- While adults 65 and older can get mental health insurance coverage through Medicare, that coverage isn’t always sufficient, a survey shows.
- Compared with 10 other countries, older Americans are the most likely to report being diagnosed with a mental health condition but forgo treatment due to cost.
- Medicare coverage can do better by removing financial barriers to mental health services.
Nearly all U.S. adults over the age of 65 have some mental health coverage through Medicare. But a recent survey by the Commonwealth Fund showed that was not enough.
Munira Gunja, a senior fellow at the Commonwealth Fund’s International Health Policy and Practice Innovation Program, and her colleagues compared the mental health needs and treatment of older adults in the United States with those in 10 other countries. They found that in all 11 countries, older Americans with health insurance were the most likely to report being diagnosed with a mental illness.
At the same time, they are most likely to seek mental health care, but forgo care due to cost and financial insecurity.
“The study found that just because you have health insurance doesn’t mean it’s enough,” lead study author Gunja told VigorTip.
What is medical insurance?
Medicare is the federal health insurance program for people age 65 and older, certain young people with disabilities, and people with end-stage renal disease (permanent kidney failure that requires dialysis or a transplant). If you belong to one of these groups, Medicare can cover a range of health care services, such as hospitalization, preventive tests, and prescription drugs.
“We really need to prioritize mental health,” Gunja added, especially by reducing financial barriers and promoting healthcare reform. “I think that promises to be more of a shift.”
The survey was released at the end of January.
what does this mean to you
If you or someone you know has questions about Medicare, you can chat online for information or call 1-800-MEDICARE (1-800-633-4227).
US Nursing Comparison
For mental health care, Medicare-covered services include annual depression and substance use screenings, outpatient treatment, and counseling. But the question is: To what extent does this coverage meet a need that has become dire during a pandemic?
To answer this question, Gunja and colleagues analyzed the results of the 2021 Commonwealth Fund International Health Policy Survey for Older People. They looked specifically at self-reported diagnosed mental health problems, mental health burden, and financial hardship among U.S. adults age 65 and older, and compared the U.S. findings with similar data from 10 other high-income countries, including Canada, Norway and New Zealand.
In total, their data included more than 18,000 adults aged 65 and older in these 11 countries.
Overall, the United States has the highest rates of mental health needs. 21% of Medicare beneficiaries aged 65 and older reported being diagnosed with a mental health problem, compared to 13% in New Zealand, Canada and France, and 5-7% in Germany, the Netherlands and Norway .
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Older adults in the U.S. are also most likely to seek mental health care for anxiety and/or depression. 66% of U.S. Medicare beneficiaries have a mental health need to seek help, compared with 49% in Australia, 37% in Switzerland and 22% in the United Kingdom receiving such care in other countries.
At the same time, the authors write, not everyone in the U.S. who could benefit from health care has access to it due to the undersupply of mental health workers and challenges in accessing care in rural areas.
Cost poses a barrier
Gunja and colleagues found that in all 11 countries, U.S. adults with mental health needs were the most likely to report cost-related difficulties, even if they had health insurance.
“Everyone over the age of 65 is covered by Medicare, but there are significant financial barriers that really prevent people from actually seeking the care they need,” Gunja said. “It’s something other countries really don’t have to deal with.”
To measure financial hardship under Medicare, the survey asked about the times in the past year when costs hindered their access to health care, including:
- When they have a medical problem but don’t see a doctor
- Skipping a required test, treatment, or follow-up
- no prescription
- skip drug doses
Even with health insurance, they found that 26 percent of U.S. adults enrolled in one, compared with 6-14 percent in other countries studied. Additionally, 27% of U.S. respondents age 65 and older said they were always or usually worried or stressed about financial hardship. This difficulty is defined as worrying about being able to buy nutritious meals, pay rent or mortgage, or pay monthly utility bills (including necessities such as electricity, heat or telephones).
On the other hand, in Germany, the Netherlands and the UK, only 4-5% of older adults reported such financial hardship.
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“When you have health insurance, you do get annual screening and preventive services, which is all great,” Gunja said. “But once you’ve been diagnosed with a mental health problem, it’s up in the air whether you can afford the actual cost of treatment.”
Compared with the other 10 countries studied, the United States is the only country without universal health care.
Latino seniors express more needs
When Gunja and colleagues took a closer look at the data, they found that Latino Medicare beneficiaries stood out.
Compared to white or black beneficiaries in the U.S., Hispanic/Latino adults age 65 and older are significantly more likely to say they have been diagnosed with a mental health condition In addition, compared to 28% in the U.S.,42 % reported needing mental health care.
Hispanic/Latino older adults were also more likely to report emotional distress, defined as “anxiety or extreme sadness that respondents had difficulty coping on their own within the past 12 months.” Thirty-one percent of Hispanic/Latino adults reported this, compared to 18 percent of all older Americans combined.
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Deep-rooted medical bias and stigma may influence differences between racial groups, the authors wrote. For example, although black older adults were the least likely to report a mental health diagnosis, the study found that providers were more likely to miss a mood disorder in black adults than other adults.
Meanwhile, job losses due to COVID-19, as well as concerns about immigration policy changes, have had a disproportionate impact on the mental health of older Latinos, the authors write. To better address the mental health needs of this group, further investigation and policy reforms are needed.
Accessibility to Care
The data confirm previous findings that older Americans tend to have higher rates of mental health diagnoses and financial hardship than in other industrialized countries. The two factors work together to create a negative cycle, the authors wrote.
“Research shows that unmet economic and social needs tend to be more prevalent in the United States than in other high-income countries, which may contribute to high rates of mental health needs,” they wrote. This may be even more the case for low-income adults since the pandemic began in early 2020.
To break this cycle, Gunja and colleagues stress that we need to address policy and the underlying forces at work.
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While Medicare makes care more accessible to adults, other systemic factors complicate access, the authors write. For example, not all psychiatric care services accept Medicare, possibly due to administrative burdens and lower financial incentives. On average, Medicare pays health care providers only 80% of what private health insurance costs, often with significant delays.
High drug prices and the limitations on care included in Medicare also make insurance the least helpful for those who need it most. A 2021 study found that Medicare beneficiaries who self-reported a history of depression also reported more unmet needs and financial hardship.
For Gunja, the solution lies in reducing all financial barriers to healthcare and expanding telehealth. Furthermore, as other countries surveyed have done, better integration of mental health care into health systems can benefit all.
“Other countries do, and most GPs have at least one mental health provider in their practice,” Gunja said. But now America is a very isolated system. You go to a health care provider and they will refer you to another health care provider who may or may not be in your network or accept your insurance. They may also be far away or take more time to reach.
“We really need to connect them together,” she said. “We will continue to fight an uphill battle until we agree that everyone should have the right to health care.”