Financial Influences Linked to Hearing Aid Purchases

Abstract

One of the factors that is presumed to influence the decision to obtain hearing aids is the cost of the product. The MarkeTrak 2025 surveyed individuals on a variety of factors about their decision to seek, or not seek, amplification, including the financial implications. The survey included 1,173 hearing aid owners, either prescription or over-the-counter (OTC) devices, and 1,782 non-owners of hearing aids. Key financial factors identified in the survey included differences in demographics between those choosing prescription hearing aids and OTC devices, the impact of insurance coverage on decision to pursue amplification, and the continued conflation of hearing care with hearing aids. Owners of prescription hearing aids tended to be older, white, and had higher income levels. Conversely, owners of OTC devices were younger, still working, included more non-white individuals, and had lower income levels. Non-owners are demographically similar to those individuals who chose OTC devices.

 

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Keywords

cost - hearing aids - over-the-counter - insurance

One of the assumed factors that influence the decision to obtain hearing aids is the cost of the product and/or related services. Indeed, one of the driving forces that led to the introduction of legislation to allow over-the-counter (OTC) devices was the perception that the cost of hearing aids was a key factor that prevented individuals from getting the help needed to reduce the burden of hearing loss.[1] [2] Although OTC devices are relatively new to the marketplace, the breadth of devices available to improve hearing have greatly expanded over the past 20 years. Prescriptive hearing aids continue to be refined in sound quality, form, added features (e.g., falls detection), and the patient interface. OTC devices have emerged in the market although actual patient uptake and impact on the hearing care service sector are yet to be understood. The criteria for cochlear implants have expanded to include unilateral losses and those with moderate sensory losses.[3] Osseointegrated implants are available for unique hearing loss types such as permanent conductive loss, and brainstem implants continue to be trialed.[4] Even earbuds, traditionally chosen for listening to music or podcasts, now incorporate hearing assistance features.

MarkeTrak is a biennial survey designed to gain an understanding of the decisions made by persons with self-reported hearing difficulty regarding their use of the variety of hearing assistance devices available. Although hearing aids, both prescriptive and OTC, are the primary focus of the survey, MarkeTrak 2025 (MTS25) also examined respondents' understanding and experience with implantable devices and ear-level devices that had hearing aid features (e.g., earbuds). This article will explore the cost and value factors identified in the MTS25 for persons who did and did not choose amplification. Implants, both cochlear implants and osseointegrated implants, have an entirely different cost and payment structure than hearing aids and therefore will not be included in this review. Similarly, ear-level devices that incorporate hearing aid features are generally purchased for other reasons (e.g., music, activities, etc.) and will also not be included in this review.

The MTS25 was conducted during October and November 2024 with follow-up questions in January 2025. The individuals were surveyed on a variety of psychological, financial, logistical, and satisfaction factors about their decisions to seek, or not seek, amplification. From a national sample of nearly 43,000 individuals, a sub-sample of persons with self-reported hearing loss were surveyed about their hearing loss and hearing care experiences. The sub-sample included 1,173 hearing aid owners and 1,782 non-owners of hearing aids. The MTS25 included questions about patient demographics (e.g., age, gender, employment status, income, etc.), factors that influenced decisions to seek help, expectations associated with the device, and outcomes/satisfaction with purchased devices. Embedded within these topical areas were questions associated with the financial factors and other cost influences that drove decisions. (Additional details about the MarkeTrak survey results can be found in other articles in this edition of Seminars in Hearing.) It should be noted that all individuals in the survey did not receive all questions. For example, questions about pairing a cell phone with hearing aids would only be directed toward hearing aid users and not toward those who did not pursue amplification. For this reason, the number of persons responding to each question was variable and thus results are generally reported as percentage of survey respondents who gave a particular answer to each question.

Within the sub-sample of persons with self-reported hearing loss, three different groups emerged: owners of traditional hearing aids (hereafter called prescription hearing aids), owners of OTC devices, and non-owners of hearing aids. [Table 1] shows the demographics associated with each group. It should be noted that the number of persons in the survey with OTC devices is substantially lower than other categories. Caution is urged in generalizing financial factors associated with decisions to purchase OTC devices based on this small number of respondents. Nonetheless, including OTC device responses to the question does provide perspective on trends that may be emerging for these devices.

