Mandated Hearing Aid Coverage for US Adults 65+ Declined to 16.9% by 2023 Despite Broader Gains

The JAMA Otolaryngology–Head & Neck Surgery study tracked state mandates, Medicaid rules, and federal programs through 2023. Traditional Medicare excludes hearing aids outright, and Medicare Advantage variability leaves older adults without guaranteed benefits. Medicaid drove most gains for children and working-age adults, yet 71.3% of adults 65+ below the federal poverty level still lacked mandated coverage.

These patterns reveal entrenched health equity gaps. Older adults face elevated risks of cognitive decline, falls, and isolation when cost barriers of $2,000–$7,000 persist. Lower-income households and renters show higher mandated coverage only because of Medicaid eligibility, not because needs are met. The transition from pediatric to adult coverage creates abrupt drop-offs that compound socioeconomic disadvantage.

Policy options include adult Medicaid expansion, private-plan mandates, and Medicare hearing benefits. The 2022 Over-the-Counter Hearing Aid Act addressed some access but left prescription devices and complex cases uncovered. Without structural changes, disparities will widen as the population ages.

Next steps require Medicare demonstration projects measuring falls and hospitalizations alongside coverage uptake; states expanding adult Medicaid benefits could serve as natural experiments for national scaling.