Journal of Financial Planning: November 2023
Cary W. Tucker is an author and CERTIFIED FINANCIAL PLANNER™ professional who has pivoted from paralegal to paraplanner. He is a Volunteer Income Tax Assistance (VITA) and Financial Planning Day volunteer and is a recipient of the Joel Isaacson Endowed Scholarship.
To help clients face up to truths, financial planners should face clients directly. There are numerous advantages to not only looking clients in the eye but also revealing your whole face. The benefits apply to everyone, but are especially applicable and true for prospects, clients, and colleagues with some degree of hearing loss.
The McGurk Effect1 proved that speech perception is determined not only by hearing but also by vision. The combination induces speechreading—what used to be less accurately referred to as lipreading. Making sure that your entire face is visible when you are speaking will ensure that listeners are more likely to understand what you are saying and less likely to suffer from listening fatigue.
Despite the portrayal in movies like Mission: Impossible III and Metro, speechreading is not easily done and is not entirely flawless. Aside from the difficulty of discerning homophones, there is also the challenge of homophenes—consonants or words that look identical when spoken and cannot be distinguished by speechreading alone. Even when skillfully applied, speechreading does not confer an ability to instantly recognize every word, to magically perceive “legerdemain” or “prestidigitation.”
Accommodations for speechreading can be quite helpful for anyone but particularly for people who have trouble hearing. Besides the strain to understand spoken words, hearing loss creates many challenges. When left unaddressed, hearing loss can lead to isolation, depression, and dementia. Visits with otolaryngologists and audiologists can assist patients in recognizing that their hearing loss will become a serious problem, to begin moving through the precontemplation and contemplation stages of change.
Where financial planners can play a role is in helping clients with hearing loss to move into preparation and action.2 The changes an individual needs to make will depend on the level of hearing loss. Measured in decibels (dB), there are different categories of hearing loss that in worsening decline are: mild (20–40 dB), moderate (41–60 dB), severe (60–80 dB), and profound (>80 dB). The more extreme degrees of loss, severe and profound, are less common than the more limited degrees of loss, mild and moderate.3
Insurance and Hearing Aids
The treatment of severe or profound loss often requires a powerful, surgically implanted medical device such as a cochlear implant. Fortunately, Medicare covers cochlear implants4 as do many private health insurance carriers.
The treatment of mild or moderate loss commonly requires a hearing aid device, which Medicare does not cover at all.5 Medicare may have set a precedent in that many private health insurance policies do not cover hearing aids either. The lack of coverage is significant enough and pervasive enough that many states have taken it upon themselves to pass laws that require private health insurance in the state to provide some coverage of hearing aids. However, only about half of all states mandate hearing aid coverage.
The federal government has become aware of the difficulties in buying hearing aids, which routinely require not only a medical exam but also cost several thousands of dollars. To address the high expenses, the White House issued an executive order in 2021 that allowed hearing aids to be sold over the counter (OTC). Pharmacies and retail stores now sell OTC hearing aids, commonly at much lower prices than prescription hearing aids. Like reading glasses, OTC hearing aids can make improvements but have a limited effect.
When OTC hearing aids are not enough, financial planners can still serve clients with hearing loss. Hearing aids are a qualified medical expense and can be included as an itemized deduction for federal income tax. The qualified costs include not only the price of the hearing aid device but also the batteries, repairs, and maintenance needed to operate the aid.6 Hearing aids count as a medical expense that can be paid for without taxes or penalty by drawing from a flexible spending arrangement (FSA) or health savings account (HSA).
Other Issues Related to Hearing Loss
Besides immediate expenses, hearing aids can be a long-term investment and can reduce risks. There is ample evidence that wearing hearing aids can delay cognitive decline7 and reduce the likelihood of dementia.8 There are other practices to reduce the risk of dementia, such as frequent dancing,9 yet there is a persistent, negative stigma about hearing aids. Although hearing aids are available in a wide range of colors, many people choose an aid in a discreet color to match their hair.
Tips for Inclusive Presentations
Among numerous limitations of hearing aids, their effective range is only about two meters. When speaking to clients from a distance in a conference room (or addressing an audience in an auditorium), a remote microphone or other assistive listening device can be remarkably helpful.
When a client is not in an office or conference room, there are other tools to advance comprehension. Live captions, automatic speech recognition (ASR), and speech-to-text apps are available to better understand spoken words during phone calls. For virtual meetings or video conferences, the option to use captioning can likewise be a welcome aid not only to attendees with hearing loss but to all participants. Prior to starting each virtual or video event, the financial planner needs to make certain that captions are an option with the software and that the caption feature has been fully activated.
Overall, to better serve clients, planners need to address clients’ hearing loss, which can be a serious detriment to people of all ages. It is not safe to assume that hearing loss is an issue that will only come up or is only worth discussing with clients who are retired. Gradual presbycusis, or age-related hearing loss, is a common consequence of aging but is not inevitable.
There are other causes of hearing loss. Hearing loss can be a late effect of central nervous system (CNS) cancer.10 The onset of hearing loss may be genetic and passed down within a family,11 so hearing loss can affect several generations of clients. The demographics of clients can also affect the prevalence of hearing loss. Hearing problems are a top concern among military veterans, for example.
Regardless of the age of onset, living with hearing loss can be a heavy weight to bear: financially, physically, and emotionally. A little help with the financial burden can go a long way.
Endnotes
- McGurk, H., and J. MacDonald. 1976. “Hearing Lips and Seeing Voices.” Nature 264 (5588): 746–748.
- Klontz, B., R. Kahler, and T. Klontz. 2016. Facilitating Financial Health. Erlanger: National Underwriter.
- Goman, A.M., and F.R. Lin. 2016. “Prevalence of Hearing Loss by Severity in the United States.” American Journal of Public Health 106 (10): 1820–2.
- 42 CFR 411.15(d)(2)(ii)
- 42 CFR 411.15(d)
- IRS Publication 502
- Sarant, Julia, David Harris, Peter Busby, Paul Maruff, Adrian Schembri, Ulrike Lemke, and Stefan Launer. 2020. “The Effect of Hearing Aid Use on Cognition in Older Adults: Can We Delay Decline or Even Improve Cognitive Function?” Journal of Clinical Medicine 9 (1): 254.
- Huang, Alison R., Kening Jiang, Frank R. Lin, Jennifer A. Deal, and Nicholas S. Reed. 2023. “Hearing Loss and Dementia Prevalence in Older Adults in the US.” JAMA 329 (2): 171–173.
- Verghese, J, R.B. Lipton, M.J. Katz, C.B. Hall, C.A. Derby, G. Kuslansky, A.F. Ambrose, M. Sliwinski, and H. Buschke. 2003. “Leisure Activities and the Risk of Dementia in the Elderly.” The New England Journal of Medicine 348: 2508–2516.
- Keene, N., W. Hobbie, and K. Ruccione. 2000. Childhood Cancer Survivors. Sebastopol: O’Reilly & Associates.
- Eberts, S., and G. Hannan. 2022. Hear & Beyond. Vancouver: Page Two Books.