A Hearing Aid Buyer’s Guide
Let's face it. Choosing a hearing aid can feel daunting. But, when equipped with the right tools and resources, you can find a hearing aid that's right for your needs and budget to improve your hearing and quality of life. In this guide, we'll cover everything you need to make an informed decision and provide additional resources to help you along the way!
We've researched and reviewed the industry's top providers to help you find the best hearing aid for your needs.
Our detailed, hands-on reviews of the industry's most popular hearing aids will give you an inside look at our experience with the company's products and our key takeaways.
Want a closer look at pricing and value? Visit our pricing pages for these popular providers to learn more and learn how to get the best deal on your hearing aids.
With so many hearing aids on the market, comparing providers side by side is a helpful way to determine which device is best for you. If you're struggling to pick between two providers, take a look at our comparison pages.
Whether you're looking for step-by-step how-to guides or resources on Medicare coverage for hearing aids, we've got you covered with a wide range of additional hearing aid resources.
I began practicing audiology in 1992. Over those years I've seen thousands of patients and been actively involved in consumer groups for hearing loss. I wrote this Buyer's Guide to accomplish a few things:
First, I'd like more people to seek help for hearing loss. Millions of Americans (most of them seniors) suffer from hearing loss, and for nearly a century a discouraging fact remains true: just 20 percent of people who would benefit from a hearing aid wear one.1 In my experience, a big reason for that is a lack of knowledge. This guide aims to address this.
Second, I wanted to open the curtain a bit on the seemingly endless array of options. Just like buying a car, there are hundreds of makes and models to choose from, but if you zoom out a bit, all of them have four wheels, a frame, a motor, and a body. Beyond that, the variables are convenience and style rather than getting to church on time. Hearing aids are much the same.
Finally, I wanted to arm you with some not-so-common tools to weed out the good, the bad, and the ugly in terms of who actually fits these devices on you. To go back to the car analogy, you want a mechanic who won't quit “wrenching” until your ride is purring like a kitten. With a bit of knowledge and healthy skepticism, you can push your “hearing mechanic” to help you hear the best you can.
Before describing what a hearing aid does, I wanted to share an amusing insight of Sam Lybarger, a pioneer in the field of hearing improvement and chief engineer of RadioEar from 1930 until his retirement 43 years later.2 When asked to describe a hearing aid, he said “It is a product that one puts off buying for ten years after he needs it but cannot do without it for thirty minutes when it has to be serviced.”3
Hearing aids can significantly improve the lives of those who have damaged inner ear sensory cells. This type of hearing loss can be a result of aging, illness, or injury and is not reversible. Hearing aids are electronic devices you use in or behind your ear to make sounds louder and easier to understand. They have one or two microphones to pick up sound, a digital amplifier to make sound louder, and a receiver that sends the sound into the ear canal.
There are several types of hearing aids, and each person should choose one that fits their hearing loss level and lifestyle.4
Receiver In Canal (RIC) – Also called Receiver in Ear (RIE), this is the most popular style. It uses a thin wire and a snug silicone “dome” or earmold to attach to the ear.
Mini Behind the Ear (mBTE) – Similar in size to the RIC, but the speaker is inside the body of the hearing aid. Sound travels to the ear through a “slim tube” to a dome or earmold.
Behind the Ear (BTE) – In this style, the electronics components are housed in a case that fits behind the ear. Tubing connects the case to an earmold inside the ear. This can be a good choice for those with significant hearing loss.
Completely in the Ear (CIC) – These hearing aids fit tight inside the ear and are the least visible type. The small size prevents it from being as effective in eliminating background noise or having volume adjustment.
In the Canal (ITC) – Custom-fitted, this style fits partially in the ear canal. It is slightly larger than CIC so it can accommodate more features like a directional microphone.
In the Ear (ITE) – All electronic parts are housed in a case that sits in the outer ear. These hearing aids are large enough to have volume control and longer battery life.
Now that you have some general knowledge about the hearing aid types from the previous section. Take a moment to check out this video on the Types of Hearing Aids from the Senior Living YouTube Channel. In this video, we cover all of the major hearing aid types, how they work, and some of their functionalities. Hear all of this information directly from our resident audiologist Brad Ingrao, Au.D.
The human hearing system has four parts.
