Most technology gets cheaper over time — think about what you used to pay for a flat-screen TV or a laptop. Not so with hearing aids, which can set you back as much as $6,000 a pair and last only three to five years, according to the Better Hearing Institute. What’s more, Medicare doesn’t cover aids, and private insurance typically hasn’t either. Times are changing. While buying a hearing aid has often meant visiting an audiologist, new competitors are shaking up the industry. With players like Costco and online sellers gunning for more of the action, you can reap significant savings. “How aids are traditionally sold through audiologists isn’t affordable for a lot of people, so new devices and shopping avenues are gaining traction,” says Frank Lin, an ear, nose, and throat surgeon and assistant professor at Johns Hopkins. Insurers are starting to change their tune too. UnitedHealthcare, the nation’s largest insurance company, has added discounted and even free aids to its plans. A small number of other plans will pitch in $500 to $1,000 toward the cost. So it’s time you stopped ignoring missed conversations and garbled movie scenes. First, to rule out other medical conditions, get a checkup from an audiologist or an ear, nose, and throat or primary-care doctor. Then pick from these options. Over-the-counter devices What you get. Personal sound amplification products are the drugstore reading glasses of the hearing world. These gadgets, sold online and in electronics stores, are technically meant to help normal hearing people catch every word in places like restaurants. At one time PSAPs did little more than amplify all sounds, but recent improvements to the technology have made them better at reducing background noise, says David Copithorne, who publishes the industry site HearingMojo.com. Who it’s best for. Someone with mild hearing loss — meaning you miss a word here and there — could benefit from a PSAP. “Go for the higher-end version, not the $50 or $100 pair,” says Copithorne. The Sound World Solutions CS10, which costs $300 and looks like a Bluetooth headset, or the $200 RCA Symphonix, which goes over your ear, may boost sound enough for you to get by at a crowded dinner table, he says. Drawbacks. Wear a PSAP without an exam, audiologists warn, and you might miss treatable causes of poor hearing, such as wax buildup or an infection. Another potential pitfall: You try out a PSAP, conclude aids won’t work, and never trade up to the real deal. In case a PSAP is no help, make sure whatever you buy can be returned. An audiologist’s office What you get. The most handholding from a pro with the most training — four years of postgraduate study. In addition to testing, audiologists can customize aids for your ear shape and hearing condition and tweak them in follow-up visits, says Bettie Borton, a Montgomery audiologist and the president of the American Academy of Audiology. You’ll pay $2,500 to $6,000 for a pair of aids depending on the features you want. High-end add-ons include Bluetooth to sync aids with your phone. But since aids aren’t expensive to make, says Lin, a lot of what you’re paying for is service. Who it’s best for. Anyone with severe hearing loss or different levels of loss in each ear. Stick with an audiologist if you want the most advanced features or in-person help. Find one at audiology.org. Drawbacks. The price. The costs of the follow-up visits and the aid are typically bundled. Ask for a breakout so that you can negotiate on both, says Nancy Macklin of the Hearing Loss Association of America, a consumer group supported by members, including audiologists. A trip to Costco What you get. The big-box retailer stocks discounted hearing aids in 94% of its stores, often from manufacturers affiliated with the ones audiologists use. Costco’s nine models sell for $1,000 to $3,000, including fitting and follow-up care. The biggest difference from the audiologist’s office is that you’ll probably be seen by a hearing aid specialist, who has a state license and on-the-job training, not a degree. Who it’s best for. “They’re a good-quality product for someone with mild to moderate loss,” says Copithorne. Drawbacks. Costco doesn’t carry the right aids for severe loss, concedes Richard Chavez, who runs Costco’s hearing aid business. Shopping online What you get. At websites like Americahears.com and Audicus.com, you can pay as little as $800 for a set of aids. First you’ll need to get a hearing exam from a local audiologist or storefront hearing center (expect to pay $50 to $200). Once you submit the results, you can talk to a phone rep about what types of environments you have trouble in and then get a programmed device. Any adjustments are DIY, or you can mail back the aids. The website Hi HealthInnovations has local audiologists and specialists who will do in-person tests and fittings — go to hihealthinnovations.com to see if there’s one near you. Aids at this site, owned by the parent of insurer UnitedHealthcare, go for $1,600 to $2,000, less if you’re in a UnitedHealthcare plan. Who it’s best for. If you’re comfortable teaching yourself to adjust and clean your aid — perhaps this is your second set — you’re a candidate. Same goes if you’re near a Hi Health location. Many sites offer free returns without the 5% or so restocking fee you may face elsewhere. Drawbacks. Limited choice in models. And did we mention do-it-yourself adjustments? True bargains come at a price.