Table 1 Demographics of respondents in the MarkeTrak 2025 survey

Demographics	HA owners			Non-owners
	All HA owners	Prescription	OTC	All
Number of respondents	1,173	1,008	136	1,782
Average age (years)	68	70	52	57
Median age (years)	72	73	58	59
Male (%)	56	57	56	57
Female (%)	44	43	44	42
Married/Partner (%)	56	57	54	55
College degree (%)	47	48	37	35
Retired (%)	67	70	44	40
Working (FT or PT) (%)	27	24	49	43
White (only or combination) (%)	85	88	72	78
BIPOC (Black, Indigenous, People of Color) (%)	18	15	32	27
Average income ($)	91,700	93,300	79,800	82,100
Median income ($)	75,100	77,400	65,500	66,600

Note: The number of persons with OTC devices was substantially less than the number of persons in other categories.

As can be seen, owners of prescriptive hearing aids tend to be older, white, college-educated, and retired. Conversely, owners of OTC devices are generally younger, still working, fewer attended college, and include more non-white individuals. Non-owners are demographically similar to those with OTC devices in that they are younger, still working, and with fewer having attended college. Importantly, the average and median incomes for persons choosing prescriptive hearing aids are higher than those of the other two groups. The median incomes for persons choosing prescription hearing aids are approximately 16% higher than non-owners or persons who chose OTC devices. These demographics are consistent with U.S. Census data that shows 53.6% of all people in the U.S. make less than $75,000 annually,[5] and the percentage is higher among people of color.

Prepurchase Financial Considerations

Individuals surveyed cited several reasons to move forward with the process of getting their hearing evaluated. Among the reasons were personal experience or a life change, the recommendation of a professional, a request from people known to the individual, personal motivation to move toward a solution, and the need to assess or confirm hearing status. Once that decision had been made, persons were surveyed about any influences that caused them to choose a particular location for services. Respondents were asked: “What influenced you to visit/check this particular establishment/company (in person or online)?” Individuals could offer multiple motivating factors in response to this question. The factors cited as influences, ranked from least to most influential, included: advertising (mentioned by 24% of the respondents), awareness/familiarity (39%), trustworthy (40%), convenience (52%), promotion/price (52%), recommendation/referral (66%). Although the recommendations of a friend or medical professional were cited by two-thirds of the respondents, financial factors were cited by more than half the respondents. Even within the category of receiving recommendations to move forward, about 1 in 10 (13%) indicated the referral came from their insurance company and therefore had a financial implication.

Looking deeper into the 52% of all individuals who cited promotions or price as a driver in their decision to move forward, one in four (25%) cited the coverage by their insurance company as an important consideration ([Table 2]) in choosing a particular establishment for their care. The numbers were similar for both owners (24%) and for non-owners (27%) in this regard. The issue of insurance coverage as an important consideration in choosing an establishment is different, however, between those who purchased a traditional prescriptive device (26%) and those who chose an OTC device (10%).

Table 2 Reason for choosing a particular establishment for hearing care

Promotion/Price factor	Total of all respondents (%)	Owners versus non-owners		Comparison based on type of hearing aid purchased
		HA owners (%)	Non-owners (%)	Prescription (%)	OTC (%)
Coverage provided or in network with my insurance company	25	24	27	26	10
Offered free test/services with hearing aids	17	21	10	22	14
Had a special deal or a discount/guarantee on hearing aids	12	15	6	13	27
Cheapest hearing aid I could find	8	10	5	7	28

Note: Survey respondents could offer more than one factor.

Other promotion or price factors cited included being offered a free hearing test, a special deal or discount on hearing aids, or identifying a location that had the least expensive hearing aids. For each of these, owners of hearing aids were more likely to consider these factors than non-owners ([Table 2]). As might be expected, particularly given that insurance coverage was not an important reason to choose an establishment, those who purchased OTC devices were more likely to consider special deals, discounts, or the least expensive devices. In fact, those persons who chose OTC devices cited “special deal or discount” at twice the rate of those choosing prescription hearing aids (27% vs. 13%). Similarly, finding the “cheapest hearing aid” was cited by OTC purchasers at a rate four times that of prescription owners (28% vs. 7%). Again, the low number of persons with OTC devices in the MTS25 survey suggests caution to avoid over-interpretating this difference.

Even for those who did not take the next step to get a hearing test, financial considerations again were often cited. Survey respondents could offer more than one reason for not taking the next step. For individuals who have never had a professional test, roughly one-third thought the cost of hearing aids was too high and 21% believe they had no insurance or insufficient insurance coverage to cover the cost of the aids. For those who had got a recommendation to get a hearing aid but have not done so, the constraints are primarily financial with over half (56%) saying the out-of-pocket costs are too high and about 3 in 10 (29%) saying they do not have adequate coverage. Among past HA owners, about 3 in 10 (31%) feel the HA cost is too high and nearly 1 in 5 (17%) also cite lack of insurance coverage as a factor.

