By Lisa Rapaport

(Reuters Health) – In 2020, a new U.S. law will allow people to buy hearing aids over-the-counter, but that may not improve access to hearing care, a new study suggests.

Researchers found that many older people who already wear hearing aids don’t see doctors to check that the devices are achieving optimal results.

For the study, researchers examined survey data from a national sample of people insured by Medicare, the U.S. health program for the elderly and disabled. Almost 11 percent of the Medicare beneficiaries in the study used a hearing aid in 2013, even though Medicare doesn’t cover hearing exams, hearing aids or exams for fitting hearing aids.

Only about one-third of the people with hearing aids also used hearing care services, the study found.

“The concern is that for individuals with hearing aids who do not get hearing care services, they may continue to have suboptimal hearing outcomes, or become frustrated with their hearing aid and not use it as often or at all,” said lead study author Amber Willink of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

“Hearing care services include those directed at supporting the hearing aid, such as fitting, customization, maintenance and necessary repairs,” Willink said by email. “They also include those that support the individual through counseling for coping with hearing loss, communication techniques for managing difficult listening situations, and managing expectations about the hearing aid.”

Untreated hearing loss has been associated with a range of problems for older adults including an increased risk of social isolation and cognitive decline as well as less ability to follow doctors’ orders and higher health costs, previous research has found.

Affordability and accessibility have long been barriers to hearing aid use in the U.S., researchers note in Health Affairs. While the new federal law will likely make hearing aids more affordable and increase the number of people using them for mild to moderate hearing loss, it may also mean more older adults with hearing problems don’t receive care from hearing specialists, the study authors argue.

More than one in five of the poorest hearing aid users who had coverage through both Medicare and Medicaid, the U.S. health insurance program for the poor, reported a lot of trouble hearing with their hearing aid, the study found.

By contrast, only about one in 10 of the most affluent hearing aid users in the study reported a lot of trouble hearing with the devices.

And 71 percent of the poorest hearing aid users in the study reported not receiving any hearing care services, compared with 58 percent of the most affluent hearing aid users.

These results suggest that even when hearing aids become less expensive and available over-the-counter, most users may still not get hearing care services needed for optimal results, the authors conclude.

The study wasn’t designed to prove whether or how the cost of hearing aids might directly impact use of hearing services. Another limitation is that it’s also possible results from older adults with Medicare might not apply to individuals with different insurance or younger people with hearing loss.

“Being able to purchase hearing aids without hearing rehabilitative services will make it easier for adults to obtain these devices as they become more affordable,” said David Loughrey, a researcher at the University of California, San Francisco and Trinity College Dublin who wasn’t involved in the study.

“However, using hearing aids is a rehabilitative process and some adults may find it difficult to adapt to them,” Loughrey said by email.

SOURCE: Health Affairs, online January 7, 2019.