This article was written by John S. Ford MD, MPH Los Angeles, California, who is a full time assistant professor at UCLA. This article was in Dr. Fords’ blog and written on 12/19/07
Why Insurance Companies Don’t Pay For Hearing Aids
Toni Brayer MD of EverythingHealth asks the question, Why won’t insurance companies pay for hearing aids? It’s a good question and its answer has implications more far-reaching than you might think.The obvious response would be unadulterated avarice. But if that were the case, then insurance companies wouldn’t pay for anything related to health. They’d just collect your premiums. While insurance companies may try to minimize the amounts they pay out, we all know that they must pay for something to maintain credibility (and not be sued for fraud). So something else must be happening here. And it has to do with the very essence of what “insurance” actually is.
There’s nothing magical about how the insurance industry works. Its raison d’être has always been to spread the expenses of a rare, known risk from a small number of people to many people. This way, everyone pays a manageable amount so that no one person has to pay a huge amount.
If my house burns down . . .
If my house burns down, I don’t want to face the catastrophic expense of paying for a new house and its contents (and going broke in the process). So I buy homeowners insurance. I’ll probably never make a claim because my house probably won’t ever burn down. However, I sleep better knowing I’m insured for that unlikely event (also my mortgage lender makes me do it but that’s another issue).
This is insurance in its classic sense. There are other issues involved but this is the basic concept. I’ll leave it as an exercise for the reader to guess why policies exclude “acts of war” from their coverage for example.
Because having my house burn down is a rare event, fire is an insurable risk. Likewise, getting seriously ill occurs relatively infrequently rendering this an insurable event.
Why not home improvement insurance?
Compare this with getting “home improvement” insurance. Have you ever seen it? No, and the reason is that if you purchased some, the likelihood of you using it is virtually 100%. Who wouldn’t opt to replace the kitchen cabinetry if your insurance paid for it? No one. So from the point of view of the insurer, the chance of a policy holder sending in a claim for a home improvement doesn’t represent a risk so much as a certainty.
So a home improvement, in contrast with a home fire, is not an insurable risk. For the company to be able to pay off such claims, the premiums would have to equal the average cost of home improvements plus administrative costs plus the additional cost of a profit. No customer would want to pay for such a policy and no insurance company would therefore offer it.
Who has hearing loss?
Now we come to the issue of hearing aids. Let’s divide hearing loss victims into two groups: the elderly and the young. First, let’s discuss seniors.
Approximately 30% of all Americans 65 and older and 40 to 50% of those older than 75 suffer from hearing loss (NIH statistics). These prevalence rates are so high that no insurance company can rationally consider hearing loss an insurable event. The risk is simply too high to make it financially viable.
Of course the insurance company could choose to spread the risk of paying for hearing aids to younger patients thus enlarging the risk pool. The problem with this is that the younger people are then paying substantially for coverage they have very little likelihood of ultimately requiring. It wouldn’t be so much insurance as a simple gift to the older-aged risk pool.
Should Congress step in?
Sure, Congress can step in and write laws that force insurance companies to pay for such benefits. That would be the simple solution and the morality of such laws is certainly open for discussion. But make no mistake, the end result of this approach would simply be to mandate such gift-giving from the young to the old.
Insurance companies want to be able to compete with each other for young people’s premiums. Those that refuse to force younger policy holders to foot the bill for older ones will clearly have a competitive advantage. The end result? Insurance companies won’t cover hearing aids in the elderly unless the government forces them to.
Insurance is meant to cover catastrophic events, not relatively common events.
This really gets at the heart of one of the biggest problems with health insurance. Insurance was originally conceived to cover so-called catastrophic events like a major surgery or a lengthy hospitalization. These are extremely expensive, though relatively uncommon events like having your house burn down or totaling your car. Unfortunately for complex reasons, people demand insulation from all health care expenses. I’ve had patients complain to me that they spent hours on the telephone with claims people and they bombard me with “doctor’s forms” to fill out so they could get their insurer to pay for a thirty dollar quad cane. Also, patients resent even minimal co-payments for office visits.
