I wear a pair of hearing aids that cost more than $3,000 and don’t work well in noisy environments. I got them five years ago. Today, or in the very near future, I may be able to score a much better pair for less than half the price. That’s because when it comes to hearing aids, the times they are a’changing — very fast. If you’re among the 80 percent of seniors who have hearing loss and don’t wear hearing aids or wish you could have better ones, read on.

Changes in Hearing Technologies: The Short Story

Several factors are driving change in the world of hearing technologies. First, we’re learning that hearing loss is a serious health issue — that’s giving advocacy groups ammunition to push for policy changes that would make hearing devices more affordable and easier to buy. At the same time, manufacturers are capitalizing on advances in digital technologies that allow them to make more discreet,more efficient hearing aids that might be considered cool by Baby Boomers.And online suppliers are starting to drive down the cost of these high-tech hearing aids.

New hearing aids and over-the-counter “hearables” (Personal Sound Amplification Products or PSAPs) have been made possible by sensor technology that tunes in to your environment and automatically adjusts for it, along with advances in Bluetooth technology that lets hearing aids send separate signals to each ear — you pair your device with your smartphone via Bluetooth and control it with an app.

That’s the short story. The subject of hearing technology is huge, complicated and in flux, and by the time you read this, there will probably be new developments. That’s how fast this field is changing.

Here’s the bigger picture — for now.

Public Policy and Hearing Technologies

It’s probably not news to you that Medicare has never covered hearing aids. The reason: Medicare was barred from providing coverage for hearing aids when it was instituted, because hearing loss was considered a natural result of aging — it was no big deal.

This is unlikely to change soon, even though a growing body of research is showing that hearing loss is worse for you than you might think. According to the results of a study by researchers from Johns Hopkins and the National Institute on Aging, hearing loss fast-tracks brain shrinkage as we age. The findings add to a list of health consequences associated with hearing loss, including increased risk of dementia, falls, hospitalizations and diminished physical and mental health overall.

No matter how natural Medicare thinks hearing loss is, the FDA regulates hearing aids as medical devices. They must be sold by a medical professional, usually an audiologist, and you’re supposed to get a medical evaluation first. Because hearing aids are classified as medical devices, their manufacturers are required to spend large amounts on stringent record keeping and reporting, which helps keep costs high.

Meanwhile, manufacturers of relatively inexpensive over-the-counter devices that may be sufficient for some people are forbidden from saying that their devices can help people with hearing loss.

A push for change

The tide may be turning. A June 2016 report from the National Academies of Science, Engineering, and Medicine strongly recommended increased accessibility for hearing care services and affordability for hearing devices, including no medical evaluation necessary to purchase a hearing aid and an FDA category for over-the-counter wearables, or “hearables.”

That report came on top of one delivered in late 2015 by the President’s Council on Science and Technology/ The PCAST report called for measures to make hearing aids more affordable and encourage innovation. Among the recommendations: Hearing aids should be prescribed like glasses. It’s called “unbundling.”

Unbundling

Unbundling is the latest in audiology trends. It means an audiologist sells his or her services separately from the hearing aid itself. According to PCAST, consumers should be able to shop around for hearing aids and buy them over the counter from the local pharmacy or online using a prescription from an audiologist or other source, the way you do with your eyeglass prescription.

Transparency is key to unbundling. When an audiologist quotes the cost of hardware separately from fees for services such as fitting, programming and adjusting, you can shop around not just for the device, but for the services, too — and that’s an incentive for providers to keep costs in check. For example, one audiologist who unbundles quoted $1,500 for her services, exclusive of the cost of the hearing aid. That’s half of what many audiologists who bundle factor for services.

Currently, few audiologists offer an unbundled service, but their numbers are growing.

Over-the-Counter Hearables

Hearables are the next big thing. I talked to Dr. Nicolas Reed, an audiologist with the team at Johns Hopkins that’s on the cutting edge of research into what some are saying will be a major disruptor of the hearing aid industry.

A hearable is a type of PSAP that’s digitally enhanced with the latest sensor and Bluetooth technologies, and paired a smartphone app.

