Why are hearing disabilities not covered by insurance and Medicare?

Imagine a treatable disability that afflicts tens of millions of Americans and yet is generally uncovered by insurance or Medicare.  You would think it would prompt a civil rights uprising.  Mandates to treat other conditions abound.  For example, 23 states have insurance mandates for bariatric surgery or gastric bypass to assist those who are morbidly obese.

Yet it is hearing loss that is an ignored epidemic.

{mosads}According to the National Institute of Deafness and Other Communication Disorders, the number of Americans with hearing loss considered disabling rises from 2 percent from ages 45-54, to 8.5 percent of those 55-64, to a quarter of those 65-74, and, finally, to over half of those over 75.

Using Census data to make this less abstract, those percentages would mean there are over 900,000 Americans aged 45-64 with disabling hearing loss, and over 14 million of Medicare age, 65-and-older.

Even hearing exams for adults are not covered by most insurance and Medicare.  Only 16 states require coverage of hearing aids for children, and only three – Arkansas, New Hampshire and Rhode Island – are progressive enough to require coverage toward costs of  hearing aids for adults too.  That coverage is not fantastic, going from as little as $700 per device in Rhode Island to $1,500 per device in Arkansas and New Hampshire, but it is helpful considering the last household survey by the Federal Reserve Board found almost a third of Americans go without needed medical care due to cost.

Moreover, the cost of hearing aids is entirely outside the Affordable Care Act’s much-ballyhooed limits on out-of-pocket health care costs incurred by the insured.  Thus a consumer with hearing loss could pay his or her health insurance premiums, along with a $6,600 deductible, and still be not a penny closer to having his or her medical condition addressed.

Anyone who has witnessed an elderly loved one suffer hearing loss coupled with the cognitive impairment that can come with age knows the effects of untreated hearing loss only compounds the disorienting effects of cognitive impairment.  That was true with my late grandmother.  Unfortunately, to save money, many resort to sound amplifiers entirely unfitted to their impairment – such devices are regularly advertised in magazines or on TV shows aimed at the elderly demographic.  Hearing impairment is much more subtle than simply turning up the volume, and real hearing aids require follow-up with a clinician to ensure they are calibrated right.

This disability affects all walks of life.  My former colleague Mike Sells is a six-term Washington state representative who has worn hearing aids since his 40s, and he notes, “Hearing loss is socially isolating.  It is, however, not just a matter of hearing, it is the loss of the ability to differentiate articulation.  Just watching British TV or anyone with an accent sounds like a foreign language sometimes.”

His last pair of hearing aids cost over $6,000.  And, as he notes, even hearing aids may not be a cure-all.  While he says “I simply cannot hear about 90 percent of what anyone is saying unless they are in” he can become “overwhelmed with the sounds in crowded rooms where conversation seems to come at you from all directions when you wear them.”  And that is despite working with a clinically-trained audiologist; a mail-order sound amplifier would drown one in undifferentiated sound.

Rep. Debbie Dingell (D-Mich.) has introduced the Medicare Hearing Aid Coverage Act of 2015 to require that Medicare pay for hearing exams and aids for its beneficiaries.  While this legislation would not address the private insurance gaps affecting younger Americans, it could be a model for states looking to address those gaps through insurance mandates – and would benefit the vast majority of those with hearing disabilities.

Surely it is time to recognize that the ability to hear is essential to whole body health.

Williams, an Olympia, Washington attorney, is a former state representative and frequent writer on healthcare issues.

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