INTRODUCTION: Financial hardship related to healthcare, often termed financial toxicity, can influence patient decision-making. Individuals with hearing loss who experience financial strain may opt for lower-cost hearing devices despite preferring advanced features or professional support. Understanding how financial distress shapes preferences for hearing aid (HA) technology and service delivery models can help tailor patient-centered hearing care and inform equitable policy development. This study examined associations between financial toxicity, demographic and audiologic factors, and preferences for HA features and service delivery models among adults with self-reported hearing disability. METHODS: This study was nested within a four-arm randomized clinical trial and employed a cross-sectional survey design. Data were collected from 114 adults with self-reported hearing disability who completed a patient profile and the Comprehensive Score for Financial Toxicity (COST) questionnaire. The survey assessed demographic characteristics, HA feature preferences, and preferred service delivery models. Associations between financial toxicity, demographic variables, and hearing aid preferences were examined using Spearman correlation coefficients. For preferences with nominal responses (>2 categories), standardized mean differences were calculated to evaluate differences in demographic characteristics and financial toxicity across groups. RESULTS: Most participants (n = 82, 76%) reported no financial toxicity (COST Grade 0; score ≥ 1 IHCON 2026 26). Higher financial toxicity was moderately associated with Medicaid insurance status and with placing greater importance on cost when selecting HA service delivery models. Participants who identified affordability as the most important factor influencing their decision to purchase over-the-counter (OTC) devices were more likely to be younger and employed at least part-time compared to those prioritizing professional fitting or sound adjustability (medium-to-large effects). Preference for advanced OTC device features was more common among individuals with higher income (six-figure households) compared to those preferring basic features (large effect). Participants who preferred online-only over in-person support for OTC devices were more likely to be Medicaid-insured (large effect). Similarly, individuals preferring online support over hybrid models (online plus in-store) were more likely to live alone (large effect). CONCLUSIONS: Financial toxicity appears to shape HA preferences, particularly influencing the importance placed on affordability, device features, and support models. Although cost concerns increased interest in OTC devices and remote support options, participants continued to value professional involvement and advanced features, highlighting a tension between financial constraints and preferred models of care. These findings underscore the importance of incorporating financial burden into the design.