Hearing aids: what the over-the-counter rule actually changed
For decades a pair cost as much as a used car and required an audiologist. Since 2022 you can buy them off a shelf — and the price floor fell through.
Hearing loss is the most common untreated condition of later life, and the reason has never really been medical. It was that hearing aids cost thousands of dollars, weren't covered by Medicare, and required appointments with a specialist before you could even find out what you'd be buying.
In August 2022 the FDA created a new category: over-the-counter hearing aids, for adults with perceived mild-to-moderate hearing loss. No prescription, no audiologist, no referral. You can buy them in a pharmacy or online the way you buy reading glasses.
Four years on, that's produced a genuinely different market — and a fair amount of confusion about what's worth buying.
| OTC hearing aids | Roughly $200 to $2,500 a pair. Most full-featured self-fitting devices land somewhere around $800–$1,500. |
|---|---|
| Prescription hearing aids | Typically $2,500 to $6,000 a pair, usually bundled with fitting, follow-ups and adjustments. |
| AirPods Pro 2 | About $249. In 2024 the FDA authorised Apple’s Hearing Aid Feature — the first over-the-counter hearing aid software. |
| Medicare | Pays nothing toward any of them. Diagnostic hearing tests ordered by a doctor are covered; the devices are not. |
| Medicare Advantage | Often includes a hearing benefit, usually capped at a modest annual amount. Read the cap. |
The AirPods thing is real, and it surprises people
It sounds like a gimmick. It isn't.
The FDA authorised Apple's Hearing Aid Feature for AirPods Pro 2 after testing with 118 adults with mild-to-moderate hearing loss, and found benefits comparable to professionally fitted devices. You take a hearing test on your iPhone, and it tunes the earbuds to your specific loss.
For about $249, from a product many people already own, that is a substantial change. And there's a second-order effect worth naming: wearing AirPods in public reads as completely ordinary, where wearing a hearing aid still carries stigma for a lot of people. The device that finally gets someone to address their hearing may turn out to be the one that doesn't look like a medical device at all.
The barrier to treating hearing loss was never really the hearing loss. It was a $5,000 price tag and a device people didn't want to be seen wearing.
When over-the-counter is the wrong answer
This is the part the sellers gloss over, and it matters.
OTC devices are authorised specifically for perceived mild-to-moderate hearing loss in adults. That word “perceived” is doing real work — you're self-diagnosing, and people are not reliably good at it. See a doctor rather than a shelf if any of these apply:
- Hearing loss in one ear only, or noticeably worse in one ear. This can signal something that needs investigating.
- Sudden hearing loss. This is treated as a medical emergency — days matter.
- Pain, drainage, or a feeling of fullness in the ear.
- Ringing in one ear only, or severe tinnitus.
- Dizziness or balance problems alongside the hearing change.
- Severe loss — if you can't follow conversation even in a quiet room, OTC devices are not designed for you.
Also worth knowing: a lot of “hearing loss” turns out to be earwax. It's a genuinely common cause, it's trivially fixable, and it's an embarrassing thing to discover after spending a thousand dollars.
What you give up, and what you don’t
The honest comparison isn't “cheap versus good.” It's about what the price includes.
Prescription hearing aids are bundled with a professional: someone measures your hearing properly, fits the device, and adjusts it over several appointments. Getting a hearing aid to work well is an iterative process, and that expertise is much of what you're paying for. For complex loss, it earns its money.
OTC devices hand that job to you and to the app. Modern self-fitting software is genuinely good — it runs a test and tunes to your results — but if it isn't right, there's no one to adjust it but you.
The practical middle path a lot of people take: get a real hearing test first (many are free, and the diagnostic one is covered by Medicare when a doctor orders it), then use those results to decide whether your loss is in OTC territory before spending anything.
Worth doing
- Get your ears checked for wax before buying anything. It is the cheapest possible fix and a genuinely common cause.
- Get a real hearing test. Knowing whether your loss is mild, moderate or severe is what tells you which market you are shopping in.
- Check the return window before you buy — OTC devices are required to have one, and you will want it. Thirty to forty-five days is common.
- If you have an iPhone and AirPods Pro 2, try the Hearing Aid Feature first. It costs nothing to find out.
- Give any device two to three weeks. Amplified hearing sounds strange at first and most people who quit, quit in the first few days.
- On Medicare Advantage, check the hearing benefit cap before assuming it covers a decent pair.
Untreated hearing loss isn't only about missing conversation. It's linked in research to social withdrawal and to a faster pace of cognitive decline — which is a good reason not to file this under vanity or wait until it's obviously bad.
Medicare still won't pay. But the number it isn't paying has fallen by roughly an order of magnitude, and that is a genuinely different situation from the one most people still assume.
This is general information, not personal advice. We report the rules, the numbers and the deadlines as clearly as we can. We don't know your income, your state, your health or your family — and all four can change the answer. Treat this as a good place to find the right questions, not a substitute for someone looking at your actual situation.
Where these facts come from
Checked against primary sources on 10 August 2026. Dollar limits and program rules change — if you're reading this well after that date, verify the numbers at the links below.
- FDA — OTC hearing aids: what you should know — https://www.fda.gov/medical-devices/hearing-aids/otc-hearing-aids-what-you-should-know
- FDA — Authorisation of the first OTC hearing aid software — https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-over-counter-hearing-aid-software
- NIDCD — Hearing aids — https://www.nidcd.nih.gov/health/hearing-aids
- Medicare — Hearing and balance exams — https://www.medicare.gov/coverage/hearing-balance-exams-and-hearing-aids
Edward Silva
Edward spent more than forty years as a computer professional — long enough to pick up one useful occupational habit: when somebody hands you a summary, go and read the actual documentation. He started The Second Half Guide after noticing that most writing aimed at people his age was either talking down to him or quietly selling him something, and that the plain facts — the dates, the thresholds, the dollar figures — were somehow the hardest part to find.
He's married, with two grown sons, both married themselves. He is not a financial adviser, an attorney or an insurance agent, and this site doesn't tell you what to do with your money. It tells you what the rules actually say, and links to where he checked.