According to the National Institute on Aging (NIA), mental health in the elderly is a critical, yet often overlooked aspect of overall well-being. The NIA emphasizes that older adults can experience various mental health challenges, including depression, anxiety, and even cognitive decline. The NIA highlights the prevalence of these issues that show increasing numbers from 20% of adults who are aged 55+ who may experience some form of mental health concerns. The NIA also underscores the importance of early detection and proper interventions for the elderly, as untreated mental health issues can lead to a drastic decline in physical health, increasing the risk for chronic conditions. 

Mental Health in the Elderly, the Facts:

According to Pan American Health Organization (PAHO/WHO), seniors are very susceptible to various mental health ailments from anxiety disorders, to dementia, and even psychosis.

• At least one in four older adults experiences some mental disorder, such as depression, anxiety, or dementia.
• Due to population aging, the number of seniors with mental disorders is expected to double by 2030.
• Depression is the most common mental health problem in older people.
• People aged 85 and older have the highest suicide rate of any age group.
• Two-thirds of seniors with mental health problems do not get the treatment they need (the “treatment gap”).
• Mental health services for older adults are extremely limited in most countries of the Americas.

Medicare and Mental Health Coverage:

The Commonwealth Fund does a deep dive into the intricacies of mental health coverage as it exists under Original Medicare and Medicare Advantage plans, but large barriers still exist. While there is notable expansion in mental health coverage, like lower cost sharing for outpatient mental health services, and free annual visits from the Affordable Care Act, many improvements are still needed – especially for those with chronic or serious mental health needs. Limitations to the 190-day lifetime cap on inpatient psychiatric hospital care, provider shortages, and lack of coverage for specific mental health coverage highlight serious needs that are seeking improvement.

Expanding Access to Mental Health Care for Seniors through Medicare: A Step in the Right Direction

It is no surprise that in recent years, the inadequacy of mental health care for seniors on Medicare has been a forefront issue. Older adults have been facing significant hurdles to acquire the mental health services they so desperately need, and the dire need for these services only increased for the elderly from the ongoing COVID-19 pandemic. In the recent eye-opening article by Judith Graham in The Washington Post, the critical need for reform is highlighted, as well as initiatives aimed at making mental health care more accessible for Medicare beneficiaries. 

The Challenge: Medical Specialist Shortages

The New York Times takes a closer look at the shortages of medical specialists as they relate to Medicare and mental health. There is an increasing importance of having a certain number of highly qualified professionals to meet the growing needs of the elderly, especially in a post-Covid world. Acknowledging the problem is half the battle, once we name the issue, we can begin to develop effective strategies to ensure seniors receive appropriate care, within a reasonable time frame.

According to The Washington Post, more than 124,000 behavioral health practitioners have opted out of Medicare, making it the medical specialty with the most significant number of non-participating providers.

In addition, The WHO emphasizes the dire significance of integrative care as it relates to the mental health of the elderly population. While many seniors are blessed with good health, there is a large portion who require some form of long-term care. Integrative care combines both mental and physical health, social support, and other factors which can assist and influence well-being.

Hope on the Horizon: Legislative and Regulatory Changes

While this all may seem quite dark and drastic, there is a ray of hope on the horizon: 

• Inclusion of Marriage & Family Therapists – Legislative and regulatory changes are poised to expand Medicare’s pool of behavioral health providers, which is a significant step forward in addressing these challenges. Starting in January, Medicare will, for the first time, allow marriage and family therapists and mental health counselors to provide their services. This group of professionals, numbering over 400,000, accounts for more than 40 percent of the licensed mental health workforce and plays a crucial role, particularly in rural areas.

• Expansion of service coverage – Furthermore, Medicare is extending its mental health coverage by offering up to 19 hours per week of intensive outpatient care as a benefit. The program is also set to improve navigation and peer-support services for individuals with severe mental illness and expand mobile crisis services to provide treatment in patients’ homes or on the streets. These changes are in direct response to the recognition that access to effective mental health care must be improved, especially as the nation emerges from the COVID-19 pandemic, as noted by Meena Seshamani, Deputy Administrator of the Centers for Medicare and Medicaid Services.

• Telehealth Expansion – COVID-19 brought about several changes, one notable one being the expansion of telehealth services. This has provided older adults access to services from the comfort of their homes, and granted additional access to adults who may have a more difficult time making in-person appointments. Continuing to maintain and reimburse mental health telehealth visits at the same rate as in-person visits remains crucial moving forward, and Medicare plans have extended the coverage of these services for the 2024 Calendar Year.

While Growth is Imminent, Challenges Remain

While there are many positive changes looming on the horizon, and they certainly highlight a step in the right direction, several challenges remain. 

Medicare must ensure that mental health counselors and therapists who work with Medicare patients are adequately compensated. In this effort, it becomes crucial to establish fair and competitive reimbursement rates to attract and retain qualified mental health professionals within the Medicare network.

The willingness of Medicare Advantage plans to include these providers in their networks and provide adequate services is also in question due to inconsistent oversight with data indicating that Medicare Advantage plans often do not include a sufficient number of in-network psychiatrists. 

Additionally, there is the pressing issue of mental health parity. While private insurance plans are required to adhere to parity standards set by the 2008 Mental Health Parity and Addiction Equity Act, closing the gap in parity for Medicare is imperative. Advocating for legislative changes to ensure that mental health services under Medicare receive equal consideration as medical and surgical benefits is crucial for providing comprehensive and equitable healthcare to older adults.

The NCOA offers insights about improving access to mental health care for Medicare recipients that draw from their expertise. While challenges exist, there is a strong advocate for change. By advocating for change and putting more policies in place, we can ensure that the fight for more accessibility and effective mental health systems are in place for older adults.

Overcoming Mental Health Biases for the Elderly

Perhaps the largest struggle of all is the societal bias that minimizes the mental health needs of older adults. No legislation or policy change can directly address or change the minds of the masses. The belief that seniors should don a “grin and bear it” approach when dealing with depression remains prevalent. While we here at Los Gatos Doc believe in the physical health of your body, your mind plays a large role in your wellness routine too.

It is clear that while progress is being made, there is still work to be done to ensure that older adults have equal access to quality mental health services.

If you have direct questions about Medicare or what your plan covers, we encourage you to visit: https://www.aarp.org/membership/benefits/insurance/medicare/

And if you or someone you love, especially the older loved ones in your life, are struggling with depression – your primary care physician in Campbell, CA is a great place to start. To schedule an appointment with Dr. V and discuss any next steps with handling the hardships life can throw your way – visit to schedule an appointment.