The problem is that when health plans cover the smaller (and decidedly un-rare) events such as minor equipment like quad canes and office visits, insurance ceases to be insurance and more like pre-payment instead. So when you add to these completely expected expenses things like administrative costs and a profit mark-up, premiums become needlessly high. With this extra overhead, it would be like buying a gift coupon for yourself at a store and paying more for it than its face value. Who would do that?
This is why many people concerned about health care finance (myself included) advocate moving back towards true catastrophic health insurance and away from insular insurance.
But hearing loss is rare in younger people
Regardless, this still leaves the question of why insurance won’t cover the cost of hearing aids in young patients. To me, this is a very interesting problem. Hearing loss is much less common in young people. For this reason, one would think this risk to be quite insurable and easily distributed. It doesn’t make sense that it’s not covered unless something else is going on here.
My guess? Age discrimination laws. I believe the insurance companies would rather not cover hearing aids for anyone than have to explain to older policy holders and various regulatory bodies why they provide them for the young but exclude seniors. Trust me, no one relishes the thought of going toe-to-toe against AARP and trying to justify a bias against older patients!
Should insurance exclude the elderly and focus on the young?
How would I like to see this handled? At the risk of being politically incorrect, I’d like to see a law specifically excluding the insurance companies from age discrimination regulation and lawsuits regarding their coverage of hearing aids. The likely result of such a law would be to permit the industry to cover hearing aids for the young (insurable) and continue to exclude seniors (noninsurable).
I’ve seen insurance coverage for hearing aids for the young – under 18 years of age and only one hearing aid every two years or something like that. It’s better than nothing, I suppose.
People are shocked when I tell them that there is no coverage for hearing aids otherwise. It burns me too – both my husband and I wear them (I am now on track for a cochlear implant) so it’s been a quadruple whammy for us (both bilateral). Only thing people can do is try to use flexible spending benefits to help pay for them.
But, but insurance companies don’t pay for senior healthcare, Medicare does. People may buy supplemental insurance to cover what Medicare doesn’t, but lots of things (like quad canes) are covered there which could be excluded, including hearing aids and quad canes–in other words, durable goods, or there could be a cap on what the insurance companies pay for durable goods in Medicare supplemental insurance.
Insurance companies pay for prosthetic legs and breasts, but even when few people wore hearing aids, they didn’t cover them. So, it’s not now because so many people are going deaf–it’s that they have gotten away with not paying all these years, and don’t want to start now. If they pay for chiropractic care (how many studies have been done to show how effective that is?), and many other things that are questionable, why not hearing aids, which are proven to improve people’s quality of life, and often their ability to hold a job? If more hearing aids were purchased, perhaps the price would go down. You mention the young and the old, but there are lots of people who grow up with a hearing loss and still have it in mid-life, and others who lose their hearing in mid-life.
Bottom line, the insurance companies have gotten away with not paying forever, and they like it that way. Yes, it’s greed. Again, not everyone with a hearing loss will get hearing aids–the vast majority, in fact, do not. The VA has finally come to realize how vital hearing is to people’s lives. It’s about time the rest of America does, too, and demands that insurance companies AND Medicare cover hearing aids. No excuses.
Why not make it, at least, tax deductible? Currently, medical costs need to be somewhere around 7% to be allowed as a deduction. There shouldn’t be, especially for hearing aids users.
Well you all leave very good points but the fact still remains, someone is making alot of money and someone is pushing real hard not to get legislation passed. Or, the hearing impaired community is not strong enough to raise hell about this. I don’t feel a tax deduction is enough. There’s no excuses. Hearing aids should be covered. No ifs ands or buts
It continually amazes me that the general public can get away with blatant discrimination against the Deaf and HoH even after they are called out on it time and time again. Why do insurance companies pay for glasses, which are far more widespread than hearing aids? Why do insurance companies pay for Plavix and insulin when 33% of the American population is obese by choice? Why do they pay for wheelchairs for people too fat to walk?
The government steps in and helps by buying hearing aids for my minor child, but something magical happens at 18 and the government assumes he will be able to afford thousands of dollars in hearing aids every few years (even though we all know employment discrimination is very much alive and well against Deaf and HoH).
Decades after civil rights movements we still struggle with blatant discrimination and paternalism. It’s sickening.