 

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Financing the Purchase

Individuals surveyed were asked the question “What influenced you to get these particular hearing aid(s)?” More than one influence could be cited by those surveyed. The answers were sorted into the following categories: Value adds, such as satisfaction guarantee, were cited by 38% of survey respondents, a positive test or trials that demonstrated a need (57%), a positive environment or experience such as quality service or an easy process (62%), good or impressive product such as the technological features or design (65%), and financial factors (69%). Therefore, financial factors were cited by almost 7 out of 10 survey respondents as being important influences for choosing a particular set of hearing aids.

Within the category of “financial factors” being important influences, the most cited factor was, again, whether the individual had insurance coverage for the devices ([Table 3]). Other financial factors include the price of the devices, money available to purchase hearing aids, or the presence of a special offer or promotion. Different financial factors were noted for those who chose prescription aids compared with OTC devices. Similar to the results associated with choosing a location of service, those who chose prescription devices were more likely to cite insurance coverage (38%) while those with OTC devices were more influenced by the price (47%).

Table 3 Financial factors that influenced the purchase of specific prescription or OTC devices

Factors that influenced choice of specific hearing aid	All hearing aid owners (%)	Response by owner type
		Prescription (%)	OTC (%)
Had coverage for some/all of the cost	34	38	13
Price was reasonable/cheaper	25	22	47
Had money to purchase hearing aids	22	21	27
Promotion/special offer/deal	11	11	16

The MTS25 calculated a per hearing aid cost from information gleaned from hearing aid owners, including their out-of-pocket costs, coverage amounts, or total costs ([Table 4]). Among those able to recall their cost(s): Over two-thirds (69%) of the prescription hearing aid owners report a total cost per HA of $1,000 or more, compared with only 16% of OTC owners. Conversely, 84% of OTC device owners report paying less than $1,000 per hearing aid and 71% report paying less than $500 per device.

Table 4 Price paid for amplification devices from those who could recall the cost

Price range	Prescription	OTC
<$500	8%	71%
$501–$999	23%	13%
$1,000–$1,999	28%	8%
$2,000–$2,999	27%	5%
>$3,000	14%	3%
Average	$1,700	$510
Median	$1,560	$150

For prescription hearing aid owners, the average cost was determined to be $1,700 per device with the median price being $1,560. For OTC hearing aid owners, the average cost was $510 per device with a median cost of $150. This indicates that while the average price of OTC devices is above $500, more than 50% of persons who purchased OTC devices paid less than $150 per device. While the difference between the average and median prices for prescription devices is $140, the difference between average and median prices for OTC devices is $350, a substantive difference given the low cost of the devices to start. It should be remembered, however, that the number of persons with OTC devices in this survey is small, and therefore caution is suggested in interpreting these cost factors. The survey did not address how the bundling of prices and services influenced the cost perspective of the respondents but it did note that 80% of respondents who purchased a hearing aid paid a single price for the devices and services combined (bundled).

Some interesting differences emerge when considering the financial implications of where the devices were purchased when compared with the median purchase price of $1,560 for prescriptive hearing aids and $150 for OTC devices ([Table 5]). For owners of prescriptive hearing aids who paid less than the median price, the purchase location was about evenly split between hearing care offices, clinics, or centers (54%) and an in-store retailer or pharmacy that sells more than hearing aids (44%). But for those persons who own prescriptive devices who paid more than the median price, 95% purchased their devices at a hearing care office, clinic, or center. For OTC device owners who paid less than the $150 median price, nearly 7 of 10 (68%) purchased their devices online, either at a retailer, pharmacy, hearing aid brand Web site (46%), or online-only retailer such as Amazon (22%). For those who paid more than the median price, 55% visited a hearing care office, clinic, or center or in-store at a retailer or pharmacy, while only 45% purchased their device online.

Table 5 Hearing aid purchase location and income levels based on whether the individual paid more or less than the median cost

	Type of device
	Prescriptive		OTC
Where the amplification device was purchased:	Paid ≤ Median	Paid > Median	Paid ≤ Median	Paid > Median
Hearing care office, clinic, or center	54%	95%	11%	22%
Retailer or pharmacy—in-store	44%	3%	19%	33%
Retailer or pharmacy or HA brand's website—online	1%	1%	46%	42%
Online-only retailer (e.g., Amazon)	0%	0%	22%	3%
Somewhere else	1%	1%	3%	0%
Average income	$89,700	$108,400	$63,200	$89,900

Note: Segments are split by the self-reported median per HA category: $1,560 for traditional and $150 for OTC.

