Tag: Mental health care

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
Medicare coverage of mental health care
According to the Centers for Disease Control (CDC), one in five Americans age 55 years or older have some kind of mental health concern. They often suffer from anxiety, severe cognitive impairment, and mood disorders, including depression and bipolar disorder. The coronavirus pandemic has led to an increased sense of loneliness or isolation among many older adults. If you need mental health services, Medicare covers both inpatient and outpatient mental health care in a variety of settings.

Outpatient mental health care under Medicare Part B:
1. What kind of care do you need? Medicare covers a wide range of outpatient mental health services, including individual and group psychotherapy, family counseling if the key purpose s to help with your treatment, psychiatric evaluation, medication management and substance abuse counseling. Medicare also covers annual screenings for depression at a primary care doctor’s office or a primary care clinic.
2. Who provides your care? Medicare covers outpatient mental health care counseling and therapy services from many different mental health providers, including psychiatrists, clinical psychologists, nurse practitioners, clinical social workers, nurse specialists and physicians’ assistants.
3. Where can you receive outpatient mental health services? You can receive care in a doctor’s or other health care provider’s office, a hospital outpatient department or at a community mental health center.
4. What does Medicare cover? Unless you receive care from a medical doctor, Medicare will pay for 80 percent of your care only if your mental health care provider is Medicare-certified and takes assignment (accepts Medicare’s approved rate as payment in full). If you’re in a Medicare Advantage plan, you must see an in-network provider and you likely will have a copay; you may also have a deductible.
Inpatient mental health care under Medicare Part A:
1. Where can you receive inpatient mental health services? You can receive care in a general hospital or a psychiatric hospital that only cares for people with mental health conditions.
2. What does Medicare cover? If you’re in a psychiatric hospital, Part A only pays for up to 190 days of inpatient psychiatric hospital services during your lifetime. After that, you may be able to get inpatient mental health care in a general hospital. If you’re in a general hospital, there is no lifetime limit on the amount of care Medicare will cover. Medicare inpatient coverage rules apply, whichever setting you are in. If you have traditional Medicare, you or your supplemental coverage must pick up the deductible. And, if you remain n the hospital more than 60 days, you will also have coinsurance costs. If you are in a Medicare Advantage plan, contact the plan to find out your out-of-pocket costs.
[Editor’s note: This post is updated, originally published June 4, 2018.]

Here’s more from Just Care:
March 7, 2022
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
UnitedHealth Group found guilty of denying millions needed care, under court supervision
If you’ve ever wondered whether your health insurer was trying to get away with not paying your insurance claims when it was legally required to, you should stop. Based on mounds of evidence, most health insurers inappropriately deny coverage for services a lot of the time. Often they get away with it. But, recently, UnitedHealth Group was fined for failing to pay for tens of thousands of mental health services their members received.

UnitedHealth Group was ordered into court-monitored supervision through a special master by a California federal judge for wrongly denying more than 67,000 mental health and substance use disorder treatment claims. The court order requires United Healthcare’s subsidiary, UBH, United Behavorial Health, to retrain its employees. It must also reprocess these claims.

One lawyer involved in the case, from PsychAppeal, made clear that UnitedHealth was not the only health insurance company guilty of this extreme misconduct. Of course not. They all tend to engage in the same behaviors. That’s how they stay competitive.

According to Violationtracker.org, UnitedHealth Group has 278 consumer-protection offenses alone in the last 20 years. For example, back in March of this year, the state of Rhode Island found UnitedHealth to be in violation of its obligations to pay for mental health and substance abuse services. It fined United Health $3.2 million for its noncompliance.

UnitedHealth Group also has been sued by a class of AT&T and CenturyLink workers, claiming that it has taken more than $1 billion each year that workers have contributed to their ERISA plans to offset money UnitedHealth owes in other unrelated plans. These offenses, along with other offenses have resulted in penalties to UnitedHealth of $603,461,164 over 20 years.

Violationtracker.org lists 25 UnitedHealth Group violations, or violations by one of its subsidiaries, that have been settled in the last two years. How many cases of fraud or misconduct have not been brought against UnitedHealth and other health insurers? Penalties are likely far smaller than the crimes, which can leave people without needed care, in medical debt or worse.

We don’t know what members of Congress think about these violations, especially those that deprive people of medically reasonable and necessary services. Here’s some food for thought: In other wealthy countries, private health insurers are not at liberty to decide for themselves when to pay claims and when to deny them. The federal government decides for them. These games can’t happen. We should urge our members of Congress to step up and protect Americans from these abuses in a similar way.

Here’s more from Just Care:
December 30, 2020
To save money on your care, consider using a free health clinic
Because health insurance no longer covers large portions of people’s health care costs, millions of people with insurance are struggling to pay their premiums, deductibles, copays and costs for out-of-network care. Did you know that even if you have insurance, you may be able to save money on your care by using a free local clinic? According to Kaiser Health News, many people rely on free health clinics and these clinics are growing to meet their needs.