I think the real problem is that the hearing impaired unlike the Deaf, lets say at Gallaudet, are not a movement. If every hearing impaired and late deafened person admitted they had a hearing problem, we would be a much stronger organization. The Deaf movement however, do not see themselves as having a hearing problem but they are a culture and have alot of leverage which the hearing loss and late deafened community should have and doesn’t have.
It baffles me why insuance companies will payout, or help, with glasses, artificial limbs, heart valves, etc., but, when it comes to hearing aids – a medical device – the vast majority of them won’t. I wear my hearing aids anywhere from 5-7 years before replacing them, thus, the yearly cost isn’t out of line w/other devices insurance covers or helps with.
Today, if I get new glasses, the total cost with frames, etc., can easily be $400-$500! (My eye Rx is strong and complex.) Rx reading glasses, w/no other corrections, can run $300! When insurance helps cover the cost the usual guideline is that I can replace my glasses every 3 years or so.
If insurance would help with hearing aids w/a replacement factor of 4-5 years, the cost wouldn’t be that much different than my glasses. Oh, there’d be a co-pay, just as there is for other health related devices.
The really big issue is that there are so many people out there who should be wearing hearing aids and they’re not because of costs. Most of them drive, too, which can be dangerous for others on the road because they, often, don’t hear a horn, a shout, etc. There are other societal disadvantages when someone who needs hearing doesn’t have them such as depression, etc. Yes, this issue disturbes me greatly.
I agree that people who need hearing aids should have help with paying for them – either lower the cost of the aids or have insurance cover the cost. As for Aaron’s remark about companies paying for insulin when people are obese by choice, I have to make a correction in his remark. People who are obese usually contract type 2 Diabetes. They usually don’t need insulin. A mere 5% of people with Diabetes have Type 1, which is an immune disorder. Those people who contract Type 1 and need insulin are NOT obese, and they certainly don’t contract the disorder by choice. I am not only severely HOH, I also have Type 1 Diabetes and take insulin. I’m not even overweight, let along obese. Please don’t generalize about Diabetes, as there is more than one type and more than one treatment.
Hearing aids are so expensive for everyone and while I do understand your points, it is heartless to exclude anyone from coverage. Not having hearing aids causes the hard of hearing to be isolated from others. Ever spend time trying to talk to your friends and feel like you’re watching a silent movie? Not pleasant, I assure you. Then there’s the matter of feeling uncomfortable leaving the house because you’re afraid to be ridiculed for not hearing things. Nevermind the fact that few movie theatres offer captioning on their movies. Jumble all this together and you get a miserable, possibly depressed individual whom is already battling age and many other life changes. Let’s just isolate the aging populations more, shall we? Forget people like myself, a 26 year old college student who is 80% deaf since the age of 14 who somehow magically has to produce $3200 to get a new pair of hearing aids because hers are dead. To the truly hard of hearing (perhaps a certain standard can be set as to HOW deaf one must be to qualify for hearing aids assistance), insurance companies should offer SOME help, 50% alone would be a huge help to me, as I’m sure it would be to many other people.
Amen! I lost my hearing when I was 14, insurance wouldn’t pay for aids then either. It’s ridiculous that I have to spend a full day crying on the phone trying to figure out how I’m going to pay for my $3200 hearing aids so I can work and attend classes.
People don’t speak up about it because of the discrimination that circles us. I get scoffed at all the time when I ask people to repeat themselves. People roll their eyes at me because I talk loudly. Perhaps if it wasn’t so stigmatized people would speak up about it. I admit, I don’t like to define myself as having a disability, it has such negative connotations but I am. I’m one person who needs to own up to it. But we need help with this issue.
I get hearing aids thought the state rehabilitative services, if I can. If they break and need repaired, I save money to fix them. If that doesn’t work, I just have to fake it until I qualify for assistance again. It’s annoying. And boy oh boy people just don’t get why I don’t buy hearing aids. Even my best friend gives me a hard time about it. She says “it’s like glasses”. HA! Not even close. Glasses are a much better fix for vision than hearing aids are for hearing loss and on top of that, buying glasses versus buying hearing aids financially speaking is like the cost between buying dime store flip flops to protect your feet and hiring someone to carry you wherever you go! One you are stupid not to do and the other, well you had better have some bank. I am HoH, my son is HoH, my dad is HoH, my grandfather was HoH, it’s a genetic dominate hearing loss and while we can all fake it, it’s hard and it cuts into what we can do and people who don’t live it, can’t really understand it. They can imagine deaf, they can imagine blind and missing limbs but not being able to hear certain frequencies while being able to hear others fine? Very few people can get that if they aren’t living it or trying hard to understand.
