A Complete Guide to Over-the-Counter Hearing Aids

Sometimes, it’s surprisingly hard for people to recognize hearing loss in themselves. The early signs—trouble having conversations on the phone or in groups, for instance—can be subtle. “Quite often, you don’t know what you’re missing,” DiStefano says.

A couple of clues: You may notice that you’re having more difficulty understanding people in noisy places or you’re frequently asking people to repeat themselves. You may also often need to turn up the volume on the TV or radio to the point that others complain it’s too loud.

If you experience any of the above, free online tools can give you some helpful information, says Larry Humes, PhD, distinguished professor emeritus of speech, language, and hearing sciences at Indiana University Bloomington. He recommends starting with some form of what’s known as the Hearing Handicap Inventory questionnaire (versions exist for people of different ages; find a shortened screening version here). It can help you figure out whether you have a hearing problem and how severe it might be. 

A good next step is taking the online Consumer Ear Disease Risk Assessment (or CEDRA). That research-backed online tool will help identify whether your hearing loss is related to a medical condition that should be handled by a doctor—not with hearing aids. 

Of course, you can also have your hearing evaluated by a professional. An otolaryngologist (also called an ENT, a physician specializing in treating the ears, nose, and throat) or an audiologist (a healthcare professional licensed to evaluate hearing problems and prescribe hearing aids) can perform hearing tests—which are usually covered by insurance. Those experts can diagnose the extent of any hearing loss and check for treatable medical conditions, such as impacted earwax or an infection, that could be interfering with your ability to hear.

If your hearing issues are not caused by a treatable medical condition, consider hearing aids.

While some hearing devices have long been sold online or by mail order without a prescription, they were loosely regulated, so there were few guardrails in place to ensure that they worked. But thanks to a 2017 law designed to make hearing aids more accessible and less expensive, there is now a clear set of rules for OTC aids. These rules, which went into effect in the fall of 2022, require that hearing aids sold without a prescription meet specific standards for safety and effectiveness. And they can’t be sold to children.

OTC aids must also comply with certain technical requirements, including restrictions on how much they can amplify sound, which is intended to protect users from hearing damage. These restrictions, however, also make OTC aids unsuitable for people with severe hearing loss. (Signs of severe hearing loss include being unable to hear spoken words even in a quiet room or trouble hearing loud music or power tools.) That’s why OTC aids are specifically intended for people with self-perceived mild to moderate hearing loss. (Signs of mild to moderate hearing loss include trouble hearing speech in noisy places, in groups, and during phone calls.)

Prescription hearing aids and OTC devices function in essentially the same way. Both pick up sounds with tiny microphones, amplify them, and transmit them to your ear via a speaker. And they use similar technology to do this.

Perhaps the most significant difference between OTC and traditional aids isn’t the technology they use but how you go about obtaining them—and in some cases, setting them up.

With prescription hearing aids, you go to a healthcare provider such as an audiologist, an otolaryngologist, or a licensed hearing aid specialist. These providers test your hearing and evaluate your needs, and help you decide on the hearing aid that might be best for you. They also program the device you select so that it’s set up for your specific hearing profile—a “fitting”—and provide follow-up adjustments as needed.

With OTC hearing aids, there’s no requirement to go to a provider or even have a hearing test before settling on a device. And though some OTC companies provide substantial customer support, setup and adjustments are often largely up to you.

Most people with hearing impairment have loss that falls in the mild to moderate range that OTCs are meant to address. So how to choose between the prescription and OTC routes? 

Even if OTC hearing aids are appropriate for your level of loss, it’s wise to consider whether you’ll be comfortable choosing and maintaining them without professional assistance. “If you like to have somebody guiding you and being a resource, then I’d encourage you to stick with an audiologist or dispenser,” says Jasleen Singh, AuD, an assistant professor of speech, language, and hearing sciences at the University of Massachusetts Amherst. (A hearing aid dispenser is a professional who’s licensed to sell prescription hearing aids.)

Plus, even with milder hearing loss, you may want professional help if you have complex hearing needs—say, you work in a classroom full of kids with sounds all around, says Sumit Dhar, PhD, a professor in the department of communication sciences and disorders at Northwestern University.

If you opt for OTC hearing aids, it’s important to take your time to determine which model is best for you. If you end up with OTC aids that don’t serve your needs, it may deter you from trying other, more effective ones later, says Nicholas Reed, AuD, faculty in the NYU Langone Health Optimal Aging Institute in New York City. Good places to start are CR’s ratings of hearing aid brands and our evaluations of eight OTC hearing aids. Some experts we reached out to also recommend checking HearingTracker or HearAdvisor, which test both OTC and prescription hearing aids. Read on for four important considerations. 

