More than two out of every three Americans over age 70 have meaningful hearing loss, experts say, but according to the New York Times, only 20 percent of people in this country who need hearing aids buy them. Hearing loss is so gradual, you may not even realize what you’re missing. Or you may know you need hearing aids but balk at the cost, thinking you can get by without them. The problem is, hearing loss is more devastating than many of us realize. If you have uncorrected hearing loss, you’re more likely to suffer falls and broken bones, social isolation and depression, even Alzheimer’s.

Since expense is the biggest roadblock that Americans with hearing loss confront, we’ve been on a mission to search out viable options for lower-cost solutions. The hearing aid options below—some of them fairly new—range from technologically basic to advanced, with basic offering little more than sound amplification and advanced giving you multiple app-enabled settings for sound customization and tech that automatically adapts to your audio environment; the most sophisticated also stream wirelessly from your mobile device.

Maybe you’ll find something that serves your needs in your price range.

IQ Hearable Earbuds

Cost

$299 per pair

What you get

One of the latest developments in hearing technology is hearables. These are not hearing aids as such, but do combine amplification with high tech audio control options. Because they look like regular earbuds, they’re just the ticket for people with mild hearing loss who (ageism alert!) can’t stand to be seen as “old.”  One of the best currently available is Nuheara IQ Buds for $299.  These Bluetooth enabled buds not only stream music and phone calls directly to your ears, but efficiently dampen ambient noise, enhancing your ability to hear speech both at home and in noisy environments.  The smartphone app that the device pairs with has settings for different audio environments—home, music, restaurant, driving, office, and so on.

How it works

Since these are not hearing aids, they’re available without prescription by ordering online. There are no programming or adjustments to be made, except to customize your hearing experience via the paired app.

Word up

Hearable options are sure to expand and improve in the next couple of years. Stay tuned.

The downside

While hearable buds like the IQ may work well for people with low hearing loss, or in certain situations for people with moderate loss, they are not currently a viable everyday solution for anyone with moderate to severe hearing loss.  They only work properly when paired with a smartphone app,  have limited battery life and can cause discomfort if worn for long periods.

Visit Nuheara.com

iHearMedical

Cost

$699 per pair

What you get

You’ll get a basic hearing aid from this online-only manufacturer-supplier. You can choose between two versions—an invisible, in-the-ear model and one that fits behind the ear. Unlike more expensive hearing aids, neither version is highly versatile; while the devices have basic settings, they are not designed to distinguish between and automatically control for different audio environments. Nevertheless, these hearing aids will substantially improve mild to moderate hearing loss in a variety of situations where there’s not a lot of ambient sound.

How it works

You send iHearMedical your audiogram (which you must get from the audiologist who tests your hearing), and the company will pre-program your hearing aids. You also can do the programming yourself with a gadget iHearMedical sends you, but it’s a very difficult process.

Word up

iHearMedical has improved its service, not only by offering the pre-programmed option, but also by buttoning up its shipping operations. Delivery schedules are now reliable.

The downside

While you do receive a pre-programmed hearing aid, any adjustments that you’ll need to make over time are DIY by using the complicated gadget iHearMedical ships with its hearing aid. You also don’t get the kind of testing and precise fit that you get with an audiologist, or even from a hearing care specialist.

Visit iHearMedical.com

BuyHear

Cost

$1000 to $3500 per pair

What you get

This online-only company sells all major manufacturers’ hearing aids at 50  percent off a typical audiologist’s price. At the lower end of the scale are basic options; at the top are the high-tech Oticon Opn and Widex Beyond, both of which offer advanced technology.

How it works

You select your hearing aid from the company’s website. Then you send the company your audiogram and get your new hearing aids mailed to you pre-programmed. If you need adjustments, you can make them yourself at home up to twice a year with phone help from a company representative, using an adjustment kit that you can order for free through BuyHear.

Word up

BuyHear’s in-home self-adjustment service has been reviewed and deemed easy and painless. If you know which brand you want, this may the cheapest way to get it.

The downside

As with any other online-only supplier, you don’t get the kind of testing and precise fit that you get from a professional. And without the benefit of an audiologist’s advice, you have to do your research and know which hearing aid is a good choice for you—or you could be sneaky and ask an audiologist for recommendations (consults are usually free), and then buy from BuyHear.

Visit BuyHear.com

HearingRevolution

Cost

$1500 to $4500 per pair

What you get

This company offers insurance providers deeply discounted hearing aids from major manufacturers for their members through a national network of audiologists (in that role the company is known as HearingCareSolutions). The company also sells direct to the consumer, using the same audiologist network and offering similarly discounted prices. The top of the line Oticon Opn, one of the newer iPhone compatible hearing aids, is $3995 a pair from HearingRevolution. That’s only $500 more than BuyHear’s price and comes with in-office fitting and ongoing adjustment services. The company also offers a new Signia model that claims to offer significant relief for tinnitus sufferers.

How it works

When you call HearingRevolution, you’re referred to a local audiologist. The company prides itself on its expertise in hearing health and education, along with transparency; that means when you call, you can get up-front advice as well as up-front prices on hardware options you’re interested in before you visit the audiologist—a rarity in this industry. You can find a list of brands and models with prices on the website.

