Hearing loss can lead to cognitive decline or even dementia, but is often unaffordable, and financial aid for it is shrinking

By Trudy Lieberman
Rural Health News Service

Nearly two-thirds of adults over age 70 have hearing loss that doctors consider “clinically meaningful.” In plain English that means as people age, they are likely to become hard of hearing. Many of those people, however, don’t get the help they need, often because they simply cannot afford it.

“The prevalence of hearing loss almost doubles with each age decade of life,” says Dr. Frank Lin, an otolaryngologist at Johns Hopkins University, but for older people, he adds, “there are multiple barriers that prevent individuals from getting their hearing loss addressed.”

Lin spoke about the subject to a group of journalists in a recent phone conference sponsored by a Washington, D.C., advocacy group the National Committee to Preserve Social Security and Medicare. He is a co-author of a June report issued by the National Academies of Sciences, Engineering, and Medicine that recommends better access and support for treating hearing loss.

Lin told the group that although hearing loss is a normal part of the aging process, “hearing care is inaccessible” to many seniors. He said studies over the last five years have shown that such loss “can increase the risk of cognitive decline.”

Using data from a longitudinal study (one that tracks data from the same people repeatedly over many years or decades) that began in 1958, Lin and his colleagues at Johns Hopkins found that those with hearing loss had a higher probability of developing dementia. The more severe the loss, the more likely the dementia.

Photo from howmanyarethere.net

That isn’t the only problem. Hearing loss is also associated with a greater risk for falls and other accidents because a person can’t hear traffic or a smoke alarm in their home. Furthermore, those with hearing loss often feel isolated and shun normal social contacts because they can’t hear others speak. That’s a blow to productive aging, the goal promoted by the late Dr. Robert Butler, a well-known gerontologist who fought against ageism.

So why, then, is hearing care so inaccessible? Cost may be the major barrier. Nearly all expenses for hearing care must be paid out-of-pocket, and for many seniors on fixed incomes, that’s sometimes hard to do. Lin told me the average cost of two hearing aids is $4,700 and rarely covered by insurance.

Medicare doesn’t cover hearing exams, hearing aids, or exams for fitting hearing aids. It does cover diagnostic hearing and balance exams, but only if your doctor orders those tests to see if you need medical treatment. In that case, if a person has traditional Medicare and a Medicare supplement policy, often called a Medigap, he or she has to pay 20 percent of the approved amount for the exam. Some Medicare Advantage plans may include hearings tests as part of the extra benefits they offer.

The National Committee and other advocacy groups are campaigning to add a hearing benefit to Medicare’s benefit package. Their campaign is bucking a trend in Washington to cut Medicare benefits by raising the age of eligibility, making richer seniors pay more, and requiring those with traditional Medigaps to have more skin in the game.

Politicians have already begun redesigning Medigap policies to make seniors pay more out of pocket for their care. Beginning in 2020, for example, insurers will not be allowed to sell Medigap policies that cover the deductibles for Medicare Part B that pays for physicians’ services, lab tests and hospital out patient care. The theory behind this shift is that seniors will pay more and the government less, thus helping to save Medicare money.

I asked Dan Adcock, the National Committee’s policy director, about the chances of adding benefits to treat hearing loss, or for that matter vision and dental care, when the focus has been on cutting benefits of all kinds. He said one major source of funds to pay for hearing aids could come from lowering the price of what Medicare pays for drugs. The 2003 legislation that gave seniors a drug benefit also prohibited the government from negotiating prices for the drugs it buys. Drug makers strongly oppose such negotiations.

Adcock said he remains hopeful. If better hearing means a decrease in dementia, falls and accidents, fewer people would need treatment for those conditions. The savings could potentially “pay” for the hearing aids, he said.

For now, though, seniors and their families are on their own. The National Academies offer an “Action Guide for Individuals and Families” that suggests actions people can take to prevent hearing loss, and strategies for families to cope with it when it occurs. It’s available at

What experiences have you or a family member had with hearing loss and obtaining treatment? Write to Trudy at trudy.lieberman@gmail.com.

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