Original Medicare Excludes Hearing Aid Coverage for 30+ Million Seniors

Original Medicare does not cover routine hearing exams or hearing aids, leaving beneficiaries to pay $500 to $8,000 per pair out of pocket. While OTC hearing aids (averaging $930/pair) became available in 2022, they require self-fitting without audiologist verification, are limited to mild-to-moderate hearing loss, and are sold without professional follow-up care. Only five U.S. states require private health insurance to cover hearing aids for adults. Why it matters: Seniors with hearing loss cannot afford the devices they need to communicate. So what? Untreated hearing loss accelerates cognitive decline; a Lancet Commission identified it as the single largest modifiable risk factor for dementia. So what? The resulting dementia cases cost Medicare and Medicaid far more in long-term care than hearing aids would have cost to provide. So what? OTC hearing aids, marketed as the affordable alternative, lack the professional fitting and real-ear measurement that ensures effectiveness, meaning many seniors buy devices that do not actually solve their hearing problem. So what? The policy creates a false choice between unaffordable professional care and affordable but potentially ineffective self-service, while the system that excludes coverage (Original Medicare) is the primary insurer for the population most affected by hearing loss. Structural root cause: When Medicare was enacted in 1965, hearing aids were considered cosmetic or convenience items rather than medical necessities, and this classification has persisted through decades of legislative inertia despite overwhelming clinical evidence linking untreated hearing loss to dementia, falls, depression, and social isolation.