“Companies are seeing the potential of producing these devices,” Reed says, “but the biggest problem for consumers is that there’s no one out there helping them choose what to buy.”

Reed’s lab tested several hearables and recommended two brands. I tested both and got feedback from an audiologist I visited in Delray Beach, Florida, Dr. Cori Walker.

Both Dr. Walker and I liked one of them, the Soundhawk [update: Soundtooth is currently offline and not taking orders]. A tiny Bluetooth-enabled speaker goes in your ear, and you clip the microphone onto a person or put it on a table or in front of the TV speaker to broadcast the sound to your ear. It pairs with an app, which allows you to control for different environments: indoor, outdoor, driving and dining. You can drag a finger around the screen to adjust the volume, brightness or background noise. Since the Soundhawk looks like an ordinary Bluetooth phone headset, no one knows it’s a hearing device, which will please some people. I tried it with Dr. Walker talking to me softly from another room and could hear her perfectly. Without the device I couldn’t hear her at all. Amazon reviewers are reporting that it works well in noisy environments, too. The Soundhawk costs around $400.

We can expect to see more hearables — and more advanced hearables — in the near future, including the IQbuds from Nuheara. These wireless earbuds are available for pre-order and will start shipping in early 2017. The price: $249. The IQbuds do what the company calls “intelligent hearing.” Simple and surprisingly comfortable, they do a good job of dampening ambient noise while isolating and amplifying the human voice you’re trying to listen to. They also let you stream your phone calls, or listen to audio books or music via your smartphone.

If you want to find out how hearables and other PSAPs stack up to each other and to hearing aids, you’re in luck. HearingAidReview.com compared them in a study published in July 2016. It concluded that high-end hearing aids are the best and most versatile (no surprise there), but some high-end PSAPs could be a good fit for people with low to moderate hearing loss, and some low-end PSAPs are appropriate for mild hearing loss.

Read more about Bluetooth enabled wearables.

High Tech Digital Hearing Aids

Digital hearing aids are tiny computers with electronic chips that you wear just like analog versions, and with recent tech advances and initiatives — especially Apple’s decision in 2013 to partner with hearing aid manufacturers on app-controlled hearing technologies — they’re becoming increasingly “smart.”

The first Apple-ready hearing aid was the ReSound LiNX, which took advantage of the iPhone’s accessibility settings. The LiNx enabled hearing aid wearers to stream phone calls, FaceTime chats, music, movies, turn-by-turn navigation and other audio directly to the hearing aid without the need for a separate remote. It also let you control the right and left ears independently and save settings for specific locations that you visit often.

In the past three years or so these technologies have continued to advance and others have brought more improvements.

Smartphone app-enabled hearing aids

Many high-end hearing aids now work with iPhone apps and Android, but most if not all require iPhone to stream audio, including phone calls, without an intermediary device. In August, 2016, the FCC adopted new rules requiring cellphone manufacturers to make most of their handsets compatible with the latest app-enabled hearing aids by 2018.

Hearing Aids with smart technology

The latest high-end hearing aids, including many that work with apps, know what type of sound environment you’re in and automatically adjust. Some learn from your manual app-based adjustments and gradually perfect a personalized automatic adjustment based on that learning; adjustments can include tinnitus modulation. But the very latest in “smart” hearing aids is the new Oticon Opn, which claims to duplicate the auditory processing center in the brain based on the idea that “We hear with our brain. Not our ears.” (Opn refers to the groundbreaking “open sound” system that delivers a more natural soundscape.) I tested the Opn in a group situation and was impressed with how well I could hear my friends around the table without being distracted by ambient sounds and without having to make manual adjustments.

In the near future, more hearing aids like the Opn will be connected to smart devices in your home via the internet, so when you turn on your hearing aids in the morning, your lights will turn on or your coffee machine will start operating — all programmed by you via an app.

The not-so-good news: Smart hearing aids don’t come cheap — a pair can cost about $7,000 from an audiologist — but bargains are available from online suppliers (see below).

Click here to read more about the latest smart hearing aids.

