[ Theme IV ] Acquisition and reimbursement of a hearing aid (France)

This topic is the fourth in a series of 13 topics that cover a range of questions regularly asked by our customers and web users about hearing aids. To return to the summary of this special report on Hearing Aids and to consult the other topics, go to this page.

As we mentioned earlier, there are many benefits to wear a hearing aid : a positive impact on your professional and personal life and on your health. So how do you go about getting a hearing aid and how do you get reimbursed ? We answer these questions in full in this article.

How to acquire a hearing aid ?

In order to bring more clarity and understanding to our answer, we break it down by distinguishing on the one hand between people with a hearing disability / handicap / deafness (atypical hearing loss, greater than or equal to 90dB, specific to the individual) and, on the other hand, people affected by presbycusis (classic hearing loss, less than or equal to 90dB). Indeed, the procedure for acquiring a hearing aid may differ according to these hearing problems :

• The person with a hearing disability will follow a regulated path, with a hearing aid that is necessarily custom-made, as his or her hearing loss is atypical and specific to him or her (disability) ;
• The person suffering from presbycusis will have the choice between a regulated pathway or an over-the-counter (OTC) hearing aid, their hearing loss being classic, “symptomatic” of presbycusis.

The elements developed below are specific to the French market. However, the same response structure can be found if we consider the different European countries or the United States, which explains – as we will discuss in this article – the worldwide development of pre-configured hearing aids as a response to a real problem of access to care.

The acquisition of a hearing aid for people with a hearing disability

In France, there are approximately 700,000 people with a hearing disability (people who speak sign language and/or practice lip reading). 90% of them are equipped with a hearing aid : without this hearing aid they would not have been able to lead a normal life (acquisition of language, socialization). For these people, the care process is necessarily :

• Long, since the hearing disability must be detected, which can take years ;
• Regulated, since it opens access to the MDPH Deafness file allowing almost complete coverage of hearing aids (see theme II for the conditions to be fulfilled and the documents to be provided in order to submit an MDPH Deafness application).

For these people, the hearing aid must :

• Be adjusted to the patient’s atypical audiogram ;
• Be accompanied by a service to adjust the settings over time, since in these cases it is a matter of learning or relearning to hear, with the difficulties and inaccuracies that this entails and which are all specific to the individual’s feelings as well as to the technical limits of hearing aids.

Thus, for people with a hearing disability, a prescription is mandatory to acquire a hearing aid ; the medical prescription allows the MDPH file to be constituted and to benefit from an almost complete coverage of the device (almost no out-of-pocket expenses for the patient).

The acquisition of a hearing aid for presbycusis

It is estimated that there are 360 million presbycusic people in the world (6 million in France). According to WHO figures for 2022, the proportion of people who do not use hearing aids when they should is high worldwide, ranging from 77% to 83% in the different WHO regions and from 74% to 90% depending on income levels. Faced with this massive rejection, the global offer diversified in 2010 with the appearance of ready-to-hear pre-set hearing aids (OTC), delivered without follow-up services, at much lower prices than the traditional, “made-to-measure” offer. In 2012, a double-blind, placebo-controlled American clinical trial praised the merits of these new hearing aids and praised their effectiveness to those concerned. This diversification of the offer has the advantage of giving the presbycousis person the choice between :

• Acquire a traditional hearing aid, delivered on prescription by an ENT doctor (who performs the hearing test / audiometric assessment) and exclusively distributed by a hearing care professional ;
• Acquire a preset hearing aid, available without prescription (over the counter) and distributed in pharmacies (maximum amplification limited to 20dB), in independent opticians (no maximum amplification limit) or on the Internet (website of the different brands or market places such as Amazon or La Fnac, for example).

We will come back to the common points and differences between these different hearing solutions in a later section of this file.

In conclusion, in order to acquire a hearing aid, a person with a hearing disability / deafness must have a medical prescription, whereas this is not compulsory for a person with presbycusis, who can opt for a pre-configured hearing aid, available over the counter.

Do I need a prescription for a hearing aid ?

We have just answered this question : a prescription is necessary for people with a hearing disability, but not for people with presbycusis.

In France, what is the reimbursement of a hearing aid in 2023 ?

Reimbursement of hearing aids for the disabled (MDPH Deafness file)

The reimbursement of hearing aids for people with a hearing disability, upon presentation of an MDPH deafness file, is excellent. For children (under 20 years old), it is fully covered, the hearing aid specialist being obliged not to offer a hearing aid at a higher price than the one covered. For adults, it is almost complete (limit of 3,960€ over 3 years) and can be combined with other aids (especially for people involved in a professional career or looking for work).

