Keywords
hearing aids - hearing aid adoption - adoption rate
With changes in service delivery models, regulatory policies, research, and coverage
landscapes, hearing health continues to innovate and evolve, amplifying both media
and research interest in the sector. These service delivery models and regulatory
policies have merged with the introduction of over-the-counter (OTC) hearing aids
in the United States (U.S.), alongside evolving coverage policies for both OTC and
prescription (or “traditional,” used interchangeably in this article) hearing aids.
Running parallel to accessibility policies is a growing body of research and public
attention to hearing loss comorbidities. Notably, these include a relationship between
untreated hearing difficulty and cognitive impairment and dementia, social isolation,
and overall health and quality of life, including mental, emotional, and physical
well-being.
Hearing loss is a global health concern, but there are distinct drivers, adoption
rates, and access pathways as illustrated by consumer sentiment and behavior surveys
administered in multiple regions. This article examines the similarities and the differences
in select hearing aid market in three countries: the United States, France, and Germany.
Market studies have been conducted in these jurisdictions by the U.S.-based Hearing
Industries Association (HIA) and the European Hearing Instrument Manufacturers Association
(EHIMA) in Europe and beyond. Information on markets not included in the discussion
of this article are available through the EHIMA website.[1]
Although conducted separately, there are multiple areas of corresponding longitudinal
data across the MarkeTrak and EuroTrak surveys (survey methodology and administration
are described in more detail below). These areas include, but are not limited to,
adoption rates, satisfaction, self-reported hearing difficulty rates, and more.
The three markets that are reviewed in this article have different delivery systems
for hearing aids and are highlighted for the purposes of illustrating additional trends
in these different hearing health models. The U.S. market includes multiple delivery
pathways, including a large private pay segment, increasing coverage options through
programs such as Medicare Advantage and health insurance policies, and robust U.S.
Veteran access to hearing health services and treatment provided by the government.
Germany and France, on the other hand, have a highly developed socialized hearing
health system. The system in France is primarily a reimbursement system, in that covered
participants pay out-of-pocket for medical costs and are reimbursed by the insurance
system (Assurance Maladie). Under this system, there is also a link between their insurance card and the reimbursement
system leading to quicker refunds. The German system is paid for by a combination
of statutory health insurance (Gesetzliche Krankenversicherung) and private health insurance (Private Krankenversicherung). The public system is funded by a shared 14.9% contribution from the employee and
employer, while the private insurance system has additional premiums paid by the individual.
Although these differences exist, there are many commonalities in hearing difficulties
as well as patient perceptions about hearing aids across these three countries, which
makes their comparison interesting and valid.
Methodology
The specific methodology for MarkeTrak 2025 (MT25) can be found in the article by
Dobyan and Kihm[2] in this issue. The EuroTrak surveys for France and Germany were fielded by an external
partner, Anovum, in 2025, with results recently published. The data for France include
over 14,000 individuals, with over 1,300 responding as having hearing difficulty.
Of those, 705 identified as hearing aid owners and 599 as non-owners. The data for
Germany have over 13,000 individuals, with over 1,300 reporting hearing difficulty.
Of those, 663 identified as hearing aid owners, and 657 as non-owners. The data for
all three surveys (U.S., France, Germany) were constructed and weighted to represent
the overall population of the country with respect to age, income, and gender.
Self-reported Hearing Difficulty
Self-reported Hearing Difficulty
The overall self-reported hearing difficulty for the U.S. in 2025 was 9.1%, which
represented a decrease from MarkeTrak 2022[3] (10.2%). Both France and Germany reflected similar decreases as shown in [Figs. 1] and [2]. There are multiple assumptions for the decrease, one of which may be improved attention
to hearing awareness and use of hearing protection for both workplace environments
and social situations (e.g., concerts, use of earphones or earbuds at high volume),
as global awareness campaigns continue to promote noise prevention messages.
Figure 1 Self-reported hearing loss for the U.S. across surveys.
Figure 2 Hearing loss prevalence in Germany and France for those over 18 years of age by year
of survey.