Another difference regarding the purchase location compared with the price above or below the median is with respect to average income levels ([Table 5]). For those who paid above the median levels for devices, prescriptive device owners had incomes that were approximately 20% higher than those that paid below the median price. For those purchasing OTC devices, those that paid above the median price had incomes that were 42% higher than those who purchased devices below the median price. This suggests that income levels may be correlated to purchase decisions and likely had some influence on the decision-making process regarding eventual price paid for the devices as those with lower incomes seek lower price devices. It is also interesting that those who paid less than the median for prescription hearing aids has similar incomes as those who paid above the median price for OTC devices, further validating the influence of income on cost factors associated with amplification systems.

The MTS25 looked at income levels as compared with adoption rates for hearing aids. The survey indicates that persons with incomes less than $50,000 have an adoption rate of 29%, while those making $50,000 to $100,000 adopt at 34%, and those with incomes greater than $100,000 have an adoption rate of 35%. Whether these differences are meaningful in terms of delivery and retention of products is difficult to ascertain from the data. For OTC devices, those making less than $50,000 have an adoption rate of 5%, with rates of 7 and 6% for $50,000 to $100,000 and greater than $100,000, respectively. Although the OTC adoption rate across income levels is proportional to prescriptive hearing aids, the low number of persons adopting OTCs makes drawing conclusions about the influence of income level on the decision to purchase this type of device difficult at best.

Individuals who purchased hearing aids in the last 5 years were asked to respond to their satisfaction with various aspects of the device chosen, including (1) the overall value, defined as the quality and/or performance compared with the price paid, and (2) the out-of-pocket costs. Respondents were asked to respond on a seven-point Likert scale where “1” is very dissatisfied and “7” is very satisfied. The lowest three scores (1–3) were grouped together as “Dissatisfied” with the price or value, while the three highest scores were grouped as “Satisfied.” A score of “4” was labeled as “Neutral” ([Table 6]). As can be seen, the satisfaction metrics associated with the overall value were about the same for those who chose prescription devices as those who chose OTC devices. Differences can be seen in satisfaction with out-of-pocket costs as more individuals were satisfied with the costs associated with OTC devices versus the prescription devices (85% vs. 69%).

Table 6 Satisfaction with the overall value and out-of-pocket expenses associated with amplification devices

	Prescription hearing aid			OTC hearing aid
	Satisfied (%)	Neutral (%)	Dissatisfied (%)	Satisfied (%)	Neutral (%)	Dissatisfied (%)
Overall value	83	11	6	80	13	7
Out-of-pocket costs	69	16	15	85	11	4

 

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Future Plans

The MTS25 asked non-owners of hearing aids: “When, if ever, are you likely to purchase a hearing aid?” About one-third (36%) of the individuals with self-reported mild to moderate hearing loss indicated they would be purchasing hearing aids in the next 7 years, 11% would be purchasing in 7+ years, 38% did not have a sense when they would purchase hearing aids in the future, and 15% indicated they had no plans to purchase hearing aids ever. These numbers are consistent with the commonly understood delay of 7 to 10 years in seeking care for persons with hearing loss. For individuals with more extreme hearing loss, one-third (32%) expect to purchase hearing aids within the next year, and another 17% within the next 2 to 7 years. Similar to those with mild–moderate losses, 31% did not have a time frame to purchase hearing aids and 14% indicated they would not be purchasing hearing aids in the future. The paradox for this data is that though many of those with extreme self-reported hearing loss appear more likely to seek help soon, the data does not indicate how long these individuals have been delaying seeking care. For those individuals who report a plan of seeking care within the near term (next 3 years), 62% indicated they plan to pursue prescription hearing aids and 18% plan on getting OTC devices. About 20% were unsure of what they would purchase. The decision regarding which type of device to purchase varied by income level with those choosing prescription hearing aids having higher average incomes than those planning on choosing an OTC device ($88,800 vs. $75,800 respectively).

