In 2022, the Biden administration finalized rules permitting hearing aids to be sold over the counter (OTC) to millions of Americans with mild to moderate hearing loss. The rules—which effectuated the bipartisan 2017 Over-the-Counter Hearing Aid Act—led to a significant drop in the price of hearing aids. Before the 2022 rules, prescription hearing aids averaged $4,744 per pair; today, OTC hearing aids cost a few hundred dollars or less. But despite the sharp drop in price and the widespread availability of OTC hearing aids,
consumer uptake has been much slower than anticipated. It appears that deregulating the hearing aid market to allow OTC sales has been a necessary, but insufficient, step toward widespread consumer adoption and the associated health benefits.

This report explores why reforms to date have not produced widespread adoption and what steps policymakers and private actors can take to spur further use. Specifically, it provides an overview of the extremely consolidated hearing aid market; outlines barriers to broader consumer adoption, including consumer concerns about purchasing a medical device without the assistance of a licensed professional, retailer concerns about such consumer reluctance, and a widespread lack of insurance coverage for OTC hearing aids; and recommends policy solutions, including reversing the vertical integration in the hearing industry and eliminating its inherent conflicts of interests while expanding insurance coverage, particularly within Medicare.