OTC vs. Prescription Hearing Aids – Why the Price Gap Is So Big

You need hearing aids. If you’ve got mild to moderate hearing loss, you need to spend only $250-$1,200 for a pair of over-the-counter (OTC) self-fitting hearing aids. But if you’ve got severe hearing loss, be prepared to pay $4,000-$8,000.

Why do prescription (Rx) hearing aids from an audiologist cost three to 30 times as much as their OTC counterparts? And why aren’t there OTC solutions for those with severe hearing loss?

While the answer to the first question requires some explanation, the answer to the second question is rather simple.

“The biggest difference between OTC and Rx [hearing aids] is that OTC is limited in terms of loudness,” explains audiologist Abram Bailey, founder and president of HearingTracker.com. “Depending on the model, [OTC hearing aids] may be limited to a few preset gain curves, often adjustable with bass/treble/volume. Rx hearing aids are typically highly customizable and offer professional software for licensed practitioners to make more fine-grained tweaks, and are more often able to give a lot more amplification.”

But, Baily admits, “what you’re paying for is the audiologist/hearing instrument specialist’s time and expertise more than anything when you purchase an Rx device.”

While largely accurate, Baily’s explanation is only the visible part of a large prescription hearing aid iceberg that disguises a great deal of medical expertise and care under the surface.

After speaking with multiple hearing professionals and going through the process with Hearing.com and its prescription Horizon Go 7 IX hearing aids, I found the multiple reasons for the higher pricing of prescription hearing aids completely justifiable.

And yet, there are cheaper prescription alternatives.

How Bad Is Your Hearing?

Before you decide between RX or OTC hearing aids (HA), you first need to determine if you suffer merely from mild to moderate hearing loss that an OTC HA can solve or from severe hearing loss that requires an Rx HA.

First, find a free DIY hearing test.

If you own an iPhone and a pair of Apple AirPods Pro 2 or 3, you can take Apple’s iPhone app hearing test. Or, if you’re an iPhone owner but not an AirPods Pro owner, download the Mimi Hearing Test app for iOS, as long as you own one of the app’s compatible earbuds/headphones.

There are also several free online hearing tests, such as the one on Costco’s Hearing Aid Center website, which I’ll have more to say about later. Or, just do a Google search for “best free online hearing tests.”

Many of these free online tests are offered by prescription hearing aid companies. If you don’t trust the test from an interested party, take tests from multiple sites to confirm your results.

What Is Severe Hearing Loss?

Once you’ve taken one or more DIY hearing tests, the results will usually provide you with a “score” – the level of your hearing loss expressed in decibels. My hearing loss (HL) is around 40-42dB HL, which falls between the “mild” and “moderate” ranges.

How do you know where your hearing loss score falls? Here’s a helpful chart from the American Speech-Language-Hearing Association(ASHA):

Treating anything less than 25dB HL means you just want to hear the TV or your spouse (not necessarily in that order) better. If you suffer only slight hearing loss, you can get away with one of those cheap hearing aids advertised on late-night TV.

OTC hearing aids were designed to address those of you with hearing loss between 26 and 55dB HL. Techlicious reviews as many of these as we can, including:

• Apple AirPods Pro 2
• Apple AirPods Pro 3
• Elehear Beyond
• HP Hearing Pro
• JLab Hear
• Lexie B2
• Sennheiser All-Day Clear
• Soundwave Sontro
• Sony CRE-C20
• Zepp Clarity Pixie

You can find all of our reviews and news on our OTC Hearing Aid page, and new reviews will show up there as we do them.

Audiologists advise that any hearing loss above 50dB HL warrants a prescription hearing aid. Considering the huge cost difference, a more affordable OTC HA will be a tempting choice over an Rx if your hearing loss falls in the murky middle between moderate and severe. Which brings us back to the reasons behind that huge price chasm between OTC and prescription hearing aids.

Why a Prescription Hearing Aid May Be Worth the Higher Cost

First and foremost, the price of prescription hearing aids is not just for the device but includes “lifetime service.”

“Lifetime” doesn’t refer to you or your audiologist’s eventual mortality, however, but to the lifetime of the hearing aids. And sometimes, not even then.

The price for the Rx HA includes audiologist services. An initial exam ensures your hearing loss isn’t simply caused by age or a loud hearing incident such as Pete Townsend’s, but something medical or even surgical, such as nerve, bone conduction, or other physical damage or blockage in your ear, wax buildup, an injury, neurological issues, or additional impaired hearing conditions such as tinnitus or poor speech discrimination. You also may need a hearing aid accessory, such as custom hearing molds or a remote microphone.

According to John Luna, CEO of Sound Business Consulting Services, you should see an audiologist if:

• Your ear has a birth defect or an unusual shape
• Your ear was injured or deformed in an accident
• You saw blood, pus, or fluid coming out of your ear in the past six months
• Your ear feels painful or uncomfortable
• You have a lot of earwax, or you think something foreign could be in your ear
• You get really dizzy or have a feeling of spinning or swaying (vertigo)
• Your hearing changed suddenly in the past six months
• Your hearing gets worse, then gets better again
• You have worse hearing in one ear
• You hear ringing or buzzing in only one ear

Prescription hearing aids’ “lifetime service” usually includes ongoing audiologist counseling, checkups, treatment, hearing aid fittings, adjustments, or retuning, and even replacement hearing aids if outside the initial hearing aid warranty period, typically around three years. Once the hearing aid’s warranty period ends, and assuming the hearing aids are still in working order, you might be charged a nominal fee, probably less than $50, for annual checkups and hearing aid adjustments.

