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A silent crisis is emerging for seniors struggling to access psychiatric care under Medicare Advantage plans. The structural limitations and regulations of Medicare policies are creating an “invisible wall,” making mental health care access increasingly difficult for the elderly and disabled.

The problem: Medicare is the primary source of health insurance for over 60 million Americans, and approximately 26% of Medicare beneficiaries experience some form of mental health disorder. But Medicare is often not accepted by such professionals. One study found that over 50% of practicing counselors had turned away Medicare-insured individuals seeking counseling services.  

Further, there is significant inefficiency in the current Medicare mental health policy. In a study involving nine mental health providers ineligible for Medicare, it was revealed that the program faced considerable challenges in delivering equivalent care levels to Medicare beneficiaries when compared to clients insured by other means. 

A woman taking her medication, after successfully finding psychiatric care under Medicare.
Those with private Medicare coverage (Medicare Advantage) are struggling to find the support they need.

And even those with private Medicare coverage, Medicare Advantage, are struggling to find the support they need. In fact, psychiatrist networks in Medicare Advantage plans are noticeably narrower than those in Medicaid managed care and Affordable Care Act (ACA) plans. One study found that nearly 65 percent of psychiatrist networks under Medicare Advantage were classified as narrow, with less than 25 percent average network breadth.

More alarmingly, of the 1,905 counties included in the study, over half (51.4 percent) had not a single psychiatrist participating in Medicare Advantage plans. This geographic shortage is further compounded by a scarcity of psychiatrists, particularly those accepting insurance, which poses substantial difficulties for plans attempting to locate providers.

What’s next? To address this growing crisis, a more comprehensive and direct approach is needed to tackle these Medicare policy issues. Fortunately, serious steps are being taken in this direction. A bill reintroduced in the House of Representatives aims to tackle barriers to accessing virtual behavioral and mental health care for Medicare beneficiaries.

This offers hope that Medicare policies will be given a much-need update and that elderly and disabled citizens do not find themselves at an impasse in their quest for mental health care.