Are Mental Health Patients covered  by Medicare?

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According to statistics, about one in four people on Medicare have a mental health condition yet only about 40% to 50% receive treatment.

Many older adults are undiagnosed or untreated for mental health conditions because symptoms like depression or anxiety are often mistaken for normal aging. Yet, mental health issues in those 65 and older are real, and care is vital at this stage of life.

Events like the death of a loved one, or concerns about loss of independence, deteriorating health, alcohol or drug dependence, social isolation, and loneliness are real psychological challenges for thousands of older people.

Medicare-Mental-Health

About one in four people on Medicare have a mental health condition, yet only 40% to 50% receive treatment, according to a new report by The Commonwealth Fund.

Since the start of the pandemic, anxiety and depression have more than doubled among older people an analysis by KFF (formerly the Kaiser Family Foundation) found.

Medicare will pay for many mental health services, but the challenge for countless beneficiaries has been finding a mental health professional willing and able to accept new patients. Some do not accept assignment, and those who do have months-long waiting lists, thanks to a shortage of providers.

New Medicare payment rules which went into effect at the start of the year should help alleviate some of the provider shortage. Marriage and family therapists, and licensed mental health counselors are now eligible for reimbursement, which could potentially add about 400,000 more mental health professionals to the mix.

That’s especially important for people living in rural areas, where workforce shortages are more significant. The new reimbursement guidelines mean more older adults can get the help they need. Primary providers may not understand the nuances of diagnosing or treating the unique characteristics of mental health conditions in older adults.

Sometimes it’s difficult to tease out what’s happening with a person when they present with different symptoms that could be related to depression, other chronic conditions, the use of substances, or to early dementia. Knowing how to ask the right questions and use the right diagnostic tools is critical.

Additionally, many older people have other chronic illnesses, and medication side effects for those conditions could mimic or exacerbate mental health issues. Or, medications for conditions like bipolar disorder or depression could worsen diseases like diabetes or heart problems.

Getting help for mental health to more older adults

Those on Medicare—both older adults and people with certain disabilities—face many of the same mental health challenges as other special populations.  Some may not seek treatment out of fear and maybe due to a lack of understanding that having a mental health issue is not a weakness.

Overall, our culture has stigmatized mental healthcare, and we have stigmatized aging to all be associated with less than, not a good as, damaged, lessen ability to contribute, and incapable. 

Older adults also face some unique challenges,. In addition to challenges like declining physical health, there may be family challenges, such as increased reliance on an adult child or caregiver, or even grandparents becoming caregivers for grandchildren. All of these create many mental health challenges and the need for therapy, and its been found that over time that Medicare has not been able to provide the kind of coverage needed.”

Some 40% of mental health providers—marriage and family therapists and mental health counselors—all of whom are all at least Master’s level trained and licensed, were excluded from Medicare coverage until now

Mental health services covered by traditional Medicare

Traditional Medicare pays for both inpatient (Part A, hospital coverage) and outpatient (Part B, medical coverage) mental health treatment from psychiatrists, psychologists, clinical social workers, nurse-practitioners/nurse specialists, and physician assistants, in addition to the newly-approved family therapists and mental health counselors.

Outpatient coverage includes annual depression screening by a primary care provider, individual and group psychotherapy, testing and evaluation, medication management, diagnostic tests, some prescription drugs that a provider must administer, opioid use disorder treatment, including drug counseling, medication, therapy and periodic assessments, an annual alcohol misuse screening which may include four brief face-to-face counseling sessions each year. 

Coverage of more intensive outpatient psychiatric treatment went into effect on January 1, 2024.

Beneficiaries are responsible for 20% copayment after meeting their Part B deductible. A supplemental, or Medigap plan, will pick up that cost difference. Additionally, there’s no cost-sharing for opioid use disorder treatment from a Medicare provider.

Most antidepressants and antipsychotics are covered under the Part D drug plan, but not all drugs are included, so make sure you know what your plan covers before enrolling in a Part D plan.

Adding additional therapists into the coverage pool will alleviate some of the backlog. Medicare reimbursement increases access to care and treatment for the elderly. Our older adults have the right to select their provider and receive mental healthcare within a professionally caring community.

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