If you need to buy new hearing aids, you start a new “lifetime service” period.

Just make sure you check with your audiologist what, exactly, is and isn’t included in the “lifetime” service.

What Does an Audiologist Test That an App Test Can’t?

In addition to making sure your hearing loss isn’t caused by a medical rather than a simple age-related reason, an audiologist conducts more than app-based tone/volume/frequency tests. The most important of these is for speech discrimination.

“Speech discrimination is your ability to repeat words at least 50% of the time correctly,” Luna describes. Your resulting “speech discrimination score tells you how your brain is taking that information and how it’s using it. If you have mild to moderate hearing loss, you might have 100% discrimination, meaning you can repeat everything. Some people with moderately severe hearing loss can have 80% discrimination. Some people might have severe hearing loss or profound hearing loss and be only 60% or 50% discriminant. They need a product and technology that’s different from what somebody with a mild to moderate hearing loss most of the time.”

These additional and more precise tests mean that an audiologist must more finely – and, if/when necessary, more frequently – and expertly tune a prescription hearing aid to counter the more individualistic issues faced by those with severe hearing loss.

Do Prescription Hearing Aids Cost More to Make?

No, not really. Rx HAs require a bit more R&D and include more sophisticated processing, both of which add a bit more to the device cost. For instance, a prescription hearing aid chip might include neural networks that can process your speech discrimination issues, reduce ambient noise, etc., and marry everything back together.

All this makes Rx HAs more expensive than OTCs – but not five to 10 times more. Overall, according to Luna, the cost of manufacturing a prescription hearing compared to an OTC model “is very similar.”

Also adding to the cost of an Rx HA is how they’re sold.

Rather than the standard OTC mass-market manufacturer-wholesale-retail product sales model, prescription hearing aids require a more specialized sales process, akin to how big pharma sells prescription drugs. Hearing aid makers first must recruit audiologists to sell their hearing aids, then audiologists must sell to customer patients who require more expert fitting and aftercare handholding – especially older patients unfamiliar with smartphones who can have trouble with the prescription hearing aid app, all of which adds to the cost.

Finally, because those with severe hearing loss make up only a sliver of the overall population with impaired hearing, Rx HA manufacturers lose the advantage of volume production enjoyed by more mass-market products.

Why Aren’t There ‘Severe’ OTC Hearing Aids?

There is also a solid medical reason why the FDA hasn’t approved OTC HA options for those with severe hearing loss.

OTC consumers tend to “cheat” on their DIY app hearing tests – not tapping when a sound is heard only faintly – to increase the potential volume of their hearing aids. Shifts of 5dB one way or another at the relatively low amplification levels of an OTC hearing aid can’t really hurt you.

But boosting the already high amplification of hearing aids intended to assist those with severe hearing loss could make a bad situation worse.

“High hearing aid outputs can worsen users’ residual hearing,” Baily warns. “Output limits were added and tightened [by the FDA] to reduce the risk that OTC hearing aids could worsen hearing through excessive or cumulative sound exposure. In a clinic, a professional sets and verifies output so the device rarely, if ever, operates at its maximum.”

Also, given the amount of chicanery practiced by, shall we say, less assiduous OTC hearing aid makers, the FDA limits on OTC hearing aid volumes “is to protect the person from bad actors,” notes Luna. “So, there’s those guardrails that the FDA put in place to make sure.”

Will There Ever Be OTC Hearing Aids for Severe Loss?

Currently, no one is developing OTC hearing aids for people with severe hearing loss. According to Barbara Kelley, executive director of the Hearing Loss Association of America, there was a lot of debate over output level limits when the OTC regulations were being formulated. Those limitations limit potential OTC solutions for those with severe hearing loss.

But, “if you would have told me 20 years ago that I’d be holding my computer, my phone, my TV in my hand, I would have said that was science fiction,” Kelley quips. “Thirty years from now, who knows? Maybe there’s a hearing aid that you just put in your ear [without] the intervention of a hearing healthcare professional.”

Baily believes it may not take 30 years for an OTC hearing aid with higher volume output to appear, not because of advancing technology but because of the potential lack of hearing care professionals. For instance, President Trump’s recent order to eliminate nursing as a profession could dampen entry into the hearing care profession.

“My theory is that [limits on output] will change,” Baily opines, “and eventually put pressure on the industry where there may be a shortage of care. This is all very much in flux, and anything is possible over the coming years.”

In the meantime…

Are There Cheaper Prescription Alternatives?

Yes.

Navigate to Costco’s Hearing Aid Center,and you’ll see prescription hearing aids – not for $4,000 or more, but for $1,700 or less.

Costco achieves its lower prescription hearing aid prices thanks to its volume buying power. If you make an appointment, you’ll even get examined by an audiologist; if you walk in, you’ll be tested by a clinician if an audiologist isn’t available. As with an audiologist, the Costco Rx hearing aids also include “lifetime service.”

Costco carries over-the-ear models from well-respected Rx hearing aid brands, including Jabra, Philips, Sennheiser, and the Rexton brand from WSA Audiology (the parent company of Signia, Widex, and Horizon brand hearing aids), as well as accessories such as extra chargers, microphones, and Bluetooth TV streamers.

You won’t find higher-priced, fancy models from Phonak, Sonova, Horizon, or Starkey that include noise canceling, AI noise discrimination features, or in-ear bud-like designs. But you will be able to select from a solid lineup of affordable prescription hearing aids, which is what all of us hearing-impaired folks want and need.

Get the latest hearing aid-related news and reviews on our OTC Hearing Aid page.

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