When selecting where to purchase a hearing aid, the majority of individuals surveyed indicated they would be seeking assistance from a hearing care provider. Among the reasons given for making this choice were the desire to compare and select the device, the appeal of expert advice, or the need for one-on-one service. For those choosing this pathway, only 4% cited financial reasons (works with my coverage/insurance) as a reason. Conversely, financial reasons were more likely to be cited as reasons for choosing other pathways to access hearing care. For those who would likely choose online with remote assistance from a hearing care provider, financial reasons were cited 11% of the time. Those who would choose to get a device from a store or pharmacy without assistance cited financial reasons 21% of the time, and for those who would choose the online pathway, cost was a factor for 13% of respondents.

With regards to insurance coverage for hearing aids, 41% of non-owners believe they have insurance coverage for hearing aids while 27% believe they do not have coverage. About 32% of respondents were not sure of their coverage. The top source of coverage available to non-owners are Medicare Advantage programs (42% of non-owners with coverage), followed by private insurance or HMOs, e.g., TruHearing, Epic, etc. at 27%, and Medicaid at 21%. Others indicated they believe they had coverage through the VA, military, a union, or employer plan. These sources of coverage are similar to previous MarkeTrak surveys, particularly for Medicare Advantage programs.

 

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Conclusions

Owners of prescription hearing aids tend to be older, white, retired, with higher average and median income levels, and nearly half had a college degree. Conversely, owners of OTC devices were generally younger, still working, included more non-white individuals, had lower average and median income levels, and only about one-third had a college degree. Non-owners are demographically similar to those with OTC devices.

Survey respondents often conflated hearing care with hearing aids, citing the cost of the aids as a reason not to get a hearing test. This is consistent with the findings of McMahon et al[6] who found that older adults equated hearing care with purchasing hearing aids. Whether this perspective leads to the delay in accessing care or to the use of OTC devices is unknown.

Individuals choosing OTC hearing aids paid approximately 10% of the price of prescription devices, even though some OTC devices reportedly had a price of $3,000 or more. The difference in cost factors across prescription devices, and between prescription and OTC devices, may be due, in part, to the associated service being bundled within the price of the prescription hearing aids. This review did not address outcomes, satisfaction, warranties, follow-up care, etc. even though these may be equated with the financial decisions made by individuals seeking hearing care. Nonetheless, it is highly likely that the price points discussed herein do not take into account the bundling of services. The MTS25 did note that 80% of respondents paid a price that included both the device and the associated services.

Financial considerations continue to be one of the driving forces in decisions regarding accessing and using hearing care services. A review of financial factors from the MarkeTrak survey of 2022 concluded there were individuals who chose not to pursue hearing care due to constraints such as income levels, insurance coverage, or out-of-pocket expenses.[7] These same factors are evident in the MTS25 results. Persons with higher incomes are more like to get their devices through prescription hearing aid dispensing practice, and to acquire devices that are higher priced. Those with lower incomes are more likely to choose less expensive options, both for location (e.g., online) and device cost. Persons who opt for prescription hearing aids often cite the potential to use their insurance coverage. OTC owners are more often motivated to visit a place that has inexpensive hearing aids or offers special deals. Despite these differences, the majority of owners of hearing aids, both prescription and OTC, are satisfied with the value received and the out-of-pocket costs.

 

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Conflict of Interest

None declared.

• References

• 1 National Academies of Sciences, Engineering and Medicine. Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Washington D.C: The National Academies Press; 2016
• 2 Warren E, Grassley C. Over-the-counter hearing aids: the path forward. JAMA Intern Med 2017; 177 (05) 609-610
• 3 Zwolan TA, Schvartz-Leyzac KC, Pleasant T. Development of a 60/60 guideline for referring adults for a traditional cochlear implant candidacy evaluation. Otol Neurotol 2020; 41 (07) 895-900
• 4 De Cos V, Gibson M, Li M. , et al Audiometric outcomes of auditory brainstem implantations during vestibular schwannoma resection in NF2 patients. J Neurol Surg B Skull Base 2024; 86 (01) 6-12
• 5 Census US. Table A-2. Households by total money income, race and Hispanic origin of householder: 1967–2019. Accessed July 12, 2025 at: https://www2.census.gov/programs-surveys/demo/tables/p60/270/tableA2.xlsx
• 6 McMahon CM, Mosley CL, Pichora-Fuller MK. , et al Older adults' perceptions of current and future hearing healthcare services in Australia, England, US and Canada. Public Health Res Pract 2021; 31 (05) 3152128
• 7 Windmill IM. The financing of hearing care: what can we learn from MarkeTrak 2022. Semin Hear 2022; 43 (04) 339-347

Publication History

Article published online:
03 October 2025