My only experience is going through audiology via my PCP and paying for hearing aids via insurance. I'm in Oregon, which has a number of good programs for low income or disabled households, and I find it isn't too difficult to get the help my family needs as long as I ask around. I'd recommend searching online for local programs that may offer discounts or even free services to people who don't have insurance and/or may be on low income in your area. I'm a fairly young individual though, with mild hearing loss, so I'm not too familiar with many programs geared toward older adults.
As far as stt and tts, I recommend Speechify. The basic tools are all free, and so far the AI seems the smartest out of all other speech/text apps I've tried. It's also got a dashboard where you can design sound-oriented projects and upload documents from other websites for easier reading/hearing. I use it a lot because I have dyslexia, but it's also really helpful for when I need some extra audio tools and cues.
Hope I'm kind of some help! I'm new to the community, so I can only offer a teeny bit of input at the moment.
