OTC Hearing Aids vs. Insurance-Covered Hearing Aids: Cost Comparison

The hearing aid market changed dramatically in October 2022 when the FDA's over-the-counter hearing aid rule went into effect. For the first time, adults with perceived mild to moderate hearing loss could buy hearing aids directly from stores and online without a prescription, medical exam, or audiologist fitting. This opened up a new category of more affordable devices alongside traditional prescription hearing aids.

According to the CDC, approximately 15.9% of American adults report some degree of hearing difficulty. Among adults age 70 and older, that figure rises to 43.2%. Yet an estimated 70% of people who could benefit from hearing aids do not use them, with cost cited as a primary barrier. This article provides a detailed comparison of OTC and prescription hearing aids to help you understand the trade-offs and choose the option that best fits your hearing needs and budget.

Understanding the FDA OTC Hearing Aid Rule

The FDA finalized its OTC hearing aid rule in August 2022, with devices becoming available for sale in October 2022. This rule created a new regulatory category for hearing aids that can be sold without the involvement of a hearing healthcare professional.

Key provisions of the rule:

• Intended users: OTC hearing aids are intended for adults age 18 and older with perceived mild to moderate hearing loss. They are not intended for children or for adults with severe hearing loss.
• No prescription required: Consumers can purchase OTC hearing aids without a medical exam, prescription, or audiologist fitting.
• Safety requirements: OTC hearing aids must meet FDA performance and safety standards, including output limits to protect against additional hearing damage.
• Retail availability: OTC hearing aids can be sold at pharmacies, electronics retailers, and online stores, making them widely accessible.

The rule was designed to increase competition, lower costs, and make hearing aids more accessible. Since the rule went into effect, dozens of OTC hearing aid models have entered the market at a range of price points.

Cost Comparison: OTC vs. Prescription Hearing Aids

The most significant difference between OTC and prescription hearing aids is cost. Here is how they compare.

• OTC hearing aids: $200 to $3,000 per pair. Budget models start around $200 to $500. Mid-range options with features like Bluetooth and rechargeable batteries run $500 to $1,500. Premium OTC models with advanced noise reduction and app-based customization cost $1,500 to $3,000.
• Prescription hearing aids: $2,000 to $7,000 per pair. This price typically includes the hearing evaluation, the devices, custom fitting and programming, and follow-up adjustments. Basic prescription models start around $2,000 per pair, while premium models with the latest technology can cost $6,000 to $7,000 or more per pair.
• Prescription with insurance: With a Medicare Advantage plan offering $1,500 per ear in hearing aid benefits, a $5,000 pair of prescription hearing aids could cost you $2,000 out of pocket. With a more generous benefit of $3,000 per ear, you might pay $0 to $1,000. Some plans with preferred provider networks offer specific models at a flat copay of $0 to $500 per pair.

This is where insurance changes the math significantly. Without insurance, OTC hearing aids are clearly more affordable. But with good insurance coverage, prescription hearing aids can cost less than premium OTC models while offering superior performance and professional support.

Feature Comparison: What You Get at Each Price Point

Beyond cost, OTC and prescription hearing aids differ in features, customization, and support. Here is what you can expect from each.

• Sound processing: Prescription hearing aids use advanced digital signal processing that is programmed based on your specific audiogram. They can target the exact frequencies where you have hearing loss. OTC hearing aids use broader amplification profiles. Higher-end OTC models offer some degree of customization through smartphone apps, but they cannot match the precision of a professionally programmed prescription aid.
• Noise reduction: Prescription aids typically have more advanced noise reduction algorithms, making it easier to hear conversation in noisy environments like restaurants. Premium OTC models are improving in this area, but budget OTC models may amplify background noise along with speech.
• Fit and comfort: Prescription aids can be custom-molded to fit your ear canal precisely, which improves comfort and sound quality. OTC aids come with a selection of standard ear tips in different sizes. Many people find a comfortable fit with the included tips, but some may not.
• Connectivity: Both OTC and prescription hearing aids increasingly offer Bluetooth connectivity for streaming phone calls, music, and audio from devices. This feature is now common at most price points above $500.
• Professional support: Prescription hearing aids come with the expertise of an audiologist who evaluates your hearing, programs the devices, verifies the fit, and provides ongoing adjustments. OTC hearing aids are largely self-service, though some manufacturers offer phone or online support.

When OTC Hearing Aids May Be Enough

OTC hearing aids can be a good fit for certain people and situations. Consider OTC hearing aids if the following apply to you.

• You have mild to moderate hearing loss, not severe or profound loss
• You want to try hearing amplification for the first time without a large financial commitment
• You are comfortable using a smartphone app to adjust settings
• You do not have insurance coverage for prescription hearing aids
• Your hearing loss is relatively similar in both ears (symmetric)
• You primarily need help hearing in relatively quiet environments

If you fall into these categories, a mid-range OTC hearing aid in the $500 to $1,500 range may provide meaningful improvement in your hearing at a fraction of the cost of prescription aids.

