One of the biggest problems with Medicare is the limited access older adults have to mental health services, according to Lynn Cooper, the behavioral health specialist for the Pennsylvania Association of Area Agencies on Aging.
Cooper said Medicare only allows psychologists, psychiatrists, licensed clinical social workers and nurse practitioners to provide therapy to older adults. The Centers for Medicare & Medicaid Services issued a 2023 Physician Fee Schedule (PFS) proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B payment policy issues.
“It’s not nearly enough, and it’s impossible to find psychiatric time, to find psychologists and licensed clinical social workers,” said Cooper. “This new proposed regulation is going to open it up so that they will allow for marriage and family therapists and other mental health professionals to bill Medicare. If we can get this through, this will help our mental health providers a lot.”
The proposals include modernizing coverage for behavioral health services and improving access and quality by allowing licensed professional counselors, marriage and family therapists, and other types of practitioners to bill Medicare under general supervision; allowing psychiatric diagnostic evaluations to serve as the initiating visit for behavioral health integration and paying clinical psychologists and licensed clinical social workers providing integrated behavioral health services as part of a patient’s primary care team; bundling certain chronic pain management and treatment services into new monthly payments; and covering treatment and recovery services from mobile units, said Cooper.
Cooper, who is in therapy for depression, said she lost her counselor on the day she turned 65. Her counselor couldn’t bill Medicare because that specific coverage doesn’t cover a master’s-level licensed marriage and family therapist.
“These new regulations would allow her to,” she said. “I was able to find a new therapist, but it took me six months on a waiting list. The only reason they accepted me was because I have a supplemental insurance policy to my Medicare. If I had Medicare only, they would not accept me. The rate is so horribly low that it doesn’t even cover their cost.”
Jessica Cohick, the PA MEDI local coordinator with Northumberland County Area Agency on Aging, said she assists Medicare beneficiaries with finding insurance as well as helping them access benefits, like PACE/PACEnet, Extra Help, the Medicare Savings Program and in some cases even Medicaid. The program is free and can provide all Medicare beneficiaries, regardless of age, with insurance counseling to help them select the insurance that will best suit their needs.
Traditional Medicare covers mental health care services for conditions like depression and anxiety, such as counseling or psychotherapy, said Cohick.
“Coverage includes services that are typically provided in an outpatient setting like a doctor’s office or hospital outpatient department,” said Cohick. “These services can include visits with a psychiatrist or other doctor, clinical psychologist, clinical nurse specialist, clinical social worker, nurse practitioner, or physician assistant. Covered mental health care includes partial hospitalization services, which are intensive outpatient mental health services provided during the day. Partial hospitalization services are provided by a hospital to its outpatients or by a community mental health center.”
Typically, Cohick said, the beneficiary will pay 20 percent of the Medicare-approved amount and the Part B deductible applies for mental health care services.
“Although this is how traditional Medicare works, beneficiaries can purchase other insurance to help with health care coverage, such as Medicare Supplements (Medigap) or Medicare Advantage Plans. In the case of a Medigap policy, Medicare rules will apply,” she said. “However, if a beneficiary chooses to enroll in an Advantage plan, the beneficiary will be subject to that plan’s guidelines.”
As with any insurance, there are certain things enrollees need to do to access services, said Cohick.
“The type of secondary insurance a beneficiary selects can affect how easily services are delivered,” said Cohick. “If a beneficiary is enrolled in traditional Medicare or a Medigap plan, the beneficiary can be seen anywhere that Medicare is accepted. There could be deductibles and coinsurances, depending on what Medigap plan they have, but as mentioned, as long as that provider accepts Medicare, they will be able to schedule an appointment. If a beneficiary has selected an Advantage plan, typically a PPO or HMO, they will have to find a provider that accepts their plan, and pay any copays that are due per the plan’s rules.”
Some of the challenges that exist when it comes to older adults accessing mental health services would be transportation, which is an ongoing issue for many of the Valley’s residents as well as providers not accepting certain insurances, said Cohick.
Karen Leonovich, the administrator for the Northumberland County Area Agency on Aging, said Cohick is a “no-opinion third party.”
“You can go to a local insurance company and they will talk to you about the same issues, but they have a tendency to sell you their specific plan,” said Leonovich. “Jess will look at all plans and doesn’t have a bias toward any of them. She’s there to provide information and make changes if you’re interested.”