Mental health – JustCare

Few psychiatrists accept Medicare

If you and your spouse are not working, you likely need to enroll in Medicare at 65. But, as with many health insurance policies, it is extremely difficult to find psychiatrists who will accept Medicare coverage, reports Eugene Rubin, M.D. for Psychiatry Today.

A study by John Havlik et al., reported in JAMA Network, finds that just over 18,000 psychiatrists were willing to bill Medicare for their services, out of a total of more than 56,000 psychiatrists nationwide. The number willing to bill Medicare decreased by nearly 4,000 over eight years between 2014 to 2022. That’s a 16.8 percent decrease in the number of shrinks willing to bill Medicare. Overall, only about one in three psychiatrists take Medicare.

The researchers could not study the number of psychiatrists who contract with Medicare Advantage plans. But, overall, fewer physicians agree to work with Medicare Advantage plans than traditional Medicare. And, Medicare Advantage plans do not tout their great mental health coverage. So, it’s more than likely that it’s even harder to see a shrink in Medicare Advantage than in traditional Medicare.

Other research has shown that people with Medicare can wait up to six months to see a therapist. But, Medicare now covers mental health care from marriage and family therapists, mental health counselors, and drug addiction specialists, as well as psychiatrists, psychologists, psychiatric nurses and licensed clinical social workers, increasing the pool of mental health providers available for people with Medicare.

People with employer coverage and in state health insurance plans also struggle to get insurance coverage for visits to the shrink. Fewer than three in five shrinks accept any health insurance.

To be clear, access to Medicare coverage for visits to the shrink differs depending on where you live. In Wyoming, for example, there are just 13.8 shrinks who take Medicare for every 100,000 people with Medicare, in Mississippi, 22.1 shrinks, and Montana, 27.4 shrinks. In Rhode Island, there are 174.7 shrinks for every 100,000 people with Medicare. In nine states, there are fewer than 40 shrinks for every 100,000 people with Medicare.

While Medicare Part B covers mental health services for people enrolled in Medicare Advantage and traditional Medicare, the federal mental health parity laws do not apply to Medicare. They should!

Here’s more from Just Care:

March 25, 2025

Mental health care is unaffordable for one in four Americans with anxiety and depression

Researchers at Johns Hopkins found that 25 percent of adults with anxiety and depression in the US cannot afford to pay their mental health care bills, keeping them from receiving psychiatric care. Medical debt doubled the likelihood that people would either go without treatment or delay treatment for mental conditions, according to the research findings published in the JAMA Network. Mental health parity continues to be a dream.

Nearly one in five households in the US carry medical debt, making it hard to get treatment for mental conditions when needed. Medical debt is prevalent among Americans with anxiety and depression.

More than eight percent of Americans have not paid their medical bills of $250 or more. Overall, Americans in debt often face poor health outcomes and struggle to pay for their daily needs, including food and housing. Having health insurance does not help them.

Sadly, not even half of adults with a mental disorder get treatment for it in the US. It’s expensive, even with insurance. And, psychiatrists tend not to accept insurance. So, out-of-pocket costs for mental health treatment can be exceptionally high.

The researchers surveyed nearly 28,000 adults. Insured Americans with high deductible health plans were most likely to forego or delay mental health treatment.

Here’s more from Just Care:

July 23, 2024

Will Congress extend Medicare telehealth coverage?

During the Covid-19 pandemic, Congress opened up telehealth coverage in Medicare and millions of older adults and people with disabilities have taken advantage ever since. Telehealth allows them to get medical attention without the burden of leaving home. But, with the pandemic behind us, the Medicare telehealth coverage provisions are set to expire at the end of this year. Emily Olson reports for HealthcareDive on a House Ways and Means Committee bill that would extend telehealth coverage in Medicare through 2026.

As of now, the House Committee bill to extend telehealth coverage another year has unanimous bipartisan support. They have until the end of this year to get it through Congress.

