Hearing Aid Buying Guide
If you have hearing loss, hearing aids can make a big difference in your ability to communicate and connect with the world around you. And studies have linked untreated hearing loss with other serious health issues, including depression, problems with memory and concentration, and even an elevated risk of dementia.
Unfortunately, the marketplace for hearing aids—which are often costly, complex, and not typically covered by insurance—can be confusing to navigate. Until 2022, hearing aids were largely available only with a prescription. That year, over-the-counter hearing aids became available for the first time, providing a pathway for many people with hearing loss to access these devices without visiting an audiologist or another hearing healthcare provider. Though this removed some barriers and opened the door to some lower-cost devices, uptake of OTC hearing aids remains low. That may be due to factors including lingering hesitancy about their benefits, limited availability at brick-and-mortar retailers, and costs that are still too high for many consumers.
CR aims to help consumers navigate this marketplace with a few different tools. Our survey-based ratings of hearing aid brands can help you narrow your search for prescription aids and provide guidance on a few OTC brands, too. Our survey-based ratings of hearing aid retailers can also help you figure out the best places to buy them. And for anyone considering the OTC route, our lab tests and ratings of OTC hearing aids can help you figure out which ones may be worth trying for you. (We can also help you figure out whether OTC aids make sense for you.)
Keep in mind: No hearing aid can restore you to perfect hearing the way glasses can restore you to 20/20 vision. Most hearing aids will never completely remove background noise, for example, but they will still help you hear better.
If you think you might need a hearing aid, it’s worth trying one because you’re likely to have better outcomes the earlier you get one. Our buying guide can help demystify hearing aid types, configurations, and features to help you figure out which hearing aid might be right for you.
Types of Hearing Aids
When you start shopping for hearing aids, one of the first big decisions you’ll need to make is how to get them: from an audiologist or hearing care provider, for prescription hearing aids, or online or in a store, for over-the-counter models. OTC hearing aids are an option for anyone with self-perceived mild to moderate hearing loss. If you go the OTC route, you should be aware of the two main types, self-fitting and preset, which differ in their capabilities and in how they’re regulated.
Prescription Hearing Aids
Prescription hearing aids are the kind you get from an audiologist or another hearing care provider. These include the aids you’d get from visiting hearing clinics inside big-box stores or wholesale clubs like Costco. The provider tests your hearing, helps you select from a few different options for brands and models, then programs the hearing aids based on your individual hearing needs.
Pros: Your hearing aids are customized. They’re programmed to address your hearing and may also be shaped to fit your ears. You’ll get plenty of instruction and guidance from your provider on how to use and maintain them, and you can come back to have your programming or fit fine-tuned if something isn’t working well.
Cons: Cost. Though some retailers offer more affordable prices, prescription hearing aids can cost upward of $4,000 per pair. Going the prescription route can also sacrifice convenience, and accessing care (such as follow-up visits) can be particularly difficult for people who don’t live close to a hearing care provider.
Self-Fitting OTC Hearing Aids
Although it’s true that if you buy an OTC hearing aid you have to make sure the fit in your ear is correct, that’s not what "self-fitting" means in this context. It means that you have to use built-in digital tools to customize its settings yourself, so it "fits" your particular hearing loss. Self-fitting OTCs are designed to be used with a smartphone app that has some feature—often a brief hearing test—that customizes the device’s settings.
Pros: You can achieve a high level of customization without needing to visit an audiologist. Self-fitting hearing aids are also more stringently regulated than other (preset) OTCs. That’s because, in order to receive a designation of self-fitting, hearing aid manufacturers must submit data to the Food and Drug Administration demonstrating that their hearing aid and accompanying app are safe and can improve users’ hearing at least as well as an audiologist-programmed prescription hearing aid. For self-fitting hearing aids, manufacturers must also submit usability testing showing that people can use the devices as intended. This can give users an extra measure of confidence that their OTC hearing aids can actually help.
Cons: Of the two OTC options, self-fitting hearing aids are generally more expensive, with some even approaching or exceeding the prices of budget prescription aids. Still, several models are available for under $1,000 per pair. They are also generally somewhat more complicated to use, given that they must be programmed by the user and paired with a smartphone app. Companies offer different levels of support for this process. But they may not be the best choice for someone who’s less tech-savvy.
