Medicare Recipients Days Away From Expanded Access

Starting in just a few days, Medicare recipients will gain access to more mental health care under their insurance plans.

In previous years, Medicare has failed to cover beneficiaries' mental health care, but Congress approved the expansion beginning January 1, so recipients will be able to pay for licensed mental health counselors and marriage and family therapy services in the new year.

Medicare is available to seniors as well as those age 18 and up with a major disability. But gaining access to the benefits often meant losing the ability to get counseling and therapy services.

"People who previously relied on their work insurance for mental health services might have found themselves at a crossroads upon retiring," financial advisor Christopher Hensley, the CEO of Houston First Financial Group, told Newsweek. "The deficiency in Medicare's mental health coverage could have led some to forgo essential treatment."

Options were typically limited to psychiatrists and psychologists, which often have shortages depending on which area you live in.

"This is monumental," licensed clinical social worker Brent Metcalf, owner of Tri-Star Counseling in Kingsport, Tennessee, told Newsweek. "Many seniors struggle to find affordable mental health providers, especially in rural areas."

In those areas, one in three adults are enrolled in Medicare, according to the Census Bureau, and that's often where Americans face the lowest number of psychiatrists and psychologists.

But now that Medicare is being extended to licensed counselors and marriage and family therapists, another 400,000 providers will be available. That comprises roughly 40 percent of the entire mental health workforce.

For many years, people have debated if Medicare should cover mental health services, with much of the reluctance for coverage being generational, said Christopher Fong, CEO of Arizona-based Smile Insurance Group and a Medicare insurance specialist.

"Many of the people we meet who are older and on Medicare either don't believe mental health is something that exists or that they fear sharing their mental health concerns," Fong told Newsweek.

Medicare's mental health coverage has historically been offered if "medically necessary" but often has met that standard, Fong said. Still, older Americans are facing a mental health crisis, with Fong saying he's had several senior clients who ended up taking their own lives after struggling with severe depression.

According to the U.S. Centers for Disease Control and Prevention (CDC), 20 percent of those age 55 and older experience some type of mental health concern. Anxiety, cognitive impairments and mood disorders like depression are especially common.

Older men have the highest suicide rate of any age group, the CDC said, with 45.23 per 100,000 compared to a national average of 11.01 per 100,000 for all ages.

"This is long overdue because in the past Medicare restricted coverage to services only provided by a much narrower section of mental health providers," licensed psychologist Lauren Napolitano told Newsweek.

Napolitano, who routinely sees clients for a range of mental health concerns, said the pandemic played a role in getting services more properly covered by Medicare.

"Since COVID there is much more attention and understanding of the suffering of many Americans, even those over the age of 60," she said. "I think there's also greater appreciation that mental health treatment aids with medical conditions."

Untreated depression, anxiety and other conditions have been found to exacerbate chronic illnesses like heart disease and diabetes.

"I think insurance companies are coming around to the idea that an ounce of prevention is worth a pound of cure," Napolitano said. "The more mental health resources are available for seniors, the less they will suffer from loneliness, depression and anxiety."

If you or someone you know is considering suicide, please contact the 988 Suicide and Crisis Lifeline by dialing 988, text "988" to the Crisis Text Line at 741741 or go to 988lifeline.org.