If passed, the bill would lift all geographic restrictions on telehealth services. (For a time, telehealth was available only to rural residents.) The bill would also allow more health care providers to offer health care services through the internet and phone. The entire House of Representatives will vote on the bill shortly.

While there is widespread support for telehealth, there is some concern about it as well. Does it allow for appropriate treatment? How does it affect the most vulnerable people with Medicare? And what are the risks of fraud and abuse?

For sure, Medicare’s coverage of telehealth services improves access to care for many people, particularly people in rural communities. It also makes it easier for people to get mental health services.

The Preserving Telehealth, Hospital, and Ambulance Access Act, as written, covers Medicare telehealth services by FQHC’s, federally qualified health centers, as well as rural health clinics. It also allows most hospice agencies to use telehealth for recertification purposes as an alternative to face-to-face requirements.

Of note, telehealth does not come for free. But, bill sponsors believe that its costs will be covered by new money-saving prescription drug requirements.

Here’s more from Just Care:

May 20, 2024

Mental health treatment remains challenging to come by, even with insurance

Notwithstanding federal law requiring “mental health parity”–insurance coverage for mental conditions–mental health treatment remains hard to come by in the US. Even with health insurance, the majority of Americans in need of treatment for a mental health condition could not get it in 2021. If you have Medicare, few health care providers are willing to treat you because Medicare’s rates are so low, and the data suggest that Medicare Advantage plans do a poor job of including mental health providers in their networks.

About one in five people in the US have a mental health condition. But, only a small minority of them are able to get treatment for their conditions. Fewer than one in seven people with Medicare–15 percent–receive treatment for mental health conditions.

A story on NPR, based on a new Milliman report, explains that about two in three Americans with health insurance could not receive treatment for their mental health conditions. Of the people experiencing mental health crises who required emergency treatment or hospitalization, only one in three got follow-up treatment within 30 days of leaving the hospital.

Inseparable, an advocacy group focussed on the treatment of mental health conditions, commissioned the Milliman report. Its founder, Bill Smith, wanted to see the data underlying the endless stories his group was hearing about insurance companies refusing to cover mental health care.

What keeps people from getting treatment for mental health conditions? In addition to a health insurance industry that does not want to cover the care, there’s a shortage of workers, poor provider reimbursement rates, and government failure to ensure compliance by insurance companies to cover mental health care as required under federal law.

Milliman’s findings show that almost one in four people with insurance, including Medicaid, Medicare and commercial insurance, had a minimum of one mental health condition in 2021. People with Medicaid had the highest likelihood of receiving mental health care.

Here’s more from Just Care:

December 19, 2023

2024: Access to Medicare mental health services is expanding

Even with Medicare, it can be hard to see mental health providers. Tens of thousands of mental health providers will not take Medicare because of its low payment rates and, on top of that, for people in Medicare Advantage plans, a lot of administrative burdens. But, beginning in January 2024, Medicare will cover mental health care from marriage and family therapists, mental health counselors, and drug addiction specialists, increasing the pool of mental health providers available for people with Medicare to see, reports Judith Graham for The Washington Post.

To date, Medicare has only covered care from psychiatrists, psychologists, psychiatric nurses and licensed clinical social workers. They are a small group, and nearly half of psychiatrists and more than half of psychologists, 124,000 mental health providers, have opted out of Medicare. In addition, many Medicare Advantage plans do not contract with adequate numbers of mental health providers, according to a recent report from the Kaiser Family Foundation and a recent Senate Finance Committee survey.

People in Medicare Advantage plans can struggle to access mental health services as well as a wide range of other services, particularly costly ones such as rehab therapy and nursing home care. Even if they can find a mental health provider who will see them in network, Medicare Advantage enrollees generally need approval from their Medicare Advantage plans before their mental health care will be covered. And, that approval can be hard to come by.

Inability to get Medicare-covered mental health care has been a huge issue for the more than 15 million people with Medicare who have a mental health condition. Aa many as 7,500 of them do not receive mental health treatment today. The wait for a therapist who accepts Medicare can be six months.