Preset OTC Hearing Aids
Unlike self-fitting, “preset” isn’t an official FDA term, but it’s a common way to refer to OTCs that aren’t self-fitting. The name refers to the fact that many non-self-fitting aids generally come with a few different preprogrammed hearing profiles. These may be situation-specific—such as for a noisy restaurant—or they may aim to cover a few different levels of hearing loss within the mild-to-moderate range for which OTCs are designed. The amount of customization you can do varies widely across presets. Some offer only those few profiles, while others allow for much greater customization within those presets.
Pros: Preset OTCs are generally less expensive than self-fitting OTCs or prescription aids. Often, they’re also simpler and may not pair with a smartphone app, which will appeal to some users. There’s a wide variety of levels of customization that can be found with preset aids. A few retailers offer more expensive preset aids that you can have programmed before they’re shipped to you, based on the results of an online hearing test you take or from an audiogram that you send to the company.
Cons: Some of the least expensive presets are highly pared down in terms of features, sometimes offering little more than volume control. Also, because presets aren’t required to be cleared by the FDA prior to being sold, there’s less assurance they’ll be effective, even when they offer more customization.
Configurations
Whether you go the prescription or OTC route, you’ll have a few different options for hearing aid configurations. These are categorized by where on or in the ear they’re worn, and where the various components—receiver (the speaker that sends sound to the inner ear), microphone, and amplifier (the hearing aid’s sound processor)—are located. Some styles that usually have custom-molded parts may not be available OTC.
Behind-the-Ear Hearing Aid (BTE)
With BTEs, all electronic components are housed in a plastic case worn behind the ear. Sound is sent to the ear through the tubing that connects the case to the receiver and an earmold (a piece of soft material made to fit snugly in the ear and channel sound into it) worn in the ear canal. For OTCs, instead of the custom earmold that’s typical of prescription aids in this style, BTEs may come with different sizes or styles of earpiece or buds.
Pros: Their larger size means that BTEs can hold more features and offer considerable low- and high-frequency amplification. For this reason, they’re generally the best choice for those with severe hearing loss. They’re the most durable form of hearing aid, and they are easy to clean and maintain. On larger, traditional models, the controls are easy to manipulate and the telecoil mode is easily selected and used. (See below for more information on the telecoil.) Their larger size accommodates larger, longer-lasting batteries. Feedback is rare because of the snug fit.
Cons: Their main drawback for many people is their larger size, which makes them more visible. The earmold used in prescription BTEs must fit snugly and fill the entire ear canal, which can cause a plugged-up feeling.
Receiver-in-the-Canal Hearing Aid (RIC)
This type goes by various other names, including mini behind-the-ear (mBTE), receiver-in-the-ear (RITE), and canal receiver technology (CRT). These look similar to BTE hearing aids, but here the receiver is inside the ear canal, rather than in the housing that sits behind the ear. A thin wire runs between the case that sits behind the ear and the receiver, which is housed in either a custom-made earmold or a non-custom dome-style ear-canal piece.
Pros: These are comfortable and are often barely visible because the case behind the ear doesn’t contain the receiver and can be smaller. These can have an open fit, which means they don’t completely block your ear canal. That prevents a plugged-up feeling, especially when using an open ear tip.
Cons: Because of its placement deep in the ear canal, the receiver in RICs is vulnerable to wax and moisture, and may need more frequent cleaning or repair.
In-the-Ear Hearing Aid (ITE)
All electronic components are housed inside a case that rests in the bowl of the outer ear.
Pros: Compared with smaller in-the-canal styles, these offer more room for features such as a telecoil, a directional microphone, and wireless streaming. They’re comfortable and relatively easy to insert, and can be a good option for people with limited dexterity because their controls are easy to use.
Cons: Because they fill much of the visible space of the outer ear, some people find them cosmetically unappealing. Also, the telecoil might not be as powerful as one inside a BTE hearing aid because it’s smaller.
In-the-Canal (ITC) and Completely-in-the-Canal Hearing Aid (CIC)
ITCs are generally prescription and custom-made, and fit inside the ear canal. CICs are very similar but may be even smaller and sit even farther inside your ear canal. CICs can also be prescription and custom-molded, but a number of OTC hearing aids are also CIC-style.
Pros: ITCs are usually barely visible and cause less of a plugged-up feeling because the aids sit deep in the canal. Larger units can include directional microphones (which reduce background noise by picking up sound from a specific direction) or features like Bluetooth compatibility. CICs are generally invisible and fit deep in the ear. That placement can offer better sound quality and produce minimal feedback when used with a phone, and means they’re less sensitive to wind noise.
