Hearing Aids: A Guide to Types, How They Work, Cost, and More

If you find yourself working harder to hear others at a party or a noisy restaurant, you might be experiencing hearing loss. If so, using a hearing aid can be helpful. Hearing loss is a common problem, affecting about 48 million people in the United States. But it can be overwhelming to sift through all the different types of hearing aids out there. And — will they even work for you? 

So whether you choose digital or analog, prescription or over-the-counter (OTC), in-the-ear (ITE) or completely-in-the-canal (CIC) options, we’ve got you covered. We’ll review the ins and outs of hearing aids, so you can make an informed decision about what’s right for you. 

How do hearing aids work for hearing loss?

Hearing aids are small electronic devices that help people hear better by making sounds louder. 

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First, it helps to understand how we hear in the first place. Small hair cells lining the ears pick up sound vibrations and send corresponding signals to our brain. Damage to those hair cells (from aging or loud noises) causes hearing loss. The more hair cells are damaged, the worse the hearing loss. 

That’s where the hearing aid comes in. A hearing aid helps the remaining undamaged hair cells do their job more easily. 

The technology used for a hearing aid can be different depending on the type, but all hearing aids use these three elements:

• Microphone: This captures sounds in the environment and converts sound waves to electrical signals.

• Amplifier: This increases the power of those electrical signals or numerical codes, and sends them to a speaker.

• Speaker: The speaker receives these signals and then converts them back to sound waves that are sent directly to the remaining hair cells in the ear. These sound waves are now much louder than they would be without the hearing aid.

Digital vs. analog hearing aids

Digital or analog refers to the technology powering the hearing aid. Digital hearing aids are more common, but it’s helpful to know about the differences between these two technologies when making a choice. 

Analog hearing aids 

Analog hearing aids are becoming less common, since newer models are more likely to use digital technology. Analog hearing aids: 

• Are less expensive

• Are created to amplify all sounds equally, so background noise and speech will both be increased

• Can be more simple to use — they often come with button settings that can be used for different environments like a quiet room, a crowded restaurant, or an open stadium

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Digital hearing aids

Digital hearing aids can be thought of as smart microcomputers in your ears. Newer models are more likely to be digital hearing aids. They:

• Are able to process sounds in a more complex way, which can help target some sounds (like speech) while minimizing background noises 

• Have more flexibility and can be programmed to target your specific type of hearing loss

• Can often connect to other digital devices (so you might be able to change settings from your phone)

• Might be more expensive

Prescription vs. OTC hearing aids

In October 2022, the FDA authorized OTC hearing aids. This means that there are more choices than ever for hearing aids. OTC hearing aids are similar to prescription hearing aids, but there are some important differences. 

OTC hearing aids

Now that hearing aids are sold over the counter, they’re easier than ever to buy. Keep in mind that OTC hearing aids are:

• Sold without a prescription — this means that you don’t need a hearing test and you don’t need to see a specialist before buying one 

• Often less expensive than prescription hearing aids

• Only for people with mild to moderate hearing loss

• Only authorized for people 18 years and older

Prescription hearing aids 

These are hearing aids that require a prescription from a hearing specialist (audiologist) or an ear, nose, and throat (ENT) specialist. 

Prescription hearing aids are different from OTC options because they: 

• Can be used for severe hearing loss 

• Can be prescribed for people younger than 18 years

• Are better for people born with abnormal shape to their ear

• Require an office visit with an audiologist or ENT specialist

Keep in mind that if you buy an OTC hearing aid, you can still choose to see a hearing specialist. A hearing specialist can help determine if an OTC hearing aid is right for you, and can make sure that your hearing aid is programmed the best way to help you.

Should you get a hearing aid?

Hearing loss due to aging or chronic exposure to loud noises usually causes a type of hearing loss called sensorineural hearing loss. If you have this type of hearing loss, hearing aids can help you feel more comfortable interacting with people in work or social situations. 

It may be worth trying a hearing aid (either OTC or prescription) if you: 

• Have trouble hearing speech in noisy places

• Find it hard to follow people’s speech in group settings

• Have trouble hearing on the phone

• Need to turn up the volume on the TV or radio (even when others complain it’s too loud)

• Feel tired after listening for a while

Signs that you could have severe hearing loss and might need a prescription hearing aid include: 

• You can't hear speech even if the room is quiet.

• You have trouble hearing loud sounds like power tools, loud music, and engines.

