Medicare has explicitly excluded hearing aids since 1965, forcing 17% of seniors to go without because they cannot afford $4,600 out of pocket

Original Medicare — the federal health insurance covering 67 million Americans over 65 — categorically excludes hearing aids and hearing aid fitting exams. This exclusion dates back to 1965 when Medicare was created, and unlike vision or dental, Congress has never amended it. The average cost of a pair of prescription hearing aids in the U.S. is $4,672, with premium devices exceeding $8,000. Seniors on Original Medicare pay 100% of this cost themselves. This matters because age-related hearing loss affects roughly two-thirds of adults over 70, which means the population most likely to need hearing aids is the exact population whose primary insurance refuses to cover them. A Government Accountability Office analysis found that 17% of Medicare beneficiaries cannot afford hearing aids costing $500 or more. These seniors simply go without. They stop attending family gatherings because they cannot follow conversations. They miss medication instructions from doctors. They withdraw socially, which accelerates cognitive decline — the 2024 Lancet Commission identified untreated hearing loss as the single largest modifiable risk factor for dementia. The structural reason this persists is legislative inertia combined with lobbying dynamics. The Medicare Hearing Aid Coverage Act (H.R. 500) was reintroduced in the 119th Congress in 2025 but has stalled repeatedly in prior sessions. CBO scores the cost as significant because of the sheer volume of beneficiaries, and there is no powerful constituency pushing back against the exclusion the way hospital or physician lobbies push back against payment cuts. Meanwhile, Medicare Advantage plans (which cover ~50% of beneficiaries) have quietly added hearing benefits to attract enrollees — 97% of MA plans offered some hearing benefit in 2025 — creating a two-tier system where seniors on Original Medicare are left behind. The OTC hearing aid rule (effective October 2022) was supposed to be the pressure-release valve, but OTC devices are limited to mild-to-moderate hearing loss, lack professional fitting, and have high abandonment rates. For the millions of seniors with moderate-to-severe loss, there is no affordable path. They need prescription devices, professional fitting, and ongoing adjustments — none of which Original Medicare covers.