I only see the last input on this question in Jan 2012. This has been a source of malcontent for me for 27 years. My son was born with a 40 percent hearing loss. I know this sounds like child abuse but I never realized the issue untill he was almost 8 years old. As a child young child he just seemed very distracted but always happy , so how does one know? When he began going for his yearly physicals at the age when they begin testing for hearing, his pediatrician never made a big deal of it, maybe when he was about 5 they said his hearing was a little off but it was probably due to the cold that he had at the time.
Same thing happened again the following year but they made no mention that I should take him to an ENT or anything else, so again I dismissed it. He had trouble in school with concentration so the doctors treated him for ADD and put him on ritalin. Finally in 2nd grade and the day before spring break, his teacher told me that she thought he should repeat the grade. His worst grade was a C so I really couldn’t understand why he should repeat the year. She then mentioned that perhaps I should take him to an ENT, since (without my knowledge, the school system had done a preliminary check on all students in the fall and his hearing check at the time was impaired. The school system were supposed to have followed up on this again within 2 months but we live in a very rural area and they never came back.
Needless to say the day school was out I immedialey took him to an ENT and found that he had been born with this loss of hearing. They put some devices in his ears and asked me to take him out for the lunch hour and watch what would happen. There was a pond nearby, so we walked there and within minites my tears would not stop flowing. It was only then that I realized he had never heard a cricket or a siren, just to name a few. Shortly after, he was watching TV and the sound was very low, he was laughing and I asked what was so funny and he told me what he had just heard, the sound was too low for him to hear it ,he had been reading lips for all those years. I was a single parent with 2 children, self employed, ins, never has paid one dime to the ENT or for the hearing aids that follow. As you know ears keep growing and changing size esp. in the young so at most we might get 2 years out of them. Then you have to buy ins on them to cover when they get broken and believe me , with kids, they get broken a lot.
So easily I have spent out of pocket 25 K on hearing aids to get him through college. He is now 27 and walking around reading lips again. I can no longer afford to pay for them and even with a college degree, in this economy he is working 2 jobs to stay above water. He is also going back to school to become a nurse. He has been turned down by the US ARMY and THE PEACE CORP because of his lack of hearing. He has been willing to serve his country and they have turned him away, and this country will not even contribute a penny to help him get ahead.
Sometime others , esp in authority positions think he is being disrepectful or subordinate when they have issued instuctions and he does not comply. That is what most people would think. So basically when he meets someone new or goes for a job interview etc. he has to say, or and by the way, I’m half deaf and can’t afford hearing aids. So who do you think that employer is going to hire, him or the next guy?
This country has come up to back up every critical illness known to man here and in other country’s.
They insure your eyes and your teeth but if you can’t hear forgit it. I’d love for all those in congress and in the insurance industry to walk around with earplugs in their ears for a week. Maybe then we would see some action.
I would really like to know if anybody reads this and what your thoughts are. Please respond.
Thank you, my email is edislow@hotmail.com.
I read your reply, and I feel very sorry for what you and your son have been through. I think it’s horrible that insurance doesn’t cover hearing aids, and I hope this gets changed soon.
Not unless some “important” figure realizes what it is like to live life only hearing half of what they should will anything ever be done! I’ve had SSD (Single Sided Deafness) for over 34 years and have avoided MANY social events because it is just too embarrassing to never know what is being said around you. I’ve recently heard of TransEar and my insurance company won’t have anything to do with me unless I’m under 18 years of age. Really??? I can hear if I’m 17 but not if I’m 19? Could someone out there wake up and maybe have a heart? I understand that hearing loss is a natural progression in life but catching a 24 hour virus which leaves you 50% deaf is NOT a natural progression. So sorry for all of my hearing impaired peeps out there! It really stinks.