Medicare’s expansion of mental health services to marriage and family therapists and mental health counselors should mean that people will have less trouble finding a mental health provider who takes Medicare, at least if they are enrolled in Traditional Medicare. An additional 400,000 mental health providers are eligible to see patients with Medicare. In particular, people with Medicare in rural areas should have better access to mental health services.

However, a lot turns on the payment rates Medicare sets for these providers. If Medicare’s approved rate is not fair, these providers may refuse to see Medicare patients. And, if Medicare Advantage plans engage in inappropriate denials and delays of care or refuse to pay mental health provider bills, as they too often do, these mental health providers will refuse to contract with them. Often older adults needing mental health services also have multiple chronic conditions. Providing treatment for them is not as simple as caring for younger adults.

Medicare will also cover as much as 19 hours a week of outpatient mental health care for people most in need of outpatient mental health services–people with severe mental illness and people in need of substance use disorder care. Medicare will also enable some people to get mental health treatment in their homes through an expansion of mobile crisis services.

Since the Covid pandemic began, people with Medicare can receive mental health services through telehealth, on the phone or through a computer. Medicare pays providers the same rates for telehealth services as for in-office appointments.

Graham raises the question of whether Medicare will ever have mental health parity as is required for private insurance plans. Given so many other issues with Medicare mental health coverage, it’s not clear how much difference it would make, beyond an important symbolic one. But, at least it would eliminate Medicare’s 190-day lifetime limit on psychiatric hospital care. Medicare has no lifetime coverage limit on hospital care.

Here’s more from Just Care:

November 1, 2023

Need a shrink? Your Medicare Advantage plan might not think so

Reed Abelson reports for the New York Times on the difficulty people in Medicare Advantage plans can have getting mental health care. Too often there are no psychiatrists in their Medicare Advantage plan network, according to a new study published in Health Affairs. If you would like to see a shrink and have your care covered–if you’d like to get any specialty care and ensure it is covered– traditional Medicare is likely to be a better option than a Medicare Advantage plan.

Researchers were not able to find even one psychiatrist in more than half of the Medicare Advantage plan networks they analyzed. Even in the networks with psychiatrists, psychiatrists were few and far between; fewer than one in four psychiatrists in the area were in network. And, it’s not clear that these psychiatrists were taking new patients.

Loneliness is a huge challenge for many older adults, only aggravated by the Covid-19 pandemic. Many older adults need to see a psychiatrist for their mental well-being. About 25 percent of people with Medicare suffer from depression, anxiety or another mental illness. But, the Commonwealth Fund has found that not even half of them get mental health care.

There are too few psychiatrists in the US. So, it can be hard to find a psychiatrist no matter what health insurance coverage you have. But, the researchers note, people with Medicaid and people in state health insurance exchange plans created by the Affordable Care Act have considerably better access to psychiatrists than people in Medicare Advantage.

Lack of access to mental health care in Medicare Advantage plans is a problem getting mounting attention. Senator Ron Wyden’s team on the Senate Finance Committee conducted a study of Medicare Advantage plans in Oregon and could not find a single psychiatrist taking new patients in any of their networks. Senate Wyden described their networks as “ghost networks” at a recent Senate Finance Committee hearing. In Medicare Advantage plans outside Oregon, Senate Finance staff could not get an appointment with a mental health provider more than 80 percent of the time.

A psychiatrist from the American Psychiatric Association testified at the Senate Finance Committee hearing that as hard as it is for psychiatrists to deal with insurance company paperwork, it is all the harder for them to deal with administrative requirements imposed by Medicare Advantage plans. “Many of the challenges and frustrations are emphasized in the Medicare Advantage plans.”

The researchers who published the Health Affairs study found that some insurers offering Medicare Advantage plans pay mental health providers less than the Original Medicare rate. That impedes access to care for people in Medicare Advantage plans and should be prohibited.

Here’s more from Just Care:

July 11, 2023

Will Medicare continue to cover telehealth mental health services?

