Medicare Mental Health Services

At least one in five older Americans has a mental health condition. The most common conditions among Medicare beneficiaries age 65 and older are depression, anxiety, dementia, and other neurocognitive impairments. By 2030, the number of older people with such disorders is expected to double. 

Mental and physical health conditions often are present together. For example, depression is associated with increased risk of coronary heart disease and premature death. Depression also often co-occurs with substance abuse disorder and other chronic illnesses such as Alzheimer’s disease, cancer, and arthritis. 

Mental health conditions are frequently undiagnosed or misdiagnosed in older patients. Older adults are more likely than younger adults to receive inappropriate or inadequate mental health services. One reason is that primary care practitioners provide most mental health care under Medicare. And these practitioners have insufficient training in assessing and treating mental disorders associated with aging. Although geriatric mental health assessment tools exist, their use is often not part of routine practice. Perceived social stigma and denial can also impede accurate diagnosis and treatment. 

Many older people are reluctant to seek counseling to help them cope with the challenges of later life, such as bereavement, disability, loneliness, and isolation. This may explain why older Americans are disproportionately likely to die by suicide. 

Medicare’s coverage of mental health and substance abuse services has improved over the years. However, Medicare is not subject to the Mental Health Parity and Addiction Equity Act. As a result, restrictions that do not apply to other health services continue to be used for mental health care. These include a lifetime limit of 190 days for psychiatric care in freestanding psychiatric hospitals. Despite growing evidence supporting the effectiveness of multi-disciplinary, community-based geriatric mental health treatment teams (e.g., physicians, social workers, nurses, psychologists, and pharmacists), Medicare limits access to this type of care. 

Medicare covers some mental health-related preventive services with no cost-sharing. Services that are covered include annual screenings for depression and alcohol misuse screening. But coverage for subsequent services can be limited. For those who screen positive for alcohol misuse, Medicare will cover four brief, face-to-face behavioral counseling interventions per year (see also this chapter’s section on Mental Health for a broader discussion of mental health issues). 

Medicare covers outpatient mental health services provided by physicians (especially psychiatrists), clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician assistants. Medicare does not cover treatment by licensed professional counselors. Medicare no longer has geographic and originating-site restrictions for mental health services delivered via telehealth (video conference), though it will require an in-person visit within six months prior to the telehealth services after the current telehealth waivers end on December 31, 2024. 

 Based on the large and growing number of older adults who misuse substances like alcohol and prescription drugs, demand for mental health and substance abuse services is also expected to grow with the aging of the baby-boom cohort.