Cons: Both are vulnerable to moisture and earwax buildup. Their smaller sizes mean the battery life may be shorter, especially for CICs. Their unusually small size means they can also be challenging to handle and adjust. Discomfort or a plugged-up feeling can still be a problem for some users. CICs may be too small to include a directional microphone or Bluetooth capability.
Earbuds
While earbuds aren’t a typical configuration for hearing aids, the rise of OTCs has led to the introduction of some models that look more like the Bluetooth earbuds you might use to listen to music, phone calls, or other audio. Apple, for example, simply added a software feature to its existing AirPods Pro 2 (and later models) that turns the earbuds into hearing aids. Sometimes earbud-style aids are classified as ITE.
Pros: Although they’re clearly visible, they don’t look like traditional hearing aids, which may appeal to some users. In the case of Apple AirPods Pro, you may already own them and would thus be able to turn your earbuds into hearing aids by simply changing your settings. They’re usually rechargeable and Bluetooth compatible, and are often designed with streaming audio and phone calls in mind.
Cons: Some models have somewhat limited battery life between charges (especially if you’re using features like Bluetooth streaming). Some people may not like the appearance of wearing earbuds all day and during conversations.
Features to Consider
Smartphone Compatibility
Many hearing aids, including all self-fitting OTCs, can be paired with an app that allows you to change your hearing aid settings from your phone, which can be easier than using the small controls on the device itself.
Battery Type
Traditionally, using hearing aids required regularly replacing their tiny batteries. Increasingly, newer hearing aids are made to be rechargeable, which means you don’t have to mess with replacing batteries. However, you’ll probably have to remember to recharge them every night, whereas batteries may need to be replaced only every few days or weeks. Fortunately, you can find both prescription and OTC options for whichever battery type you prefer.
Media Streaming
Many hearing aids offer the ability to stream phone calls or audio such as music, podcasts, or your TV’s sound right to your hearing aid via Bluetooth. That can be convenient, but it can also add to the cost of your aids, and it may not be available if you’re looking for very tiny hearing aids like CICs.
Telecoil and Auracast
A telecoil is a small sensor or copper wire in the hearing aid. When activated, it wirelessly picks up a magnetic signal from hearing-aid-compatible telephones and public address systems—such as those that may be in conference rooms, concert halls, museums, taxis, airport terminals, and even subway trains—and converts that signal into sound. An audio induction loop, or hearing loop, which is a wire that circles a telecoil-compatible room or space, emits the signal that the telecoil picks up.
Such technology helps people—especially those with moderate to profound hearing loss—to better understand a speaker’s voice by making it louder and eliminating most background noise and reverberation.
If you’re buying prescription hearing aids, you’ll probably need to specify to your provider that you want a telecoil. In part because of the trend of making hearing aids smaller and smaller, telecoils aren’t necessarily standard. Ask your provider for a manual T-switch, which enables seamless connection to loop systems. Your provider should also activate your telecoil and show you how to use it.
Another technology to consider for your prescription hearing aid: Bluetooth Auracast capability. This technology is intended to provide the same benefit as a telecoil, but without the need for the hearing loop infrastructure in the venue. An event space outfitted with Auracast would be able to transmit audio via Bluetooth to many listeners with compatible devices inside the space. Auracast is still in the very early stages of being implemented. But it’s worth considering seeking out a hearing aid that has it equipped because it’s expected to eventually replace telecoil and hearing loop technology as the primary assistive listening system used by event spaces and public address systems.
When it comes to OTC hearing aids, the options here are limited; very few OTCs offer a telecoil or Auracast capabilities. But that may not be a huge problem for OTC users because these technologies are most important for people with more severe hearing loss, for whom an OTC isn’t designed.
Directional Microphones
Many modern hearing aids have a directional microphone, which helps you converse in noisy environments by making the audio signal in front of you louder than the noise from the rear or sides. When you’re shopping for OTCs, this may show up in product features like a “noisy” or “restaurant” setting or profile. This technology works best when you’re close to the sound source—like a person sitting across from you at a small table. Almost all hearing aids with this feature are able to automatically switch between directional and omnidirectional settings, depending on the environment. Advanced versions can focus behind the listener or on the listener’s side. One negative: It’s prone to picking up wind noise.