Word up

Besides offering one of the least expensive options for hearing aids with full audiologist services,    HearingRevolution also offers a low-cost by-mail hearing aid repair service, which might save you the cost of ordering a new pair.

The downside

None that we know of.

Visit HearingRevolution.com

Epic Hearing

Cost

$1,000 to $5,000 per pair

What you get

Epic Hearing does not advertise to consumers and is known primarily as a provider of major hearing aids to Medicaid recipients, and members of managed care organizations, health plans and unions (EPIC claims to be the country’s largest provider of hearing benefits). Some employers also offer the EPIC hearing health plan as part of their benefits package. But the company does sell directly to consumers at very affordable prices for hearing aids from eight major manufacturers. EPIC partners with audiologists across the country and offers a free hearing test, pre-programming and adjustments as part of the package. Epic offers hearing aids by price tier. The company has nine set price points for all hearing aids: $495 to 1899 per ear for basic; $2099 per ear for advanced and $2399 to $2499 per ear for premium.

How it works

An EPIC representative refers you by phone to a local partner audiologist. You order your hearing aids from the audiologist, but pay EPIC directly.  You can call EPIC at 877-606-3742.

Word up

You may be able to get a better deal if an association or union to which you belong offers an EPIC plan as part of its value add. It’s worth checking.

The downside

Some bad reviews on Yelp suggest that there may be a downside to EPIC’s service. That said, the company has been awarded the Health Network Accreditation from URAC, one of the country’s two top healthcare accrediting organizations.

Visit EpicHearing.com

Audient.com

Cost

$990 to $1575 per pair

What you get

AUDIENT is a national nonprofit hearing care alliance that unites audiologists with suppliers to provide deeply discounted basic to mid-level hearing aids and related care for hearing impaired people on low incomes.

How it works

You fill out an application stating that you fit Audent’s annual-income guidelines—up to $27,000 for an individual and $36,000 for a couple.  No additional documentation is required.  Once you are approved, the organization contacts you to coordinate your referral to an Audient Program participating hearing care professional. For questions, call 1-866-956-5400 extension #2.

Word up

Audient was formerly run by the Lions Club and is now administered by EPIC.

The downside

Audient offers a limited selection of hearing aids. You choose between standard and mid-level.  According to a spokesperson, “Audient’s mid-level hearing aids are great, although they don’t have all the bells and whistles you get with premium hearing aids.”

Visit AudientAlliance.com

Costco

Cost

$1799 and up per pair

What you get

Costco offers top-of-the-line hearing aids for bottom-of-the-line prices by branding models from top manufacturers with its own name, Kirkland. The company’s latest offering is the tiny Kirkland 7 Signature, which is made by Sivantos, a major manufacturer formerly known as Siemens. (Costco’s Kirklands were previously made by ReSound.) The 7 Signature’s specifications are similar to the top of the line Signia hearing aid’s, including all the bells and whistles—t-coils, multiple channels, customization of your hearing experience via a smartphone app and more. And while this Kirkland doesn’t have integrated streaming, you can buy a standalone Bluetooth streaming gadget that you wear to stream phone calls, music and other audio from your mobile device directly to your hearing aid. Costco also offers hearing aids from other manufacturers in a variety of styles and price points, but the Kirkland 7 is the least expensive.

How it works

Simple: Make an appointment at Costco, where you’ll get your hearing test and audiogram, discuss options and order a hearing aid pre-programmed for you. Come back whenever you need to for free cleanings and adjustments.

Word up

Costco was rated one of the top two hearing aid providers by Consumer Reports readers in a large survey.

The downside

When you buy a hearing aid at Costco, you see a “hearing instrument specialist” rather than an audiologist. Training requirements for these specialists vary from state to state. That said, since Costco lets you come back for as many adjustments as you need, you should end up with a hearing aid that’s programmed just right for you. Another potential downside: Costco hearing aids are “locked” which means no one but Costco can adjust them. If you are moving to an area without a Costco hearing center you might want to consider buying elsewhere.

Visit CostcoHearingAidCenter.com

HearTek Leasing

Cost

$49.00 to $149.00 per pair per month for 30 months

What you get

Leasing is a way to finance hearing aids without interest charges. HearTek, a division of EPIC, claims  that almost everyone will qualify  during the application process and there are no application fees or required security deposit. have access to all levels of technology at four monthly payment levels – $49.99 (basic), $79.99 (standard), $99.99 (advanced) and $149.99 (premium).iv By spreading hearing aid payments across a lease term up to 30 months, patients can finance a hearing aid up to  $5,000.

How it works

Patients go to a participating audiologist to select a hearing aid best suited for their needs. Call 844-586-9403 for more info.

Word up

HearTEK is using the cellphone model, giving participants the option at 18 months to trade in their hearing aid and upgrade to a new model either in their current pricing tier or a higher tier. If you’re not interested in upgrading, you can continue with your lease unchanged. You can also buy out the lease at any time to purchase your hearing aid without penalty.

The downside

Currently, HearTEK only leases hearing aids from three manufacturers: Phonak, Unitron and GNResound. And as a new program (it launched in summer 2016), it’s still early to evaluate the service. Customer communications appear to be spotty, and there are currently no independent online customer reviews.

Visit HearTEK Leasing.com

This article was written/produced with the support of a journalism fellowship from New America Media, the Gerontological Society of America and the Silver Century Foundation.