When Prescription Hearing Aids Are the Better Choice

Prescription hearing aids are recommended in several situations where OTC aids are unlikely to provide adequate benefit.

• Moderate to severe or profound hearing loss: OTC hearing aids are designed for mild to moderate loss only. If your hearing loss is more significant, prescription aids with higher gain and more advanced processing are necessary.
• Asymmetric hearing loss: If your hearing is significantly different in each ear, prescription aids can be individually programmed for each ear. Most OTC aids offer the same amplification in both ears.
• Complex hearing needs: If you spend significant time in noisy environments, attend meetings, or have other demanding listening situations, the advanced noise reduction and directional microphone technology in prescription aids provides a meaningful advantage.
• Accompanying conditions: If you have tinnitus (ringing in the ears), an audiologist can program prescription hearing aids with tinnitus masking features. Some prescription aids also include fall detection and health monitoring features.
• Insurance coverage available: If your Medicare Advantage plan or other insurance offers a generous hearing aid benefit, the out-of-pocket cost for prescription aids may be comparable to or less than premium OTC models.

How Insurance Changes the Math

Insurance coverage can dramatically shift the cost comparison between OTC and prescription hearing aids. For seniors on Medicare, Medicare Advantage plans are the primary source of hearing aid coverage. For a comprehensive overview of all coverage options, see our guide on the best hearing aid coverage options for seniors.

Here is how insurance affects the decision:

• No insurance: Without any hearing coverage, OTC hearing aids at $500 to $1,500 are typically the most affordable way to address mild to moderate hearing loss. Prescription aids at $2,000 to $7,000 require either significant savings or a financing plan.
• Moderate insurance benefit ($500 to $1,000 per ear): A $5,000 pair of prescription aids costs $3,000 to $4,000 out of pocket. This is still more expensive than most OTC options, but the gap narrows. If the premium features and professional support matter to you, the extra cost may be justified.
• Generous insurance benefit ($1,500 to $3,000 per ear): With this level of coverage, prescription aids could cost $0 to $2,000 out of pocket. At this point, prescription hearing aids with professional fitting and programming may actually cost less than premium OTC models at $1,500 to $3,000.
• Preferred provider network copay: Some Medicare Advantage plans offer hearing aids through a preferred network at a flat copay of $0 to $250 per aid, regardless of the retail price. This is often the best value available for prescription hearing aids.

The Role of the Audiologist

One of the biggest differences between OTC and prescription hearing aids is the involvement of an audiologist. Understanding what an audiologist provides helps you evaluate whether the extra cost is worthwhile.

• Comprehensive hearing evaluation: An audiologist conducts a detailed hearing test that maps your hearing ability across different frequencies and volumes. This audiogram is the basis for precisely programming prescription hearing aids.
• Medical screening: An audiologist can identify hearing loss that may have a medical cause, such as an ear infection, earwax blockage, or a more serious condition like acoustic neuroma. These causes would not be identified with an OTC purchase.
• Custom programming: Prescription aids are programmed to amplify the specific frequencies where you have hearing loss, resulting in a more natural and comfortable listening experience.
• Ongoing adjustments: As you adjust to hearing aids, your audiologist can fine-tune the settings based on your feedback. This ongoing optimization is one of the key advantages of prescription hearing aids.
• Real-ear measurement: Audiologists can verify that the hearing aid output matches the prescription using real-ear measurement, which places a tiny microphone in your ear canal to measure the actual sound being delivered. This verification is not available with OTC aids.

Making Your Decision: A Practical Framework

To help you decide between OTC and prescription hearing aids, consider the following framework.

• Step 1: Get a diagnostic hearing exam. Medicare Part B covers this when ordered by a doctor. This establishes the type and severity of your hearing loss.
• Step 2: Check your insurance benefits. Review your Medicare Advantage plan or other insurance to understand what hearing aid benefits are available and how they would apply to prescription aids.
• Step 3: Calculate your out-of-pocket costs. Compare the out-of-pocket cost of prescription hearing aids after insurance with the cost of OTC hearing aids at your preferred price point.
• Step 4: Consider your needs. If your hearing loss is mild and your needs are straightforward, OTC may be sufficient. If your hearing loss is moderate or you have complex listening environments, prescription aids are likely worth the investment.
• Step 5: Use trial periods. Whichever option you choose, take advantage of trial periods to make sure the devices meet your needs before committing.

The Bottom Line

OTC hearing aids have made hearing assistance more affordable and accessible than ever, with quality options available for a fraction of the cost of prescription aids. For adults with mild to moderate hearing loss and no insurance coverage, OTC hearing aids are a viable and cost-effective starting point. However, prescription hearing aids remain the gold standard for sound quality, customization, and professional support. When insurance covers a significant portion of the cost, prescription aids can be surprisingly affordable. The best choice depends on your hearing loss severity, your insurance benefits, and your budget. For more on how Medicare handles hearing coverage, see our detailed guide on Medicare and hearing aid coverage.