Rechargeable hearing aids

Constantly having to change tiny batteries is one of the biggest complaints of hearing aid users — especially those of us with arthritic hands. A number of high-end hearing aids now have rechargeable batteries, which means you can store the device in a charger and it will recharge overnight. The charge will last for a day, but you can use backup batteries if you run out of juice. It’s also possible to retrofit some hearing aids to be rechargeable. PSAPs are more likely than hearing aids to come with rechargeable batteries and micro USB ports for charging.

High Tech, Lost Cost Hearing Aids

Costco has rearranged the landscape for hearing aid wearers by offering high-tech smart devices like its own low-priced Kirkland Signature 6.0 that uses technology from a major manufacturer, along with in-person programming and support, and works with the iPhone to stream audio.

The sale of hearing aids online is taking off, too, and it’s now pretty much the Wild West on the internet when it comes to buying them. There are many online sellers and no oversight.

So, how do you know where to click?

I talked to Abram Bailey, audiologist and founder of HearingTracker.com, a site that evaluates hearing aids and audiologists.  “It’s important to consider how much support you’re going to get. With some sites, like Audicus.com, you can wind up spending quite a bit and end up with no professional support. Considering that you get one or more years of free service from an audiologist, it might be worth buying a basic hearing aid from an audiologist.”

That said, there are some bargains online that are worth it, and with more and more audiologists unbundling, it may soon be a lot easier to buy a hearing aid online and find a local audiologist to program and adjust it.

These sites have been recommended by users on the Hearing Aid Forums.

BuyHear.com This relatively new online company sells all major manufacturers’ hearing aids at about 50% off. You send BuyHear your hearing test, they send you a programming kit, and you program the aids with them on the phone. There’s a 60-day money back guarantee and a three-year warranty. You can get a new  pair of top-of-the-line Oticon Opns for $3798 as opposed to the $7000 that I was quoted by an audiologist.

Hearingwholesale.com also sells all major manufacturers’ hearing aids at a deep discount and will program your hearing aids based on your audiogram. You can also send your hearing aids back for adjustments. The people behind the site have been in business for 20 years and only recently started operating on the internet. They’re located on Long Island — if you’re in the New York area, they will come to your house to program your aids and will repair old hearing aids for $89 to $119 if you mail them in. After five years, most manufacturers won’t repair old hearing aids at all.

iHearMedical.com  may just be the game changer when it comes to truly affordable hearing aids. Rather than selling aids by other manufacturers, this company makes their own. Launched with a Indiegogo crowd-funding campaign in 2013, iHearMedical sells two different full-featured hearing aid models for under $600 a pair. This is not a fly-by-night outfit. The online-based company was started by Adnan Shenib, a Silicon Valley sound engineer who has been in the industry for 25 years and is well-known in the hearing aid technology world. He co-founded the well respected Dutch hearing aid company ReSound and was on the team that invented the super high tech Lyric hearing aid. Shenib is a humanitarian who was upset with an industry that he says “has moved towards expensive advanced tech that most people can’t afford. I started looking at how do we challenge ourselves here in Silicon Valley—how do we serve the majority?” There are two models, the invisible iHearHD that fits inside the ear much like the expensive Lyric, and a behind-the-ear model, the iHearMAX. They can be programmed at home on the internet with a cable that comes with the hearing aids. iHear Medical also makes the first FDA approved home hearing test for $49.

We’re in the Driver’s Seat

Audiologists complain that big-box stores like Costco use hearing-aid fitters who are not licensed professionals, and the industry is likely to have similar complaints about online hearing aid sellers. If you had a medical issue such as impacted earwax, this could be a problem, but if you’re covered by Medicare, you can visit your otolaryngologist to get checked out before you order your hearing device. It’s your choice — along with ease of access, lower cost and more choice comes more responsibility.

There’s a revolution underway in the hearing technologies industry, and the way we’ve dealt with hearing loss — or haven’t — is changing with it. We are going to have to become more highly educated consumers, learning about our options and making choices for ourselves. Stay tuned!

What type of hearing aids do you wear?