• You tried an OTC hearing aid and it’s still not helping.

When do hearing aids not help?

Some people have a type of hearing loss called conductive hearing loss. With this type of hearing loss, a hearing aid doesn’t usually help. That’s because the hearing problem is caused by a different problem that a hearing aid can’t help you overcome. 

Examples of conductive hearing loss include hearing loss from:

• Ears blocked by earwax or a foreign object

• Middle eardrum that’s filled with fluid

• Repeated ear infections

• Injury to the eardrum

• Infection or an abnormal ear bone

In these cases there are often medical or surgical treatments that can help.

Different styles of hearing aids

We’ve discussed digital versus analog hearing technologies. And the differences between prescription and OTC hearing aids. But there are still more decisions when it comes to choosing a hearing aid, such as style.

Hearing aid style isn’t just a question of appearance, although this does matter for many people. Some hearing aids are barely visible, while others are more noticeable. But there are functional implications to the style you choose, too. So, when it comes to the style of hearing aid, you have several options.  

Behind-the-ear (BTE) models 

Behind-the-ear (BTE) models tend to be a little larger than other models. So they have more power. They’re also the easiest to handle for anyone with arthritis because of their size. Since it’s placed behind the ear, this model is less discreet than other options. If you have glasses, BTE models aren’t a great choice for you.  

In-the-ear (ITE) models

These are smaller than the BTE models and may have fewer features. But they’re still large enough to include a variety of features, like volume control. They’re less noticeable than the BTE models but still large enough to be a good option for people with arthritis.  

Completely-in-the-canal (CIC) models 

These models are practically invisible. If you want your hearing aid to go unnoticed by others, these are your best bet. These models aren’t recommended for people with severe to profound hearing loss, since the smaller size can mean that they aren’t as powerful as other models. And, if you have trouble with fine motor skills or arthritis, it can be harder to get in or out of your ears. The batteries are also smaller and need to be recharged more often. 

Choosing the right hearing aid for you

With all the information about hearing aids, you might be unsure which type would be best for you. Even though you don’t need a hearing screen to buy a hearing aid, you might still want to start by seeing an audiologist to get your hearing tested. 

An audiologist can tell you if your hearing loss is mild, moderate, or severe. This might affect your choice of hearing aid. And you can also get guidance about which model might be best for your type of hearing loss along with your personal needs. 

Here are a few tips on how to choose the right hearing aid for you: 

• Best low-cost option for mild to moderate hearing loss: An OTC hearing aid that uses either digital or analog technology

• Best higher-cost option for mild to moderate hearing loss: A prescription hearing aid that uses digital technology

• Best choice for someone with arthritis or fine motor problems: A BTE hearing aid model, whether it’s prescription or OTC

• Best choice if you’re concerned about looks: A CIC model —  some types of CIC hearing aids are so small they’re called invisible-in-the-canal (IIC) models 

Where do you buy hearing aids?

You can buy hearing aids in a variety of settings, such as: 

• Pharmacies 

• Retail stores like Walmart, Costco, and Best Buy

• Online retailers like Amazon

• Hearing clinics

How much do hearing aids usually cost?

The cost of hearing aids really depends on what type of hearing aid you buy. You can buy a hearing aid for as low as $99 or as high as $8,000 for a pair. Some hearing aids are sold as a bundled product and service. This means the cost for the hearing aid includes the audiology testing, follow-up visits to fine-tune the hearing aids, and maintenance and repair services. When you buy a hearing aid this way, expect to pay more money upfront. 

Other hearing aids (especially OTC hearing aids) are often sold unbundled. So the cost of the hearing aid is lower, and then you pay separately for any services, like hearing tests, follow-up or maintenance. As OTC hearing aids become more common, more people may choose to skip the hearing testing and buy hearing aids that don’t require follow-up visits with an audiologist. 

The hope is that the lower price of OTC hearing aids will help make hearing aids more accessible for people. And as technology advances, you may be able to get hearing aids with more bells and whistles without too many added costs.

That’s important because hearing aids aren’t always covered by insurance. Some Medicare advantage plans will provide partial or full coverage, but original Medicare (parts A and B) don’t cover the cost. Some Medicaid plans provide coverage, but this depends on what state you live in. Medicaid plans in Alaska, California, Connecticut, Florida, and Hawaii do provide coverage for hearing aids

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Written by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician in a variety of clinical settings. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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