Executive Summary

The U.S. adult hearing care system remains fragmented, underinsured and reactive. Most public and private insurance plans offer minimal or no coverage for hearing aids, treatments for tinnitus or balance disorders and preventive care. Millions of adults experience hearing loss yet delay or forgo treatment due to cost and poor access. Tuned Care proposes a transformative shift from episodic care to an integrated hearing health platform that addresses the full continuum of auditory wellness.

1. Insurance Coverage Gaps in Current Hearing Care

Private Health Plans

• Major private insurers such as Aetna, Cigna, UnitedHealthcare and Blue Cross Blue Shield generally do not cover adult hearing aids unless state mandates require it

• Diagnostic hearing exams may be covered if deemed medically necessary

• “Hearing benefits” often mean discounted services rather than true insurance reimbursement

Medicare and Medicare Advantage

• Original Medicare excludes coverage for hearing aids and fitting exams

• Some Medicare Advantage plans offer capped or discount‑based benefits for hearing aids or OTC devices

Medicaid (Adults)

• Adult hearing aid coverage is state specific. Most states do not provide coverage, while pediatric coverage is common under EPSDT mandates

Self‑Funded Employer Plans

• Typically exempt from state mandates and usually do not include hearing aid benefits

2. Coverage by Device Type and Condition

Prescription In‑the‑Canal (ITC) Hearing Aids

• Covered only in states with mandates. Otherwise excluded

Over‑the‑Counter (OTC) Hearing Aids

• Rarely covered. Often considered consumer products

Tinnitus Treatment

• Treatment options are usually excluded unless accompanied by hearing loss

Balance and Vestibular Disorders

• Diagnostics may be covered. Rehabilitation and therapy coverage is inconsistent

Preventive Hearing Health

• Preventive services are typically not reimbursed. Workplace prevention is employer-mandated, not insurer-covered

3. Legal and Regulatory Landscape

• Only a few states mandate adult hearing aid coverage

• Self-funded employer plans are not subject to state mandates

• Medicare excludes hearing aids unless legislation changes

4. The Human and Economic Consequences

• Untreated hearing loss is linked to social isolation, depression and falls

• High costs delay care and reduce adoption

• Disjointed services lower care quality and outcomes

5. Market and Strategic Opportunity

• Over 40 million U.S. adults face hearing issues, with most care paid out of pocket

• Subscription-based and platform-enabled models are positioned to scale

• Demand exists for integrated, affordable care bundles supported by employers and direct-to-consumer strategies

6. Tuned Care Platform Model

Platform Offerings

• Services for hearing, tinnitus, balance and prevention

• Digital access with clinical oversight

• Tiered subscription models

Core Features

• Assessments, diagnostics, fittings and device support

• Tinnitus and vestibular care

• Preventive screening and education

Value Propositions

• One-stop hearing health access

• Predictable costs and financing

• Continuity of care with digital-first engagement

• Clinical quality via licensed specialists

7. Conclusion

The current U.S. adult hearing care system fails to provide comprehensive, affordable access to essential services. Coverage exclusions for hearing aids, tinnitus care, balance treatment and prevention result in fragmented and costly outcomes. Tuned Care offers a scalable platform to close these gaps and serve a rapidly growing, underserved market with clinical quality and affordability at the core.

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