More options + better prices = less stigma?
I can hardly wait for the FDA's over-the-counter hearing aid guidelines to take effect. Why?! Because more people like me (and you?) will be able to experience the stress-reducing, social-skill-refining, brain-reinforcing, career-transforming, self-esteem-elevating glory of better hearing. I hope this post generates some hype among those of you who might be hearing-aid-curious!
Ever since the FDA last month announced the proposed guidelines, I've been exploring what it could mean for the future of hearing diversity.
When people discover how over-the-counter hearing aids can elevate their lives, they will become a gateway drug to prescription hearing aids.
A quick recap: The Over-the-Counter Hearing Aid Act is intended for adults with mild-to-moderate hearing loss. According to the FDA, that's 15% of Americans ages 18+ (not just old people!) It was signed into law by President Trump in 2017 as part of the larger FDA Reauthorization Act. Following President Biden's July executive order Promoting Competition in the American Economy, the FDA released its proposal on how it would regulate hearing aids sold directly to consumers, without a medical exam or prescription.
The proposal addresses things like input/output/gain limits (i.e. how loud the devices are allowed to be), design requirements (making sure it won't puncture your eardrum), product labeling, how to self-diagnose mild-to-moderate hearing loss, etc. For an easy-listening deep dive into the proposal, I highly recommend this video from one of my favorite YouTubers, Doctor Cliff, AuD.
Hearing experts and consumers (like me) are now invited to share their thoughts with the FDA and hearing aid industry leaders. The public now has until January 18, 2022 to weigh in on Regulations.gov. Until I submit my formal comment, here's me gathering my thoughts:
1. OTC hearing aids will be a gateway drug to prescription hearing aids
I'm a millennial who has gone through four pairs of prescription hearing aids in 12 years. For me, the process has always involved getting a written referral from my primary provider at my annual physical, going through an audiogram (hearing test) at my audiologist's office, researching products, and coming up with $5,000+ because my employer-sponsored health insurance has never covered them. Then it's rinse and repeat when my hearing aids die every 3-5 years. It's confusing, time-consuming, and extremely expensive!
My first health insurance plan in 2009 would not cover a dermatologist office visit because my hearing loss was considered a pre-existing condition!
Now imagine just buying some cheaper hearing aids online or in stores, such as a drug store, big-box store, or even a college campus bookstore. You could see how you like them, no doctor's appointments and no financial strain. Like all hearing aids, over-the-counter products will take some getting used to and won't be perfect. But they'll give you an idea of what hearing aids can do for you, and likely provide relief from listening fatigue and other hard-of-hearing frustrations.
The first generations of OTC hearing aids won't rival prescription hearing aids, which can be fine-tuned to each individual's exact hearing loss. But when people discover how over-the-counter hearing aids can elevate their lives, they'll be a gateway drug to prescription hearing aids. I think some will be so transformed by their OTC hearing aids, they will pursue the optimized experience only prescription hearing aids can offer. As long as they have the financial means to do so.
2. Health insurance companies are still getting off the hook
This section documents my personal experience with health insurance coverage, which may not reflect the experience of others insured by the companies mentioned in this article. Always check your insurance online, by phone, and via your provider, before accepting elective care of any kind!
The rise of over-the-counter hearing aids should not excuse health insurance companies from covering prescription hearing aids, if that's what their customer decides is best for them.
In my 12 years wearing hearing aids, I have had employer-sponsored health insurance from United Healthcare, Medica, and Blue Cross Blue Shield. All have required me to drain my HSA or FSA and pay 100% out of pocket. My current plan from United Healthcare says it will cover $400 per hearing aid (my ReSound hearing aids cost $5,000+). But when my audiologist's office called to inquire about coverage, they were told I needed to provide documentation that my hearing loss is the result of an illness or injury. Because I had no written evidence that loud earbuds contributed to my hearing loss, I did not bother to pursue coverage.
I had similar experiences with Medica and Blue Cross Blue Shield. None of my plans provided me a single penny toward my prescription hearing aids. In fact, my first health insurance plan in 2009 would not cover an in-network dermatologist office visit for me to get acne medication, because my hearing loss was considered a pre-existing condition! Fortunately, the Affordable Care Act banned that practice.
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Hearing aids are the only industry I can think of that has alienated entire segments through their own marketing.
Some health insurance companies do provide meaningful hearing aid coverage in select plans, but it is often an uphill battle. I've never been able to access benefits though any employer plan I've selected. With up to ten percent of millennials living with some degree of hearing loss, insurance companies should offer more comprehensive coverage for patients of all ages, or at least be transparent about what's covered upon sign-up. I strongly recommend checking with your plan, online, by phone, and via your provider, before purchasing prescription hearing aids!