Senate Finance Committee Chair Ron Wyden (D.Ore.) and others on his committee would like Medicare to continue to cover telehealth mental health services after the public health emergency ends, according to HealthcareFinanceNews. Since the Covid-19 pandemic, Medicare has covered a wide array of telehealth services for the first time, and it has worked well for millions of people with Medicare. But, unless Congress acts swiftly, after the public health emergency ends, Medicare coverage for almost all telehealth services will also end.

Under federal law, Medicare’s coverage of telehealth services will end 151 days after the Covid public health emergency ends. As of now, the public health emergency will end mid-July, but President Biden is expected to extend it at least another 90 days to mid-October and, more likely, through the end of the year. In that event, Medicare coverage of telehealth services would end around July 2023.

There appears to be bi-partisan support on the Senate Finance Committee for Medicare coverage of mental health services delivered by phone or computer, in which case an in-person visit would no longer be required for coverage. A Finance Committee discussion draft clarifies that, if legislation were enacted, everyone with Medicare would be eligible for audio-only or video telehealth mental health services.

The goal is to help increase mental health parity in Medicare, by making it easier to get mental health care. If this policy were to become law, Medicare costs would go up, and Congress would need to find an offset to pay for the increased cost.

A recent poll shows that a wide range of Americans, including people over 65, are more concerned with mental health issues and getting care to treat these issues. During the pandemic, people used telehealth services in large part to treat mental and behavioral issues.

Logic and reason would dictate that a move for Medicare to cover mental health telehealth services would allow more people with Medicare to benefit from mental health care. However, outreach would be critical to ensure that not only better-educated and more affluent individuals benefited. There’s some evidence from a recent study of cancer patients that coverage of telehealth services for mental health care could widen health disparities. In the study of cancer patients, Black and uninsured individuals and people who live in rural areas and had lower incomes were less likely to use telehealth services.

Here’s more from Just Care:

June 1, 2022

To stave off dementia, change up your diet

There’s plenty of talk about foods that can improve brain function. Amelia Nierenberg reports for the New York Times on “brain food,” along with its effect on your mental health and how you think. To stave off dementia, you might consider changing up your diet.

We don’t yet know as much as we’d like about the causes of dementia. But, we do know that loss of mental acuity is more common among people with heart disease and high blood pressure, people who are overweight and people with diabetes. And, people who don’t eat well and don’t exercise are more likely to have these conditions and experience dementia.

We also know that people who eat more fresh foods, nuts, fruits, vegetables, as well as whole grains and olive oil are likely to have greater protection against developing dementia. Fatty fish rich in omega-3 fatty acids are particularly great for the brain, as are blueberries, walnuts, lentils, soybeans and leafy greens.

One recent study found that people who largely ate these foods and not processed foods or red meat, people who followed the Mediterranean and MIND diets, are far less likely (by 30-35 percent) to suffer from a mental impairment than people who do not.

If you’re keeping your arteries in good order, you are more likely to be keeping your brain in good order as well. Eating a variety of different-colored foods and foods packed with flavonoids matters.

Vitamin supplements are of little or no help in preventing against mental decline. Supplements are no substitute for a Mediterranean or MIND diet. And, many supplements contain harmful ingredients.

Words of wisdom from a Mayo clinic physician: “If it comes from a plant, eat it. If it’s made in a plant, don’t eat it.”

Here’s more from Just Care:

April 27, 2022

Air pollution and your mental health

Nicholas Bakalar writes for the New York Times on a new study that finds a link between the air you breathe and your mental health. Polluted air, even in small doses, can affect your mental acuity. It speeds up the aging of your brain.

Living in areas where the air is polluted for any amount of time is bad for your health. Over the long-term, it not only can affect your mental functioning, it can increase your chances of getting dementia.

The study looked at the effects of short-term exposure to air pollution on older adults. It tested their ability to answer very simple questions, such as the current year and season when air levels of PM 2.5, soot particles, averaged 10.77. The Environmental Protection Agency considers that level acceptable.