Another interesting trend in MT25 is the increasing rate of hearing loss with age
as shown in [Fig. 3]. The number of individuals with hearing difficulty increases sharply after the age
of 55. This has a similar pattern to global hearing difficulty rates. Although age-related
hearing loss may account for some of the increased rates for those over 55, another
factor may be environmental and work-related noise exposure. For many in this age
group, their working careers began during a time with limited regulations on workplace
noise exposure. This was true for all three jurisdictions (U.S., France, Germany)
as this was also a time of increasing manufacturing base in all three. Also, recreational
exposure due to concerts and the use of power equipment such as chain saws, lawnmowers,
etc., could contribute to increased hearing difficulties.
Figure 3 MarkeTrak 2025 prevalence of self-reported hearing loss by age.
Adoption Rates
Adoption rates for hearing aids have steadily increased since 2000 in all three markets
as shown in [Fig. 4]. In the U.S., the adoption rate for hearing aids (including prescription and OTC
but excluding implants) rose from 22% in 2000 to 39% in 2025. Pivoting to Europe,
the adoption rate in France increased from 32 to 47%, and in Germany, the rate rose
from 30 to 55% from 2000 to 2025. Notably, across all three surveys (U.S., France,
Germany), there were increases in the adoption rate of the lower age groups (ages
44–64). This may be the result of increased media attention and awareness of the importance
of hearing health, motivating more individuals to identify and address hearing loss.
Additional discussion of adoption rates can be found in Jilla and Jorgensen.[4]
Figure 4 Adoption rates by country shown by year of survey.
Binaural Rates
One of the more stable data points is the binaural fitting rates for all three countries.
In the 2025 surveys, the rates range from 74% in Germany, 74% in France, to 83% in
the U.S. (the U.S. percentage only includes prescription/traditional hearing aids,
not OTC or implants). All three (U.S., France, Germany) tracked in the mid-70% over
the previous two surveys.
Satisfaction with Devices
Satisfaction with Devices
An essential data point in assessing the hearing health market is the satisfaction
of users with the devices they own and wear.[5]
[Fig. 5] illustrates the satisfaction of hearing aid owners with their traditional (or “prescription,”
used interchangeably with “traditional” in this article) hearing aids. As OTC devices
are not widely available or used in France or Germany, data on prescription devices
were compared. Satisfaction remains remarkably high in all three markets at 80% or
higher, with the U.S. reporting 82%, France reporting 83%, and Germany reporting 85%.
Since 2015, the German market has shown a substantial increase in satisfaction.
Figure 5 Hearing aid satisfaction rates among current owners over time by study.
Satisfaction with the Hearing Professional
Satisfaction with the Hearing Professional
For traditional or prescription hearing aids, the hearing professional plays a critical
role in terms of fitting and follow-up care. The hearing professional continues to
receive high ratings in all three markets, with ratings at or above 90%. It is notable
that in the U.S. market, with the availability of OTC hearing aids, the professional
is still valued.
Reimbursement and the Cost of Devices
Reimbursement and the Cost of Devices
The U.S., France, and Germany have very different models for covering the cost of
hearing aids and related services. Throughout most of Europe, the cost of the hearing
aids and services provided by licensed hearing professionals are covered by the health
system. For example, in France, 90% of respondents reported having total or partial
coverage for hearing aids and/or services, while in Germany, 92% of respondents reported
total or partial coverage. The U.S. market reports lower rates of coverage due to
the statutory exclusion of hearing aids from traditional (or “original”) Medicare,
a program that provides health coverage for adults aged 65 years and older. However,
it is important to note that although U.S. coverage rates may be lower than that of
other countries, coverage has increased when looking solely at the U.S. market. In
MT25, approximately 58% of respondents indicated they had some third-party assistance
covering the cost of the devices and services. For additional information, see Windmill[6] in this issue.