Many describe our ability to hear in terms of how much we can hear (sensitivity) and how accurately we can hear (discrimination). We separate hearing ability into which parts of the hearing mechanism are affected (type of loss), as well as how loud sounds need to be for you to hear (severity of loss).
At SeniorLiving.org, we want to provide you multiple formats to learn about senior information, so we put together this video on the Early Signs of Hearing Loss on our Senior Living YouTube channel. Check it out, and learn whether or not you have some of the telltale signs of hearing loss. As an added bonus, you will get to hear some insights from Audiologist Brad Ingrao, AuD.
Now that we know a little about what might cause hearing to go south in general, let's talk about how to find out if yours isn't up to snuff.
People with hearing loss tend to exhibit one or more of the following behaviors:
If you do any of these things more often than you change the oil in your car, you should have your hearing evaluated. There are two basic forms of checking out your hearing: a screening and an evaluation.
Quick Tip: Are you looking to take a hearing test for the first time but don't know where to start? Visit our guide on how to take a free online hearing test.
Hearing loss and its treatment are a marathon, not a sprint. The relationship you have with your provider is, in my experience, much more important than the specific credential.
Both versions of the hearing test should include the following:
Additional tests that you may have would include the OAEs mentioned earlier and a Speech in Noise test. Both are considered part of best practice and are worth inquiring about when you make your appointment.
Making an appointment to visit the doctor can be stressful, but going to your first audiologist visit doesn’t have to be! Audiologists are trained professionals who specialize in hearing and the ear, and they can provide you a thorough assessment of your hearing loss. By the end in terms of your hearing and your knowledge of your ears, things will be crystal clear. Check out this video from the SeniorLiving.org YouTube channel to learn what to expect during your first audiologist visit.
In general, results for the right ear are displayed in red, and those for the left in blue. Let's look at some typical results of a hearing evaluation.
The results shown here are normal for both ears. The sharp, high peak of the curve indicates normal movement of both the eardrum and the middle ear bones. The position of the peak is consistent with normal Eustachian tube function.
O = Right Ear Air Conduction
< = Right Ear Bone Conduction X = Left Ear Air Conduction ] = Left Ear Bone Conduction U = UCL
Pure Tone Audiometry
These results would be reported as:
Right Ear (Red):
|Quick SIN at 75 dB
SRT is consistent with the average hearing thresholds in the low to mid frequencies (500, 1000, 2000)
Word recognition at average conversational levels (50 dB) is good in the right (84%) but poor in the left (56%)
Word recognition improves in both ears at amplified levels (75 dB) and further improves when both ears are stimulated together (96% in the “B” – Binaural condition).
QuickSIN results suggest mild to moderate difficulty in noise.
The first thing I'd do if this were my patient is to refer them to an otolaryngologist to investigate why the left ear is worse than the right. There are many possible reasons for this kind of asymmetry from very benign to quite serious, so a comprehensive medical evaluation is prudent. In a case like this one, I would usually recommend ordering an MRI.
If all that comes back fine, I would recommend that this person receive custom hearing aids, as well as some additional assistive technology. Let's look at that process and some of the things you should look for when getting hearing aids for the first time.
Yes, currently, you need a prescription to purchase hearing aids. Hearing aids are classified by the Food and Drug Administration (FDA) as medical devices, defined as “any wearable instrument or device designed for, offered for the purpose of, or represented as aiding persons with or compensating for, impaired hearing” [ 21 CFR 801.420(a)(1)]. This definition means that not all devices that amplify sound are technically hearing aids. Devices in this category must be fitted by a licensed audiologist or hearing instrument specialist. This model has historically restricted access to hearing care to a typical work week. Despite incredible advances in technology, this structure may be one reason that only 20 percent of those who could benefit from hearing help get it.
There are several places to buy hearing aids, including audiology clinics, retail chains, VA medical centers, and even online websites that allow you to purchase them in the comfort of your own home! Below is a full list of where you can buy hearing aids:
Hearing aids fall into two major categories and a few subcategories in terms of style or shape. In general, the internal electronics are the same across styles of a given model, but some features may not be available in certain styles due to size. The currently available styles are as follows:
|Style Name||Hearing Loss Range||Picture|
|Invisible In Canal (IIC)||Mild to moderate|
|Completely In Canal (CIC)||Mild to Moderate-to-Severe|
|In The Ear (ITE)||Mild to Severe|
|Receiver In Canal (RIC)||Mild to Severe|
|Behind The Ear (BTE)||Mild to Profound|
|Extended Wear||Mild to moderate|
*All images are courtesy of Phonak
As you can see, there are a lot of options when it comes to the size and shape of hearing aids. Most people would prefer not to advertise their hearing loss, so those looking for very discreet hearing aids should see if the IIC or Extended Wear options are appropriate. Unless you are completely bald, the RIC style, if color-matched to the hair, is nearly invisible in most cases. Hearing aids that look good (or at least acceptable) are very desirable, but it's essential to realize that going that small means you will most likely have to compromise on some of the features below.
