Medicare Increases Coverage of Mental Health Services

Medicare has increased the amount of mental health coverage beneficiaries are entitled to. After years of unequal treatment, Medicare now covers mental health care the same way it covers physical illnesses.

Previously, Medicare covered only 50 percent of the cost of mental health treatment. In 2008, Congress passed a law that required Medicare to gradually begin covering a greater portion of the cost until it was equal to the amount Medicare pays for outpatient medical care.

In 2014, Medicare began covering 80 percent of the approved amount for outpatient care, including visits to psychiatrists and licensed drug and alcohol counselors. Beneficiaries will still have to pay any applicable deductibles and coinsurance amounts. These new coverage rules apply to Original Medicare only. Individuals covered by a Medicare Advantage plan may have different costs and rules.

Medicare still puts a cap on inpatient mental health coverage, paying for no more than 190 days of inpatient psychiatric hospital services during a beneficiary’s lifetime.

For more information on Medicare’s coverage of mental health, click here.

Also, we found the following information on the American Psychological Association’s (APA) website. 

Mental and Behavioral Health Needs and Preferences of Older Americans
• Recent data indicate that an estimated 20.4 percent of adults aged 65 and older met criteria for a mental disorder, including dementia during the previous 12 months (Karel, Gatz & Smyer, 2012). More than 50 percent of residents have some form of cognitive impairment, and many nursing home patients have personality disorders exacerbated by chronic health problems (Gabrel, 2007).
• Increasing diversity in the older population will affect the provision of mental health/substance use services, requiring training in the provision of culturally competent care in the coming decades (APA, 2009). Psychologists have been at the forefront of research and development of interventions and assessment tools to address the special needs of diverse elders.
• Researchers confirm that older adults with evidence of mental disorder are less likely than younger and middle aged adults to receive mental health services and that, when they do, they are less likely to receive care from a mental health specialist (Karel, Gatz & Smyer, 2012).
• Because of their coexisting physical conditions, older adults are significantly more likely to seek and accept services in primary care versus specialty mental health care settings (IOM, 2012).
• Older Americans underutilize mental health services for a variety of reasons, including: inadequate insurance coverage; a shortage of trained geriatric mental health providers; lack of coordination among primary care, mental health and aging service providers; stigma surrounding mental health and its treatment; denial of problems; and access barriers such as transportation (Bartels et al., 2004).
• Older adults often prefer psychotherapy to psychiatric medications (Koh et al., 2010; Areán et al., 2002). However, psychological interventions are often not offered as an alternative.

Anxiety, Depression and Suicide
• Mental disorders, such as anxiety and depression, adversely affect one’s physical health and ability to function, especially in older adulthood. For example, untreated depression in an older person with heart disease can negatively affect the outcome of the heart disease (APA, 2005). Conversely, older adults with medical conditions such as heart disease have higher rates of depression than those who are medically well.
• 15-20 percent of older adults in the United States have experienced depression (Geriatric Mental Health Foundation, 2008). Approximately 11 percent of older adults have anxiety disorders (AOA, 2001). Even mild depression lowers immunity and may compromise a person’s ability to fight infections and cancers (APA, 2005).
• Depression is a major risk factor for suicide. In 2006, 14.22 of every 100,000 people age 65 and over died by suicide, higher than the rate of 11.16 per 100,000 in the general population. Non-Hispanic white men age 85 and over are at the greatest risk for suicide, with a rate of 49.8 suicide deaths per 100,000 (CDC, 2006).
• Tragically, many of these suicides may have been prevented, as many older adults who die by suicide reached out for help; 20 percent see a doctor the day they die, 40 percent the week they die, and 70 percent the month they die. Yet depression is frequently missed by physicians because older adults are more likely to seek treatment for other physical ailments than they are to seek treatment for depression (NAMI, 2009).
• For some older adults, the development of a disabling illness, loss of a spouse or loved one, retirement, moving out of the family home or other stressful event may bring about the onset of a depressive episode (NAMI, 2009).
• Symptoms of depression and anxiety in older Americans are often overlooked and untreated because they can coincide with other late life problems (APA, 2005).
• Psychologists use psychological interventions, including various psychotherapies and supportive counseling, to treat mental health disorders and help older adults cope with late life stressors. These interventions have been shown to be effective either alone or in combination with psychiatric medications (APA, 2005). Recent research has demonstrated that psychotherapy can be effective for people diagnosed with late-life depression who are at high risk for poor response to antidepressant medication (Areán, Raue, Mackin et al., 2010).

Alzheimer’s Disease and Dementia
• Dementia is an umbrella term describing a variety of diseases and conditions characterized by decline in memory, negative changes in behavior, and inability to think clearly. In Alzheimer’s disease, these cognitive changes eventually impair an individual’s ability to carry out basic bodily functions (e.g., walking and swallowing) (Alzheimer’s Association, 2012).
• Current estimates suggest that 1 in 8 persons over 65 has Alzheimer’s disease; a total of approximately 5.4 million older Americans. This number will continue to grow as the proportion of the U.S. population over the age of 65 increases (Alzheimer’s Association, 2012).
• People with dementia often suffer from depression, paranoia and anxiety. Psychologists’ skills in differential diagnosis and treatment are helpful in these complex cases. Psychologists also teach behavioral and environmental strategies to caregivers of those with dementia to deal with these common behaviors (APA, 1998). In addition, psychologists help individuals who are in early stages of dementia to build coping strategies and reduce their stress through psychotherapy and psychoeducational support groups. Memory training strategies often help to optimize remaining cognitive abilities (APA, 2005).
• Psychologists also assess a person’s capacity to make health care or legal decisions. They have been at the forefront in developing instruments used to assess capacities in older adults (APA, 2008).
• Early diagnosis of Alzheimer’s and effective treatment of the problematic behaviors that often accompany dementia are becoming increasingly possible due to the sensitive diagnostic tools and behavioral and environmental interventions developed by psychologists (APA, 2003). A recent study (Barnes, et al., 2011) notes that up to half of Alzheimer’s cases worldwide are attributable to seven potentially modifiable risk factors — such as diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity and physical inactivity. It is estimated that a 10-25 percent reduction in all seven risk factors could potentially prevent as many as 1.1-3 million Alzheimer’ disease cases worldwide.

The team at Strohschein Law Group is here to help you navigate the Medicare system so your loved one with mental illness can receive the support that best meets their needs.  Just give us a call 630-377-3241