There are 1200 free and charitable health clinics across the United States. Using a free clinic for your care could save you hundreds of dollars a year. If you qualify for care, you could get lower-cost prescriptions through these clinics as well as lower-cost primary medical care. Some clinics also offer mental health care and dental care.

Many free health clinics serve the underinsured–people with health insurance whose out-of-pocket costs for premiums and deductibles amount to at least 10 percent of their income–as well as the uninsured. So, it’s worth looking into them even if you have insurance.

The Commonwealth Fund found that in 2014 almost one in four adults under 65 were underinsured, 31 million people; people who are underinsured may have a deductible that is at least five percent of their annual income, or they may spend at least ten percent of their income on out-of-pocket costs, excluding their premiums.

If you’re struggling to get an appointment with a doctor, using a free health clinic also may enable you to get an appointment more quickly.

To find a free or charitable health clinic near you, visit the National Association of Free and Charitable Clinics.

Here’s more from Just Care on free and low-cost care:
December 19, 2019
Cures Act threatens drug safety and efficacy
After an intense lobbying campaign heavily funded by the pharmaceutical industry and featuring sick children and pleading parents, a bill called the 21^st Century Cures Act (“Cures Act”) easily passed through both houses of Congress this month, and the President is expected to sign it into law. Everyone wants cancer and other dire diseases cured, but will this 996-page bill, largely fashioned by politicians and their corporate allies really work towards those ends? Many consumer advocacy groups, such as the National Center for Health Research and Public Citizen, as well as some doctors in universities who don’t take funding from drug companies, believe that the legislation will do more harm than good.

The bait that hooked the vote of many of those in Congress is the increased funding for cancer and other research at the National Institutes of Health, although Congress still may not appropriate this funding each year. Members of Congress also liked the idea that the bill would streamline the FDA approval process for prescription drugs and medical devices. But, our FDA approves these products faster than its counterparts in other part of the world and approves almost 90% of products put forward. And, it does so already increasingly and worryingly under lower standards than in the past. Many drugs are approved that turn out not to work at all. These drug often stay on the market nonetheless.

As a result, we all pay higher drug and health costs.

The 21st Century Cures Act would actually set some standards at the FDA back to the 20^th century, as less reliable evidence would be accepted, such as anecdotes or patient experience, and observational studies, notoriously less trustworthy than randomized, controlled clinical trials.

While more than 200 patient groups supported the Cures Act, most of these groups receive a substantial portion of their support from the pharmaceutical companies that stand to benefit most from the bill.

As StatNews reported, most of the 1,300 (!) lobbyists pushing for the Cures Act worked for the pharmaceutical industry. Not surprisingly, the primary congressional sponsors of the bill, Representatives Fred Upton (R-Mich), and Diana DeGette (D-Colo) received some of the largest donations from pharmaceutical companies among members of Congress.

Although the increase in funding for the National Institutes of Health hardly needed to be linked to the provisions of the bill likely to harm public health, there are other provisions that may be beneficial. Some funding will be allocated to help states fight the opioid drug epidemic, ironically created in large part by marketing campaigns by the drug industry. A rider to the bill also boosts funding for mental health care.

Here’s more from Just Care:
December 14, 2016
U.S. spending on mental disorders higher than for any other condition
A new Health Affairs study of U.S. health spending finds that spending on mental disorders was higher than for any other condition in 2013. In total, the U.S. spent $201 billion on mental health care. In contrast, the U.S. spent about 75 percent less, just over $50 billion, to treat hypertension and about 70 percent less to treat kidney disease and diabetes.

Spending growth on heart disease is far slower than for mental disorders in large part because people are smoking a lot less, and we have better ways to control hypertension. As a result, fewer people are dying from heart conditions. Faster spending growth on mental disorders is attributed to people living longer into older age.

Here’s more from Just Care:
May 24, 2016
Half a million people with low incomes unable to get mental health care in states that have not expanded Medicaid
In 1996, the Mental Health Parity Act was signed into law to guarantee that insurers did not restrict access to mental health care but rather imposed the same or higher annual or lifetime dollar caps on mental health benefits as on medical benefits. Unfortunately, a new study reveals that the 24 states that have not expanded Medicaid eligibility have left hundreds of thousands of people unable to get mental health care. More than half a million Americans with low incomes diagnosed with a serious mental condition struggled to get the mental health care they needed in 2014.
- People with Medicaid. Medicaid covers a wide range of mental health care services. And, in the 26 states that expanded Medicaid eligibility as a result of the Affordable Care Act, an additional 350,000 people received mental health care.
- People with Medicare: Medicare covers a wide range of mental health care services. If you’re enrolled in traditional Medicare, Medicare covers 80 percent of the cost of your care from a medical doctor or from another Medicare-certified mental health provider.
- People with incomes under 138 percent of the federal poverty level ineligible for Medicaid. Today, 24 states have not expanded Medicaid eligibility to people with incomes up to $15,521, even though the federal government pays the full cost of their Medicaid coverage for the first three years. As a result, 569,000 Americans were unable to get mental health services. They were ineligible for Medicaid in their states and lacked the money to pay privately for care. Many of these people end up in jail or homeless at a significant cost to states and local taxpayers.
August 26, 2015