All of that being said, better insurance coverage would not necessarily influence more people with hearing loss to pursue prescription hearing aids. According to my friend Doctor Cliff, AuD, the UK has a low rate of hearing aid adoption despite full coverage by their universal healthcare system, NHS! That likely has to do with a lack of awareness. And stigma.
3. OTC hearing aids will reduce stigma
The sooner companies can lower prices, improve access, and create more options, the more society will accept that people of all ages can benefit from hearing aids.
It has always surprised me that in an era where perpetuating stereotypes can get you canceled, nobody blinks an eye at ageism.
Many news articles I've read about the FDA's over-the-counter hearing aid regulations has featured a photo of an old person, a demographic our culture often treats as a laughingstock. Some cultures respect their elders, but apparently in the U.S., "looking old" is to be avoided at all costs, especially if you happen to be a woman. It has always surprised me that in an era where perpetuating stereotypes can get you canceled, nobody blinks an eye at ageism. Thus, we've historically seen endless hearing aid commercials promising an"invisible" and "discrete" product that won't be "embarrassing" to wear. I'd love to know the ROI on these marketing messages telling potential customers they ought to be ashamed. This fabricated stigma has led to a widespread belief that hearing aids are an old-people thing, and thus subject to endless jokes.
When word spreads that better hearing is helping people find success, less anxiety, better health, and more confidence, we'll stop treating hearing aids as something to hide.
Hearing aids are the only industry I can think of that has alienated an entire segment through their own marketing. While it is true that hearing loss is a common symptom of aging, you don't have to be elderly to benefit from hearing aids. Companies have missed out on millions from hard of hearing consumers in their 20s, 30s, and 40s, while clumsily targeting seniors with oversimplified and sometimes insulting messaging.
I've noticed this outdated style of marketing gradually fade away. Lately, I've noticed hearing aid marketing begin to modernize, featuring smart, powerful, sophisticated-looking characters of all ages. But as pointed out by Emily from Definite Hearing, they still miss the mark when they frame hearing loss as something tragic and scary, that makes you feel trapped and imprisoned. She suggests more positive messaging around better hearing, and I could not agree more! Go subscribe to Emily on YouTube!
When more products enter the market, the lines between hearing aids and current-day earbuds will begin to blur.
I hope the FDA's new regulations lead to such an explosion in hearing aid options, that people see lots more hearing aids in real life. More visibility would spark curiosity, FOMO, and a new societal vision of who wears hearing aids. You'll see them on your boss, your child's teacher, the Starbuck's barista, professional athletes, and influencers. When word spreads that better hearing is helping people find success, less anxiety, better health, and more confidence, we'll stop treating hearing aids as something to hide.
4. OTC will blur the lines between hearing aids and earbuds
Many people don't realize over-the-counter hearing aids already exist! They entered the market before universal guidelines were proposed. When the finalized FDA take effect, more companies are expected to enter the market and create more competition. Some economists say the rules will spur more competition among consumer electronics companies and startups. One analysis predicts that the global hearing aid market will surge to more than $11 billion in by 2028 - a 40 percent jump! We're going see a lot more people of all ages walking around with some form of hearing aids, and that is very exciting!
Some existing OTC brands I'm aware of include Lively, Lucid Audio, and Eargo. Consumer electronic companies like Bose are also in the hearing aid business. Meanwhile, popular earbuds like Apple AirPods Pro and Beats can be used as hearing aids via iOS 14, while products like Noopl can further enhance the hearing features. I have yet to personally try earbuds as hearing aids, but have heard some audiologists recommend them in situations where prescription hearing aids are not an option. Some providers will even write doctor's notes telling employers you need to wear your AirPods Pro or Beats at work!
When more products enter the market, the lines between hearing aids and current-day earbuds will begin to blur. We'll get so used to seeing people walking around with devices in their ears, no one will think twice about it. I hope we reach a point where earbuds could mean someone is on a call, listening to music, managing hearing loss or tinnutus, or all of the above.
Until then, stop making assumptions when you see earbuds out in the wild. If someone doesn't remove their earbuds when they're talking to you, they're not necessarily disrespecting you. It doesn't mean they're listening to Joe Rogan on Spotify during your conversation. They might just be trying to hear.
Have you tried over-the-counter hearing aids, or taken advantage of the iPhone hearing features? I definitely want to hear from you! Go over to the Hearing Habits Forum and tell us what it's like!
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