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RENEE MONTAGNE, HOST:

Of the more than 30 million Americans who have significant hearing loss, only about a third actually get hearing aids. Some think their hearing loss isn't that bad, others are afraid of the stigma. But for many people, the strongest deterrent is financial. Hearing aids are expensive and typically not covered by insurance.

Brenda Salinas reports on why hearing aids have become a luxury good.

UNIDENTIFIED MAN: Hothouse. Baseball...

BRENDA SALINAS, BYLINE: If you ever get fitted for a hearing aid, you can expect to hear this sound. But one thing you might not be expecting, the sticker price.

ARTHUR CLARK: I was real surprised. I was really, really surprised.

SALINAS: That's Arthur Clark. He's an 82 year old retiree. He's getting his hearing aids repaired and he's looking to save some money, which is why he's here...

(SOUNDBITE OF ELECTRIC SCANNER)

SALINAS: ...at Costco. That's right. The place that sells 60 roll packs of toilet paper is in the hearing aid business. They have ties with big manufacturers and economies of scale. They can set up clinics like this one right in the store and give deep discounts on hearing aids.

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SALINAS: Chris Asaro is a hearing aids technician at a Costco in Washington, D.C. He says that even with the discounts, many people can't afford hearing aids. He's seen seniors come in just for the free test. They want to see how bad their hearing has gotten, but many walk out empty-handed.

CHRIS ASARO: A lot of the times they are on a fixed income, they're on Social Security, they only get so much a month, so they can't afford to purchase a hearing aid.

SALINAS: Digital hearing aids have been around since the '70s. With most technology, price drops over time. Think of what a flat screen TV costs now compared to few years ago. But hearing aids are an exception. Their price has stayed about the same, about $1,500 per ear, the higher-end models can go up to a few thousand.

Ross Porter is the founder of Embrace Hearing, a startup that sells their own brand of hearing aids directly to consumers online.

ROSS PORTER: So the actual hearing aid itself is fairly simple. All it has is a few microphones, a speaker, a kind of internal chip to it and then the housing and the casing. But overall, the hardware involved in a hearing aid isn't more than a few hundred dollars per hearing aid.

SALINAS: Porter says hearing aids are expensive because audiologists and distributers charge a steep markup.

Don't blame us, says Virginia Ramachandran. She's an audiologist at the Henry Ford Hospital in Detroit and says many of her patients need to learning to use their hearing aids.

VIRGINIA RAMACHANDRAN: You can imagine if someone gave you a laptop computer and you've never used one before, you wouldn't know how to turn it on, you wouldn't know what programs to open up or how to use them. And so a huge component of a hearing aid is the professional services that go along with it.

SALINAS: She says if you want to make hearing aids cheaper, make it so more people enter the market. That way some of the research and development costs incurred by the industry leaders could be divided among a bigger group. But she says what's really keeping people from buying hearing aids isn't the cost.

RAMACHANDRAN: People genuinely perceive hearing loss as being associated with older age, and so any excuse to not get them is a good one if it's something that you don't really want.

SALINAS: Dropping the cost of hearing aids can nudge a hearing impaired senior in the right direction, but there are always going to be people who would rather go without. They're embarrassed.

Ramachandran says that in European countries where hearing aids are covered by insurance, rates of adoption aren't significantly higher than ours. She says if seniors saw the devices as something as normal as eyeglasses, they'd be more likely to get them. This would expand the market, and it could even bring the price down. The industry is already working on this strategy; they're looking for aging celebrity spokes models to make the pitch.

MONTAGNE: Brenda Salinas. NPR News.

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MONTAGNE: This is NPR News.

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