My situation is exactly the same as Jan’s son. I’m 24 y.o I have been without hearing aids since I was nearly beaten to death in an alley for 25 dollars. I spent several days in the hospital and incurred several thousand dollars in medical bills including a CAT scan, X-rays, PTSD class costs. I currently wear cheap little 29 dollar amplifiers that give me less than 10% of the range of decibels I need to hear properly. I am 86% deaf and I lost my hearing at the age of 5.
I went through the whole scenario of Ritalin and being diagnosed with ADHD and the whole nine yards. My grades up til High School were mostly D’s and F’s. That is, until I got my first real pair of hearing aids. After that my grades went to straight A’s and stayed that way through HS. Now I am trying to find any means possible to save up the cost of paying for $5,000 hearing aids because the governor of my state decided she didn’t want to include adult hearing in state funded medical programs. Beautiful way to treat a person who works for international students and helps foster better friendship alliances between Japan and the US. I guess since I speak 3 languages I don’t need hearing aids all that bad. BAH! if I win the lottery I’ll start up an insurance company to help every last person who is HoH or nearly deaf to obtain quality hearing aids with free hearing exams. Peace.
Yeah, I need new one soon…this stuck!
My insurance has always covered them. I am a (now retired) state of Alaska employee. However, the cost has outpaced the insurance coverage. $2k no longer buys the aid I need. God knows what I’d do if I wasn’t totally deaf on one side so that one also needed a hearing aid. Yikes.
Contact vocational rehabilitation and the Commission for the Deaf and Hard of Hearing in your state for assistance.
Have him contact vocational rehabilitation and the Commission for the Deaf and Hard of Hearing in your state.
I am a “Poster Child” for the HoH. Although I learned to “pass” as hearing as a child, I now am very up front about my HoH status and also that I lip read and use ASL. I ask for terp or CART in courts and at present a Buddhist organization is getting a terp for meeting for me. No one makes fun of me to my face (to do so would be to risk a tongue lashing) but I did have one woman in a 12-step meeting physically assault me over having terps (it “annoyed” her) I agree the HoH need to work with the Deaf Community to create acceptance – many “Deaf/deaf” have some hearing and do wear hearing aids. Connect with ALDA, take up ASL and start ASL meetups – you’ll meet lots of HoH and Deaf/deaf folks.
Julie, many if not most Type II’s now use insulin. It is done to attempt to preserve the pancreas so they don’t end up as combo type I and type II – an inability to produce the hormone AND insulin resistance. Byetta is better for that, but very expensive and insurance companies don’t like paying for it. I agree, though, Type I is mostly autoimmune, but type II’s can burn out their ability to produce insulin and then have both types. Complicated!
Thats what I am dealing with now my husband insurance don’t pay nothing for my hearing aids and I need better ones but they are more expensive, and to top that off another company bought out the company he worked for now I need more denture and the new company insurance do not cover them, when the old company did.
All states to have what amounts to a commission for the deaf and hard of hearing. Contact them and ask for a case manager. If working, contact Vocational Rehabilitation. There is help. The VA will get them for veterans.
Dentures are not required to be employed unless one is a receptionist or something, so it is hard to get voc rehab to pay for that.
Maybe the reason is: hearing aid companies charge way too much for the instruments in order to make big profits and insurers know this.
I’ve recently read where BC/BS for Federal Employees covers up to a certain amount I think $1000. It would be a start to have some help for state employees and of course anyone with insurance.
Also, interesting and frustrating to know, hearing foundations that recycle hearing aids send them overseas (i.e.Starkey Foundation). Additionally, if they recycled them and distributed them in the US, audiologist aren’t able to work with them because the programs become obsolete. Promote sign language from birth and we won’t need hearing aids. And FYI, Deaf drivers have better safety records than hearing – hearing people think that sounds are very important and they are, in their world. If you grow up with hearing loss you are no less aware, only differently aware.
Ok, how about the fact that I am a surgical nurse and cannot hear well in the operating room? I have had surgeons complain- and also have a diagnosed hearing deficit. This could impact my life as a single mother of two if someone decides that my disability is not worth the risk