Although the researchers conducted an observational study and not a study that can find a causal link between air pollution and mental acuity, their findings were striking. Small increases in the PM 2.5 air levels resulted in people, whose average age was 69, performing less well on the simple test.

The lead author believes that the effects of air pollution on people’s mental functioning could be reversible. In effect, when an older person moves from an environment with more polluted air to an environment with less polluted air, the person’s brain gets reset at normal functioning. But, long-term exposure to air pollution can cause permanent brain damage.

It’s worth noting that some air pollutants are always in the air. There are pollutants in soil, pollen and sea salt. But, other air pollutants that are man-made are far more toxic. New technology could remove a lot of the most harmful toxins in the air and make it cleaner.

N.B. The researchers also found that participants on aspirin and NSAIDs were less affected by air pollution. And, living a healthy lifestyle–exercise and a healthy diet–always helps your mind and body.

Here’s more from Just Care:

May 17, 2021

Medicare mental health care cost and access issues

As a nation, the US has done a terrible job of meeting people’s mental health care needs. Both public and private health insurance cover mental health care, but they pay so little for mental health services that it is often hard to find mental health providers who accept insurance. CNBC reports on mental health care cost and accessibility issues.

Almost 20 percent of Americans have a mental health condition. And, spending on mental health care, including therapy, prescription drugs and inpatient care, is up 52 percent in the last 11 years. But, it’s hard to find mental health providers who take insurance.

Nine in ten physicians providing physical health care take insurance. Fewer than six in ten psychiatrists, 56 percent, take insurance. More than five times as many people are forced to pay out of pocket for the full cost of their mental health care than for their physical health care.

Mental health care tends to cost people a lot more than physical health care. People with depression typically spend $10,836 each year. People with diabetes on insulin spend less than half that, $4,800 a year.

It’s also hard to find mental health care providers in many areas of the country. More than one-third of Americans live in areas where they are scarce.

Between high costs and the difficulty of finding mental health providers, more than half of people who need treatment do not get the treatment they need. And, Black Americans have twice as much difficulty getting mental health care than white Americans.

The US needs to do a far better job of ensuring people access to mental health care for their personal needs as well as for the economic health of the nation. Mental health conditions take a toll on workplace productivity. People miss work or cannot perform at their best level. Reduced productivity is estimated to cost an additional $44 billion a year.

The 2008 Mental Health Parity and Addiction Equity Act improved access to mental health care. It requires insurers to cover access to mental health care on an equal level with physical health care. Put differently, insurers are not allowed to discriminate against people with mental health conditions. But, there are plenty of ways insurers can get around the law.

There are a few ways that people who can’t see a psychiatrist can still get help. For one, their primary care doctors have the opportunity to identify and address their mental health care needs. That’s another reason why having a primary care doctor is so important. Also, at least for now, if you have Medicare or most private health insurance, you could see whether using telehealth services, which are easier to access and cost less, can help.

Medicare coverage of mental health services has improved some, but it is still in need of significant improvement. There is coinsurance parity for outpatient mental health visits. It also now covers depression screenings through the annual wellness visit.

But, more generally, Medicare offers poor coverage for mental health treatments and substance abuse counseling. And, at most, Medicare covers 190 days of inpatient mental health care services in a lifetime. Moreover, fewer than one in four psychiatrists accept Medicare’s rates.

In addition, Medicare does not cover care delivered by mental health counselors. And, people in Medicare Advantage plan have particularly poor access to mental health providers.

Right now, if you need mental health services, NAMI, the National Alliance on Mental Illness, has a free helpline at 1-800-950-6264. And, you can find other lower-cost places to go for treatment through the Substance Abuse and Mental Health Services Administration. If neither of these resources provide you with the information you need, try the National Association of Free & Charitable Clinics or the Open Path Psychotherapy Collective.

Here’s more from Just Care:

May 11, 2021

Tag: Mental health