Health Insurance Coverage and Hearing Aid Utilization in US Older Adults: National Health Interview Survey

Objective: Assess rates of hearing aid use by insurance coverage in U.S. older adults and their changes over time. Study Design: Cross-sectional analysis of the National Health Interview Survey 2007-2018. Setting: Participants (>= 65 years) with complete data on insurance, hearing aid use, and self-reported hearing limitations. Methods: Rates of hearing aid use among older adults who self-reported hearing limitations and their trends were estimated using survey weights. Sixteen insurance categories were created based on exclusive and combinatorial coverage, with Medicare coverage only as a reference group. The associations between insurance coverage and hearing aid use were examined using multivariable regression analyses. Results: Hearing aid use rate among older adults who self-reported hearing limitations was 51.2% in the United States. In multivariable models adjusting for demographics, socioeconomic status, self-reported hearing loss, and comorbidities, Military insurance only and Military & Medicare groups reported higher hearing aid use rates than Medicare only (odds ratio [OR] 3.14, 95% confidence interval [CI] 1.49-6.64; OR 1.8, 95% CI 1.55-2.09, respectively). During 2007-2018, there were no significant changes in hearing aid use rates by insurance groups among private, Medicaid, and military insurance coverage. Conclusion: While hearing aid use remains low among U.S. older adults, Military-related insurance, which generally provides enhanced coverage for hearing aids, was independently associated with higher use rates compared to Medicare, which does not offer coverage. Future research should examine the direct impact of different insurance policies on hearing aid use and its downstream health benefits.