Current hearing aids are miniature computers that process sound digitally in real-time. They offer many features that can be confusing. To make it worse, there is no standard lingo for them. Instead, each manufacturer has its own catchy names. Below are the most common hearing aid features described in as generic terms as possible.
Hearing aids, like all electronics, need power to operate. This function was traditionally accomplished with a small “button” battery. Current versions of these use a “Zinc-Air” technology that provides between 2 and 14 days of use depending on the size and power requirements of the hearing aids. Zinc-Air batteries cost $1 each (less in bulk or online) and use a standard color-code on the labels:
In the last few years, rechargeable options have become widely available. The most common in new hearing aids is Lithium-Ion. This is available in RIC and BTE hearing aids and provides a very convenient way to power your hearing aids. Most current devices will fully charge in a few hours and provide a full 24 hours of use time. LiOn hearing aids generally come with a desktop charger, but travel chargers are available with secondary power packs that allow you to charge your devices a few times on the road.
Hearing aids will generally advertise how many “channels” they have. Think of these like a graphic equalizer on a high-end stereo. It seems logical that more channels will provide a better match to your hearing, but it really depends. The number of channels is less important than the location of those channels compared to the shape of your audiogram since the fitting is based on that curve. If you have a gently sloping loss, a device with 8 or 10 channels might be fine. If your loss steeply drops off in the higher pitches, more channels will allow the fitter to match that curve better.
Everyone, even those with perfect hearing, has more difficulty understanding speech in background noise. Directional microphones lessen that difficulty somewhat. The degree to which directional microphones allow you to hear successfully in noise depends on the amount of difficulty you have (as shown on your Quick SIN test) and the level of noise in the environment. The difference between the loudness of speech and noise is called Signal-to-Noise Ratio (SNR) and is measured in deciBels (dB). The very best directional microphone systems available on hearing aids can improve SRN by about 15 dB. If the SNR of the room is -20 (room noise is 20 dB louder than speech), then the SNR reaching your brain will still be -5. If your Quick SIN SNR loss is 2 dB, then you're golden. If your SNR loss is 10 dB, then you are still 5 dB in the hole and will struggle even though the hearing aids are performing as designed.
In almost 30 years of fitting hearing aids, I rarely encounter patients who hear their best in the real world of noise with just their hearing aids. Fortunately, there are tools to help.
Nearly all ITE, RIC, and BTE and some CIC hearing aids can connect wirelessly to external devices, collectively called accessories. The idea is to overcome the challenges of distance, reverberation and background noise by capturing the desired signal (speech, music, TV, etc.) in an ideal condition, and beam it to the hearing aids across distances ranging from 30 to 80 feet depending on the wireless technology. Wireless hearing aid accessories fall into a few categories.
These small devices clip onto the speaker of interest and capture their speech at an SNR of up to +24 dB. This optimized signal is then beamed to the hearing aids so that regardless of the SNR of the room, you hear as if your hearing aid is as close to the speaker as your remote microphone. Most of the current remote microphones can sense their position and automatically adjust the microphone sensitivity. They range in price from a few hundred to over a thousand dollars but make a significant difference. In my practice, I demonstrate and measure the effect of remote microphones for anyone with an SNR loss on the Quick SIN over 10 dB.
Hearing well on the television depends on the size and shape of the room, whether you've updated the shag carpet you installed in the 70s, the quality of the speakers, and the recording quality of the program. A media streamer neutralizes all these variables by taking a direct, hard-wired audio signal from the TV or cable box (RCA or Digital TOSLink) and then beaming that signal to the hearing aids, just like the remote microphone. Most are easy to set up, and once they are, they either automatically connect, or you just tap a button on the hearing aid or use a smartphone app to activate streaming.