Coverage of hearing aids for presbycusis

For people with presbycusis, the situation is quiet different. As we have just seen, a person with presbycusis has the choice between a traditional “custom” hearing aid with a doctor’s prescription and a pre-configured hearing aid sold over the counter. Let’s take a look at the coverage of these two options.

Coverage of traditional “custom” hearing aids

When a person with presbycusis chooses to go for a traditional hearing aid, he/she accepts a care pathway including an ENT medical consultation (audiometric assessment and medical prescription) and then the acquisition of a hearing device from a hearing aid specialist. The latter will propose a hearing aid that suits the patient’s hearing loss. Regarding the level of care for the patient, the choice must be made between :

• A class I hearing aid (100% Health offer, RAC0), the price of which is capped at 950€ per ear. The Health Insurance covers 60% of this expense (based on a fixed rate of 400€ per ear) and the mutual insurance company covers the rest. The remaining cost for the patient is therefore zero, in this case ;
• A class II hearing aid, which is not part of the 100% Health basket and whose selling price is freely fixed by the brand/network. The Health Insurance covers 60% of this expense (based on a fixed rate of 400€ per ear); the mutual insurance company covers another part of this expense and the remaining cost is for the patient.

In September 2022, a study by 60 million consumers, based on 69 quotes from 8 brands (Entendre, Audition Conseil, Audio 2000, Alain Afflelou, Amplifon, Audika, Écouter Voir, Optical Center) points out real dysfunctions in the offer of classes proposed to patients. The conclusions of this field study are as follows :

• Commercial practices that preferentially direct patients towards class II hearing aids (with payment facilities in 48 instalments, for example), resulting in a greater or lesser out-of-pocket expense for these individuals (depending on what their mutual insurance company provides) even though class I would be sufficient for this type of hearing loss ;
• Unjustified denigration of class I hearing aids, either orally or in the presentation brochure. The first denigration argument is the number of adjustment channels, on which it is worth quoting Phonak : ” Some entry-level Class I models now have 12 adjustment channels, whereas the top-of-the-line devices of ten years ago only had 10.”

Thus, rather than talking about “range” or “class” of hearing aids and hastily denigrating those that are less expensive, it is advisable to enlighten individuals on their real needs, in order to allow them to make an informed choice, which some health professionals seem to turn away from, no doubt for commercial reasons, by surfing on people’s ignorance on the subject.

Coverage of pre-configured hearing aids

In France, the coverage of a hearing aid is subject to 3 conditions :

• The care pathway,
• The registration of the hearing aid on the LPPR list (List of Reimbursable Products and Services),
• The follow-up services sold with the hearing aid.

• The care pathway

A hearing aid can only be covered by Social Security if it is prescribed by a doctor. Pre-configured hearing aids sold without a prescription are therefore not eligible for reimbursement by Social Security.

• Registration on the LPPR list

Only hearing aids that are registered on the LPPR list are covered. The assessment of this registration depends on a national commission. In France, the Sonalto brand, which markets a preconfigured BTE with a maximum amplification of 20dB (Octave), applied in 2018 for the inclusion of its device on the LPPR list, which was refused, despite a complete analysis provided (163 participants for the study) and the results of an American clinical trial, carried out in a double-blind manner in 2012 on 188 participants, which formally concluded that these devices were beneficial in the fitting of presbycusis. Preconfigured hearing aids have not yet been included on this list, despite their massive diffusion, to the great misfortune of the people concerned who are refused reimbursement by the Social Security.

• Follow-up services

For a hearing aid to be covered by the Social Security, it must also be sold with follow-up services over 4 years (life of the hearing aid). A 2015 study by UFC Que Choisir pointed out that these services account for 40% of the total bill, even though they are rarely used by the people concerned, for various reasons (the person does not use the hearing aid, the person has died, the hearing aid store has closed down, etc.). These services are therefore like compulsory fees, collected in advance, for services that will not be provided. Since pre-configured hearing aids do not require any follow-up services over time, their selling price is exempt from this and the user therefore pays a fair price, which is unfortunately not covered by the Social Security.

Since pre-configured hearing aids do not meet any of these conditions (medical prescription, LPPR list, follow-up services), they are not covered by Social Security. However, some mutual insurance companies may decide, at their discretion and upon presentation of the invoice, to reimburse them, partially or totally (for more information on this subject, please consult this page).