Feedback Suppression
Feedback suppression, or digital feedback reduction, helps quell high-pitched whistling sounds created when a hearing aid’s microphone picks up sound coming from its speaker. Most modern hearing aids include this feature, but its effectiveness differs from aid to aid. It’s useful for minimizing feedback if your aid isn’t in the proper position in your ear.
Digital Noise Reduction
This improves listener comfort and communication in noisy environments by blocking out some background noise. That makes it easier to hear and understand speech, though it’s not a fix for all situations.
Shopping Tips
As you begin to shop for prescription or OTC hearing aids, here are a few more things to consider.
Rule Out Medical Causes of Hearing Loss
If you go the prescription hearing aid route, a hearing care provider can help with this. But if you’re planning to try an OTC, it’s worth using a free online tool that can help you feel confident that your hearing problem is really the result of irreversible hearing loss, rather than being caused by a reversible medical problem. A useful tool is the online Consumer Ear Disease Risk Assessment (or CEDRA), a research-backed questionnaire that can help you get a sense of whether you should visit a doctor to address a problem like impacted earwax or an infection before going right to trying hearing aids. Talk to your provider or ask for a referral if your hearing loss is sudden or if you have any other concerns about your hearing health.
Check Your Coverage
Basic Medicare doesn’t cover hearing aids. Some Medicare Advantage plans may offer some coverage. Private insurance coverage varies, unless you live in one of the handful of states that requires insurance plans to cover hearing aids. Some states mandate that some or all health insurance plans offer coverage for adults, including Arkansas, Connecticut, Illinois, Maine, Minnesota, New Hampshire, Rhode Island, and Washington. Check the details of your plan. You can also use HSA or FSA money to pay for hearing aids.
Customer Service
With prescription hearing aids, customer service is generally built into the cost of your hearing aids. You’ll have the support of a hearing professional, including an in-person hearing test, guidance in selecting a model, multiple fittings and adjustments, and troubleshooting assistance if you have problems.
With OTCs, both self-fitting and preset types are designed so that you can set them up on your own. Still, support from a professional can make a big difference in how comfortable you feel using your hearing aids and in troubleshooting any problems you encounter. Visit OTC hearing aid brand websites to find out whether they offer users assistance in setting up and using their OTC hearing aids. Audiologists in your area might also be willing to assist with OTC hearing aids for a fee.
Return Policy
Hearing aids take some time to acclimate to. Therefore, the return period for the aids you buy should allow you a minimum of a few weeks to thoroughly try out and get used to the hearing aids and to return them if you’re not satisfied. Most states require at least a 30-day trial period for prescription hearing aids; look for a return period that long or longer for OTC models.
How We Rate Hearing Aids
CR evaluates hearing aids in a few different ways. To rate hearing aid brands and retailers, we asked 13,163 of our members to report on their experiences owning and shopping for hearing aids. In our most recent such survey, conducted in 2023, CR members shared their satisfaction with various aspects of their hearing aids, including reliability, comfort, and sound quality. They also told us how satisfied they were with their hearing aids’ performance in various situations, like group conversations or conversations had in especially noisy environments. We were able to score 17 prescription hearing aid brands and three OTC brands. We also scored 17 retailers that sell hearing aids, based on member feedback on their satisfaction with their purchasing experience, including the person who programmed their hearing aids, pricing options, cost transparency, selection, follow-up adjustment service, and more.
To provide ratings for specific models, we also test OTC hearing aids in our labs. Our evaluation of hearing aids was designed with input from professional audiologists and included feedback from people with hearing loss. We score OTC hearing aids on three main characteristics: ease of use, performance, and sound quality. To rate each hearing aid’s ease of use, our usability expert evaluates their ease of setup and operation, and the ease of using the smartphone app if the hearing aid connects with one. To evaluate a hearing aid’s performance, one group of panelists provides feedback on comfort. A separate panel of people with some mild to moderate hearing loss uses it to take a series of listening tests. We also test for each hearing aid’s noise-filtering capabilities using a hearing aid testing device (a standard piece of equipment used by audiologists to make sure hearing aids work as they should for their patients). We use this same device to measure each aid’s sound quality, putting it through a variety of tests designed to assess specs such as the maximum output, frequencies amplified, and the level of interference or “harmonic distortion” the hearing aid produces, which can muddy the sound you hear.