Even the largest hearing aids have small buttons. Those with wireless capability offer the option to control volume, programs for different listening situations, and streaming using either a smartphone app or a dedicated remote control. The stand-alone remote controls are usually the size of a key fob, and they either use a long-life watch type battery or are rechargeable.
Almost all wireless hearing aids offer a smartphone app. These apps are generally available on both Apple (iOS) and Android platforms and are provided free from the manufacturer. In addition to basic hearing aid controls like volume and program selection, some apps offer geotagging. This functionality serves two purposes. First, it allows you to fine-tune the hearing aids and accessories in specific settings, like your favorite bistro, then have them automatically go to those settings every time you walk in the door. Secondly, geotagging allows the app to “find” a misplaced hearing aid.
This technology is quite old, making its first appearance in hearing aids in the 1930s. Telecoils are electromagnetic receivers that pick up sound transmitted from hearing aid compatible telephones and special public address systems called “hearing loops.” Hearing loops are becoming more popular around the U.S., and using them provides the same benefit as a remote microphone without having to clip anything on the presenter. Telecoils are recommended in all hearing aids by the Hearing Loss Association of America8 and are so effective that several states require a signature indicating that a discussion of them occurred during your hearing aid consultation.
If a hearing aid can use wireless accessories, it probably also can stream directly from your iPhone, iPad, etc. All of the “big 6” provide at least one “made for iPhone” option, and Phonak has a way to also connect to Android devices in their Marvel line of products. Direct streaming uses the Bluetooth LE technology and can enhance your ability to understand on the telephone, but also to hear anything on that device better, such as streaming media (YouTube, Netflix, etc.) and alerts.
Modern hearing aids, particularly Lithium-Ion rechargeable models, have all been designed to resist moisture and dust. They generally are rated IP67 or IP68, meaning they are essentially impervious to dust and can withstand splashes and even submersion in up to 3 feet of water for several minutes. While not technically “waterproof,” they can hold their own in the gym or humid climates.
In addition to the above “hardware” features, hearing aids often have several software abilities that may help you hear better.
After you figure out that you need hearing aids and the features you want, it's time to pull the trigger and buy them. But it's a heavy lift. Hearing aids can be your third largest purchase after your home and vehicle. Prices vary widely, but a few commonalities exist.
By law, all hearing aids sold in the US must come with at least a 30-day return option. Some may call this time a trial period, but it’s your right to cancel the sale if you find the devices unsatisfactory. There will almost universally be a small fee retained by the dispenser, which is detailed in the sale agreement and regulated state but state. Some providers will offer a more extended return option to separate themselves from the competition.
As suggested above, the more bells and whistles, the higher the price. Medicare does not cover hearing aids at all, but some Medicare Advantage plans offer a hearing aid benefit. This coverage is typically available only through a limited number of contracted providers, but it can offset the price of hearing aids significantly. The Hearing Loss Association of America and AARP are actively working on adding hearing aid coverage to Medicare.9
Most Medicaid programs cover hearing aids and follow-up services, usually in the “Standard” tier of technology. The specific criteria for eligibility vary from state to state.
There is a wide range of coverage for hearing aids among private third-party insurance carriers. Some provide direct payment to providers at or near “street price.” The provider usually needs to be contracted with the insurance company and may have to submit positive evidence of benefit (outcome measures) and an extended return option. Others provide a fixed allowance per ear within a given benefit cycle (usually three years) that can either be paid directly to the provider or reimbursed to the patient after they have paid in full themselves and submitted a claim.
Large warehouse membership companies like Sam's Club and Costco have been offering hearing aids to their members for many years. Both sell only to their members, and the products offered generally are either modified “big 6” products or, in the case of Sam's Club, manufactured by a smaller company (Lucid Hearing) exclusively for Sam's.
The advantage to these outlets is that due to their buying power, they can purchase the instruments at a much lower price, and then pass those savings to their members. There's a lot of chatter among traditional dispensing professionals about the good and bad of these options, but having looked at both, it still comes down to the quality and attentiveness of the person fitting the instrument. Both stores employ both audiologists and hearing aid specialists and offer quality products and follow up care.
Pro Tip: If you're worried about the cost of hearing aids, there are a few ways to reduce the costs. Head to our guide on how to get free hearing aids for more details.