Self-fitting or preset: Over-the-counter hearing aids come in two categories—self-fitting and preset. Self-fitting OTC aids are designed to be used with a smartphone app that has a feature—often a brief hearing test—that customizes the device’s settings specifically for your hearing loss.

Preset OTC aids typically have just a handful of basic settings for different levels of hearing loss (in the mild to moderate range) or for common issues such as trouble hearing in noisy rooms. Functionality varies widely, however: A few higher-end presets do allow for more customization, while some of the least expensive models offer users little more in the way of features than volume control.

Both types of OTC hearing aids tend to be less expensive than prescription devices. Some preset hearing aids, for instance, are available for around $100 a pair, while self-fitting OTC aids start at around $500 a pair.

However, a few in each category are close to $2,000 or more. Eargo’s self-fitting aids, which are so tiny as to be nearly invisible when you’re wearing them, top out at $2,500 a pair, for example. (By comparison, Costco Hearing Aid Centers offer prescription hearing aid models starting at $1,500.)

Several of the experts we spoke with generally recommend self-fitting hearing aids over preset aids because self-fitting models must be cleared by the Food and Drug Administration for safety, usability, and effectiveness before being sold. Because preset OTC aids aren’t required to have that FDA clearance, there’s significantly more variability in their quality, says Vinaya Manchaiah, PhD, director of audiology at the University of Colorado Hospital in Aurora. Some, for instance, particularly the low-priced models, may have poor acoustics.

Shape: Like prescription hearing aids, OTC devices come in two basic shapes—in the ear or behind the ear. In-the-ear aids tend to be smaller, sometimes small enough to fit completely inside the ear canal. Behind-the-ear aids consist of connected pieces: a case that contains the device’s hardware and sits behind the ear, and a receiver that sits in the canal or an earbud.

Does one shape work better than the other? “I actually tend to think whatever hearing aid you want to wear and you will wear more and you like wearing, you should pick that one,” says Laura Coco, AuD, an assistant professor in the School of Speech, Language, and Hearing Sciences at San Diego State University. Still, she says that behind-the-ear styles tend to be slightly better at filtering out background noise.

Smaller devices also tend to be a bit more difficult to manipulate and clean, and may have less capacity for features like wireless audio streaming, says Anna Jilla, AuD, an assistant professor of audiology at Lamar University in Beaumont, Texas.

Customer service: Self-fitting and preset OTC hearing aids are designed so that you can set them up on your own. Even so, you may want some support as you’re learning how to use them or with troubleshooting any problems that arise. To check on the level of customer service that various OTC brands provide, visit their websites to see whether they give users assistance in setting up and using their OTC hearing aids. Companies such as Jabra and Lexie offer support from hearing professionals but may charge more for higher levels of service. Audiologists in your area might also be willing to assist with OTC hearing aids for a fee, so if you’re interested in that service, call a few.

Return policy: The return period should allow you a minimum of a few weeks to thoroughly try out and get used to the hearing aids and to send them back 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.

Prescription hearing aids can treat all levels of hearing loss, but they’re the only option for those with severe or profound loss—which OTCs aren’t equipped to address.

With prescription aids, you’ll receive more than just the devices. You should also get the support of a hearing professional, including an in-person hearing test, guidance in selecting a model, and multiple fittings and adjustments.

Costs range from about $1,500 to more than $7,000 a pair. In our most recent survey, CR members who bought prescription aids reported paying a median price of $2,592 per pair after insurance.

While insurance coverage for hearing aids is still spotty, it has become more common. So before you buy, check with your insurance provider to see what, if anything, it offers. Audiologist Michele DiStefano says she’s had patients who didn’t realize they had some coverage through their private insurance plans.

Savvy shopping can also help ensure you get proper help and fair prices. In CR’s survey-based ratings of hearing aid retailers, the Department of Veterans Affairs received the highest Overall Score. If you are a veteran, hearing aids are fully covered when you get them through the VA.

CR members also reported high levels of satisfaction with wholesale clubs, in part because they offer a variety of pricing options and are transparent about cost. Costco was the second-best-scoring retailer overall in our ratings; Sam’s Club scored highly as well. Hearing aid chains Audibel and Connect Hearing scored well, too. Hospitals, clinics, and ENTs were among the other high-scoring retailers, so consider seeking out hearing aids at a medical facility or an ENT’s office nearby.