NRNP 6547 Week 6 Policy Brief Example

Policy Brief: Ending Medicare's Exclusion of Hearing Aids for Older Adults With Hearing Loss

Student Name

College of Nursing, Walden University

NRNP 6547: The Aging Experience

Instructor Name

Month Day, Year

Policy Brief: Ending Medicare's Exclusion of Hearing Aids for Older Adults With Hearing Loss

Bottom Line

Problem: traditional Medicare does not pay for hearing aids or the examinations to fit them, although hearing loss affects a majority of adults over 70. Recommendation: Congress should add a basic hearing aid benefit to Medicare Part B, covering one pair of hearing aids every five years and the fitting visit, with standard cost sharing. Cost: new Medicare spending, partly offset by lower device prices since the creation of an over-the-counter market and by potential reductions in costs associated with untreated hearing loss.

Issue Statement

The rule, in plain terms: the Medicare statute excludes hearing aids and examinations for prescribing or fitting them from coverage, so beneficiaries in traditional Medicare pay the full cost, which for a pair of prescription hearing aids has commonly run several thousand dollars. The rule excludes most older adults with hearing loss from treatment. In a nationally representative sample, about two thirds of adults aged 70 and older had measurable hearing loss (Lin et al., 2011), yet only about one in seven adults aged 50 and older with hearing loss used hearing aids (Chien & Lin, 2012). Cost is one of the main reasons. Untreated hearing loss is linked to social isolation, depression, and cognitive decline, which fall hardest on people with low incomes, who are least able to pay out of pocket.

Background

The exclusion was written into Medicare in 1965, when hearing aids were considered routine and low-cost personal devices, like eyeglasses, rather than medical treatment. Since then, the evidence on the consequences of untreated hearing loss has grown, and technology has improved. In 2022 the Food and Drug Administration created a category of over-the-counter hearing aids for adults with perceived mild to moderate hearing loss, which can be bought without a prescription or fitting (Medical Devices; Ear, Nose, and Throat Devices; Establishing Over-the-Counter Hearing Aids, 87 Fed. Reg. 50698, 2022). Many Medicare Advantage plans offer some hearing aid benefit as a supplemental feature, but benefits vary widely and many enrollees in traditional Medicare have none.

Options

Option 1: Add a hearing aid benefit to Part B. What it changes: all Medicare beneficiaries would have coverage for hearing aids and fitting, subject to standard cost sharing and a replacement interval. What it costs: new federal spending, with the size depending on the benefit design. Who objects: budget analysts concerned about spending, and some device manufacturers concerned about price negotiation.

Option 2: Rely on the over-the-counter market with a means-tested subsidy. What it changes: low-income beneficiaries would receive a voucher toward over-the-counter or prescription devices. What it costs: less than a universal benefit. Who objects: audiologists and advocates concerned that people with more severe or complex loss need professional fitting, which over-the-counter devices do not provide.

Option 3: Keep the exclusion and rely on Medicare Advantage supplemental benefits. What it changes: nothing for traditional Medicare. What it costs: no new federal spending. Who objects: beneficiary advocates, who note that coverage would continue to depend on plan choice rather than need.

Recommendation

Option 1: a basic Part B hearing aid benefit. It treats hearing loss as the medical condition it is, reaches beneficiaries in both traditional Medicare and Medicare Advantage, and includes the professional fitting that people with moderate to severe loss need.

Objection: "The over-the-counter market has already solved the price problem." Answer: over-the-counter devices help adults with mild to moderate loss who can fit them independently, but many older adults have more severe loss or dexterity and vision limitations that make self-fitting difficult; the benefit would cover what the market cannot.

Objection: "The benefit will be expensive." Answer: its cost can be controlled through a replacement interval, cost sharing, and competitive pricing, and it addresses a condition whose untreated consequences also carry costs.

Implementation Notes

If adopted, three design choices will decide whether the benefit reaches the people it is meant for. First, the fitting visit must be covered along with the device, since a hearing aid that is poorly fitted is often abandoned in a drawer. Second, the benefit should allow either a prescription or an over-the-counter device, so that beneficiaries with mild loss can choose the less expensive route. Third, cost sharing should be low enough for people with limited incomes, or paired with existing low-income subsidies, since those are the beneficiaries least able to buy devices now. A simple outcome measure, the share of beneficiaries with documented hearing loss who use hearing aids, should be tracked from the first year so that the benefit can be judged against the problem it was created to solve.

Illustration

A composite example: a 78-year-old retired mail carrier with moderate hearing loss stops attending his church's Bible study because he cannot follow the discussion. A pair of fitted hearing aids would cost more than two months of his Social Security income. He buys nothing, and the group loses a member.

References

Chien, W., & Lin, F. R. (2012). Prevalence of hearing aid use among older adults in the United States. Archives of Internal Medicine, 172(3), 292-293. https://doi.org/10.1001/archinternmed.2011.1408

Lin, F. R., Thorpe, R., Gordon-Salant, S., & Ferrucci, L. (2011). Hearing loss prevalence and risk factors among older adults in the United States. The Journals of Gerontology: Series A, 66(5), 582-590. https://doi.org/10.1093/gerona/glr002

Medical Devices; Ear, Nose, and Throat Devices; Establishing Over-the-Counter Hearing Aids, 87 Fed. Reg. 50698 (August 17, 2022) (to be codified at 21 C.F.R. pts. 800, 801, 808, & 874).