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Addressing the gaps in mental health coverage for Medicare beneficiaries

Mental health awareness comes into focus each May, as it has since the awareness month was enacted in 1949. Following the pandemic, mental health continues to be in the spotlight, and for Medicare beneficiaries, attention is long overdue. According to recent polling by Morning Consult on behalf of the PAN Foundation, the majority of all seniors have never had a mental health screening.

Gaps in mental health coverage in Medicare

Meanwhile, studies have shown that older adults living with a chronic condition are more likely to experience depressive symptoms, considering the grief and isolation that often accompanies the aging process as family members and friends pass away. The need for mental health services is clear, but there are gaps.

For example, only certain types of mental health professionals can be reimbursed through Medicare, limiting the options available to beneficiaries in need of mental health-related services. Beneficiaries are also entitled to a depression screening, but with several stipulations, like who administers the screening and that it take no more than 15 minutes. Couple that with a national shortage of healthcare providers in the U.S., particularly in rural areas, and many beneficiaries are left with limited options.

Seniors share their mental health concerns

The Morning Consult survey of seniors living with chronic conditions showed that two in five seniors are concerned about maintaining their mental health and about a quarter had been diagnosed with a mental health condition.

Even for those seniors who have been diagnosed, there are challenges in managing mental health conditions, like access to the right professional and the cost of treatment and medication. It came as no surprise that 67 percent of seniors reported that cost was the main barrier to receiving treatment, specifically the cost of ongoing therapy or seeing their healthcare provider.

Among the same population, 17 percent said the cost of prescription medications was a barrier. At PAN, our work is centered on helping underinsured people get the medications and treatments they need, but unfortunately there is limited charitable assistance available for people with a mental health diagnosis.

High levels of trust in primary care physicians and patient advocacy organizations

The survey of seniors did have some positive findings, however. Nearly all who were surveyed—92 percent—reported that they trusted their primary care doctor to provide information about mental health. And three in five reported that they trusted patient advocacy organizations for the same information.

Mental health has long carried a stigma, so this level of openness to have a conversation with a health care provider or seek information from an advocacy organization is encouraging.

Solutions to increase access to mental health treatment

These conversations need to continue among patients and health care providers, but also among policymakers. Telehealth options were expanded in response to the pandemic, and policies to expand and maintain those options could have a significant impact on access to treatment. Congress is considering legislation that would expand the list of mental health professionals who can be reimbursed by Medicare. These would be positive steps that could help many.

More charitable assistance is also essential to help Medicare beneficiaries seek out the treatment they need without the fear of the cost. The PAN Foundation opened its first mental health assistance fund last year to help with the out-of-pocket prescription medication costs for Medicare beneficiaries living with bipolar disorder and we are committed to expanding our support to help patients living with other mental health conditions.

Get our latest mental health resources

If you or a loved one are in need of mental health services, these organizations may be able to help:

The federal government also offers resources for identifying mental health providers and finding low-cost healthcare services.

The Substance Abuse and Mental Health Services Administration (SAMHSA) offers general information on mental health and assistance in locating treatment services. SAMHSA also has a treatment referral helpline (1-800-662-HELP) and a behavioral health treatment locator on its website that can be searched by location.

The Health Resources and Services Administration (HRSA) works to improve access to healthcare, and its website has information on finding affordable healthcare, including health centers that offer care on a sliding fee scale.