The U.S. Food and Drug Administration approved the over-the-counter (OTC) sale of hearing aids in 2022 for adults with mild-to-moderate hearing loss. This policy made it possible for more people to get hearing aids without an expensive prescription, just as they can buy reading glasses. For those looking to buy OTC hearing aids for the first time, finding the right hearing aid is not the same as choosing a pair of readers. It's much trickier.

Researchers from the University of California at San Francisco describe why the availability of OTC hearing aids, although an important step, has not been enough to make sure people get the hearing devices they need and the support to use them properly in an opinion piece published in JAMA, the Journal of the American Medical Association.

Hearing aids are a large category that includes many kinds of devices. Personal sound amplification products are amplifiers, not hearing aids.

“Changing the system can create access, but it doesn't automatically create a system people can navigate,” Kathryn Phillips, corresponding author on the paper, told TheDoctor.

People who are considering buying an OTC hearing aid should first have their ears examined and their hearing tested to make sure their hearing loss is not caused by something like ear wax, Phillips urged.

First-time buyers may also be confused about which device best fits their needs. Phillips explained that although people tend to think of hearing aids as one kind of device, that is not the case. Hearing aids are a large category that includes many kinds of devices.

Personal sound amplification products are amplifiers, not hearing aids. Hearing aids themselves can come pre-programmed or some are self-fitting. Ear buds like Apple AirPods can have hearing aid software built into them.

Finding the right hearing aid is a trial-and-error process, Phillips, a professor of health economics and health services research at UC San Francisco, explained, adding, “Don't just pick something off a website.” Prescription and OTC aids are required to have a trial period, she said. People may have to try several different models. “Don't be discouraged and give up,” It takes time to match someone's personal hearing loss with the correct device.

Selecting a reputable brand is another challenge consumers face. “As a consumer, you want to know if this is an established manufacturer, and check the track record of these devices,” Phillips said. People should do their homework and look at online reviews from reliable sources like Consumer Reports and Hearing Tracker.

In addition, consumers may want a device that is cleared or registered by the U.S. Food and Drug Administration. Only about 25 percent of devices listed on Amazon as OTC hearing aids could be verified as regulated by the FDA. “Keep in mind, however, that FDA regulations are pretty broad. They are not black and white,” Phillips warned.

Good customer support is important, especially for first-time OTC hearing aid buyers. About 20 percent of consumers reported having no customer support, and only 51 percent reported a complete customer service experience that included help with device selection, fitting and use.

Only about 25 percent of devices listed on Amazon as OTC hearing aids could be verified as regulated by the FDA.

Cost and insurance coverage are two other challenges facing would-be buyers of OTC hearing aids for the first time. Prescription hearing aids can cost $3,400 and up, while OTC hearing aids are much less expensive. Buying hearing aids over-the counter can still cost about $500 — a significant expense for most people.

Consumers should know what costs their insurance covers if they hope to be reimbursed for loss or damage, Phillips cautioned. Coverage for hearing aids varies a lot. Evidence suggests more people now receive at least partial reimbursement, but some insurers do not distinguish between OTC and prescription hearing aids, so people should check with their insurance provider. In some cases, providers will cover the cost of hearing aids only if they are purchased from an approved seller, even if the same device is available elsewhere.