Bridging the Hearing Divide: Policy Solutions for Aging Americans

Hearing loss affects approximately two thirds of adults in the United States aged 70 years or older and frequently remains untreated despite its well-documented harms, including accelerated cognitive decline, increased caregiver burden, and higher health care expenditures. We examine the major barriers to accessing high-quality hearing care, with particular attention to the complex and fragmented landscape of insurance coverage across Medicare, Medicaid, the US Department of Veterans Affairs, private plans, and over-the-counter (OTC) products. We review key legislative and regulatory developments over the past decade, most notably the 2022 establishment of OTC hearing aids, and summarize early opportunities and remaining gaps. We then propose targeted reforms to improve access and affordability, including more consistent Medicaid benefits, selective Medicare expansion, integration of teleaudiology, and strengthened oversight and consumer protections for OTC devices. Finally, we advance a technology-driven policy framework that integrates artificial intelligence-supported risk prediction, teleaudiology, real-time insurance verification, and a transparent device marketplace to modernize delivery and evaluation. Together, these strategies can catalyze a fundamental rethinking of how hearing health is prioritized and managed within the broader United States health care ecosystem. (Am J Public Health. 2026;116(3):387-396. https://doi.org/10.2105/AJPH.2025.308298).