Benefits of Hearing Aid Purchase
Benefits of Hearing Aid Purchase
A closely tracked data point in MT25 focuses on the time it takes for an individual
to take steps to address hearing loss (e.g., see a professional, purchase first hearing
aid, etc.). Of note, the time it takes for individuals to purchase their first hearing
aid after becoming aware of hearing difficulty has remained steady at 4 years (consistent
with MT2022). An interesting question aligned with this insight is whether respondents
feel that they should have got their hearing aids sooner. In all three markets (U.S.,
France, Germany), nearly two-thirds of respondents agree that they should have obtained
hearing aids sooner ([Fig. 6]). The responses were 66% in the U.S., 63% in France, and 64% in Germany. By understanding
consumer hesitations, professionals and industry can create communications to combat
myths about hearing health and hearing aids while emphasizing the research linking
regular use of hearing aids to better overall health and well-being. This multi-country
snapshot highlights motivating factors for getting hearing aids sooner, including
the top two reasons across all three jurisdictions of improved social life and better
mental and emotional health (shown in [Fig. 7]).
Figure 6 Percentage of hearing aid users reporting they should have obtained hearing aids
sooner.
Figure 7 Top reasons owners reported for getting aids sooner.
Brand Awareness
In MarkeTrak 2022, awareness of the brand of hearing aids among hearing aid owners
decreased to 30%. However, MT25 showed a rebound in brand awareness, with 47% of owners
reporting that they know the brand of devices they wear, a rate similar to those seen
in 2015 and 2019. Brand awareness in France and Germany has been steady at 45 and
48%, respectively. These estimates are slightly higher than in 2022. One potential
reason for higher awareness in Europe may be tied to the delivery system and the requirement
that hearing professionals offer multiple brands in various markets by the health
insurance system. This requirement may provide an opportunity to discuss the brand
more in depth at each cycle of the hearing aid trial program, thereby highlighting
brand awareness.
Non-owners Not Proceeding with Fitting
Non-owners Not Proceeding with Fitting
All non-owners included in the survey data for the U.S., France, and Germany responded
that they had self-reported hearing difficulty; however, they had not yet taken action
to address hearing loss and/or adopt hearing aids. To better understand the rationale
for non-action, questions were included to provide insight for hearing professionals
that could improve the adoption rate among non-owners. The top reasons for each market
were:
-
U.S.: Cost, insurance coverage, hearing loss not severe enough.
-
France: Physician opinion, hearing professional opinion, uncomfortable to wear.
-
Germany: Uncomfortable to wear, hearing loss not severe enough, hear well enough in
most situations.
In the U.S. and German markets, respondents mentioned their hearing loss is not severe
enough to use hearing aids. This misperception causes many individuals with hearing
difficulty to delay obtaining devices and receiving the benefits that hearing aid
owners report (i.e., improvement of social and mental well-being).
Conclusions
MarkeTrak 25 and EuroTrak 25 provide conclusive data on the positive impact that hearing
aids can have on several aspects of overall well-being (including emotional, mental,
and physical). As noted, these markets have different delivery and coverage systems;
however, several aspects are strikingly similar. Among all three countries, the percentage
of self-reported hearing difficulty ranges between 9 and 13%. Binaural fitting rates
are also stable and consistent across these jurisdictions with the U.S. rate at 83%
and France and Germany ranging from 70 to 75%. Both hearing professionals and hearing
devices receive high satisfaction ratings in all markets. The expanded use of remote
and self-fitting has increased adoption and the ability of hearing professionals to
provide services beyond the “clinic.”
It is encouraging that over 60% of hearing aid owners report they should have obtained
devices sooner. With respect to non-owners, both motivating factors for owners and
stated reasons for not proceeding in the hearing health journey may provide a roadmap
for additional education and awareness efforts that may resonate with non-owners.
These highlights may include the positive impacts of hearing loss solutions, such
as improved communication, better quality of life, and less fatigue, all of which
can be supported by wearing hearing devices.
Although OTC devices were first introduced in the U.S., they are beginning to become
available in other markets in Europe. As we learn more about this product segment,
it could provide useful information about consumer trends that may expand distribution
and adoption of all hearing devices in other markets.