Another way to get more bang for your buck is to get your hearing aids from a community clinic at an audiology training program. Yes, students will see you, but licensed audiologists will provide direct supervision throughout the process. The prices tend to be a bit lower than the local average, and because the students are learning, you may get a bit more time at each appointment. The potential downsides include a rotating group of providers (some people like seeing the same professional every time they need care) and the reality that most university clinics shut down or reduce access between semesters.
If all of the above still make hearing aids outside your budget, there are financing options such as Care Credit and a few charitable options like the Starkey Hearing Foundation.10 Some Lion's clubs refurbish and donate hearing aids to needy community members.
After making your purchase, you need the device fitted and programmed to your specific hearing needs. In some cases, the office has stock RIC-style instruments that you can walk out the door with on the same day as your test. More commonly, the hearing aids you select will be ordered, and you will return for fitting anywhere between two days and a few weeks.
At the fitting appointment, the following should occur:
If these are your first hearing aids, these target values will probably sound too loud. Ask your provider to verify the hearing aids at target and then reduce them to comfort. Nearly all hearing aids can activate a timer so that the hearing aids return to the target values over one or two months (auto acclimatization). This feature allows you to get used to the hearing aids gradually, but it also ensures that you don't stay at the sub-optimal amplification levels longer than necessary.
Next, you should learn about each of the features you and your provider selected. Be sure you understand all the controls, how to change batteries or charge the devices and what each program and accessory does, and when to use them. Practice inserting and removing the devices as many times as you need until you feel comfortable and independent.
Ask your provider to complete a standard outcome measure with you, such as the Abbreviated Profile of Hearing Aid Benefit (APHAB) or the International Outcome Inventory for Hearing Aids (IOI-HA). Both integrate into the “Noah” hearing aid framework that most providers use or are available for download. In addition to Probe Microphone Measures, the use of an outcome measure is part of recommended best practice. This measure will be the “unaided” baseline. Just before the end of your return option, arrange to meet and complete the “aided” section of the outcome measure. If the fitting is appropriate and successful, you should see measurable improvement compared to the baseline. Anytime you add major changes or new accessories to your hearing system, there can be additional cycles of this process.
As noted earlier, hearing aids feature protections from the elements, but the part that goes in your ear (the speaker) is susceptible to damage or clogging. Your hearing aid will come with some “wax guards” that you will change every month or so, but sometimes, something else goes wrong under the hood, and the device needs to go into the manufacturer for service.
Hearing aids should come with at least a one-year warranty that covers repairs as well as a one-time loss and damage claim. Additional years of service are generally available to purchase either in the form of additional years of warranty from the manufacturer or as a “service contract” from the provider. These packages usually include quarterly cleanings, batteries, and a limited number of adjustments.
If properly fitted, hearing aids shouldn't need many adjustments, but it's important to specify exactly how many come in the price and how much additional service might cost. Hearing aids have historically been sold in a “bundled” models where a higher upfront cost is justified because all service after the sale is “included.” It's prepaid, and if you don't need a lot, or are an experienced user, it's difficult to see a positive return on that investment. To combat that, some providers offer an “unbundled” model. The initial payment is for the hearing aid, and an itemized list of services like fitting, Real Ear measurement, and orientation. A few adjustments are included, but then subsequent visits are handled a la carte. Both models work for many people, and neither is inherently better. Ask which your provider uses and why. If that matches your needs, go for it. If not, shop around and ask hard questions.
As you can see, getting hearing aids is not as simple as grabbing a pair of cheaters off the rack at the drugstore. Neither is it an insurmountable task. Hearing is one of our primary senses because it connects us with the thoughts and emotions of those in our lives. As such keeping it tuned up is worth the effort to do some research, ask hard questions, and be patient to find a solution and provider that matches your needs and personality.
After the devices hit your ears, a process or neural rewiring begins that can take up to three months, so be patient. Seek the advice of others who have walked in these new and louder shoes. On the lighter side, remember that the volume control on your new hearing aids give you the superpower of reducing the rhetoric and amplifying the awesome!
Hearing aid adoption
Hearing aid market
As a practicing audiologist since the 1990’s, Brad Ingrao, AuD has fitted thousands of hearing aids to seniors and people of all ages. Brad is the Official Audiologist for the International Committee on Sports for the Deaf and a well-known speaker. Dr…. Learn More About Brad Ingrao
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