test, Landis makes adjustments based on the patient's preferences.
All that customization is important. The mold is designed to fit the unique shape of a user's ear. "If there's any spot that's a pressure point, it's going to cause irritation," Landis pointed out. "You're not going to wear something that hurts."
The amplifier's programming is also designed for one person and one person only. "Everyone has a unique hearing loss profile," Kochkin explained. "There probably isn't any standard amplifying hearing aid that would work for more than 3 or 4 percent of people."
The result is that a well-fitted, well-adjusted hearing aid can be the difference between night and day for someone with hearing loss. And they can last a long time. While Landis said that many manufacturers suggested replacing hearing aids every four or five years, "I have people out there with 20- or 25-year-old hearing aids who are perfectly happy." The average, she said, is about 10 years.
Hearing how wonderful a technology is might be nice, but it's little help if you can't afford to pay for it. Eddie Neice, for example, said paying for his hearing aids has hit him hard. "I have had to put in lots of overtime, drain my savings and do without vacations for several years to be able to afford the aids," he said.
But don't expect any significant help anytime soon. Knowing the potential costs of millions of aging baby boomers wanting hearing aids, Congress has been in no hurry to add the coverage to Medicare. It is, however, considering the Hearing Aid Assistance Tax Credit Act. If signed into law, it would provide a $500 tax credit every five years for hearing aids purchased for someone under 18 or over 55.
While certainly helpful for the older and younger crowds, twenty somethings and middle-aged folks who are just beginning to lose their hearing will still have to pay full price. And they're not the only ones frustrated by the high price and lack of financial help. The people who fit hearing aids also feel their pain. As Landis put it, referring to insurers and Medicare, "If they'll pay for a scooter, why won't they pay for a hearing aid?"
Adapted from:, Kantor, Andrew. The Roanoke Times, “High Cost of Hearing.” August 20, 2006..
