With two in five adults now reporting symptoms of anxiety and depression, serious pressure has been put on the healthcare system. 37% of the population (122 million Americans) live in areas experiencing a mental health shortage, with rural areas the worst hit.

In response, President Biden has unveiled the most comprehensive overhaul of the Medicare system since its inception. 

The President’s FY23 budget has earmarked $700 million for a range of proposals designed to simplify the system, increasing accountability from its providers and improving access. Delivering help to those who need it most.

If you (or a loved one) are a Medicare beneficiary, this article looks at what those proposed changes in Medicare coverage for behavioral health entail and what they could mean for you.

Medicare behavioral health proposed changes

Let’s first look closer at what these changes in Medicare coverage for behavioral health would mean:

Expanded coverage for mental health services

President Biden’s proposals would see Medicare covering a wider range of mental health services than ever before. These include coverage for telehealth services – especially helpful for those in underserved rural areas – and services provided by clinical psychologists (previously only covered if provided by a physician).

Improved access to substance abuse treatment

The pandemic saw a rise in substance abuse, and in response, Medicare’s proposals for expanded coverage include:

• Coverage for medication-assisted treatment (MAT), which combines medication with counseling and behavioral therapies to treat substance abuse disorders. 
• More types of treatment facilities, including residential treatment centers and the new “Intense Outpatient Program”– attempting to bridge the gap for patients whose needs fall short of hospitalization but are too severe for outpatient care.

Increased funding for behavioral health research

In addition to expanding service coverage, the proposals include extra investment in research to improve behavioral health care. This includes funding for research into new treatments for mental health and substance abuse disorders and the best ways to provide care to those with behavioral health conditions.

Inclusion in Medicare Advantage plans

Under the terms of the proposed changes, Medicare Advantage plans would be required to include behavioral health services in their care coordination programs. This means that beneficiaries would have access to a wider range of mental health and substance abuse services, including counseling, therapy, and medication management. This change is designed to help beneficiaries better manage their behavioral health needs and improve their overall health and well-being.

Prescription drug coverage

If you need prescription drug coverage, you may be enrolled in a standalone Medicare Part D plan. These plans are also offered by private insurance companies that contract with Medicare.

President Biden is proposing that Medicare Part D plans are required to lower out-of-pocket costs for prescription drugs and improve consumer protections from discriminatory practices by insurance companies. This would improve access to prescription drugs for 300,000 low-income individuals.

Additionally, Medicare Part D plans would be required to include behavioral health services in their care coordination programs, just like Medicare Advantage plans.

Overall, the proposed changes in Medicare coverage for behavioral health are designed to provide better care for those with mental health and substance abuse disorders. Expanding coverage for services, improving access to treatment, and investing in research, would ensure beneficiaries receive the care they need to lead healthy and fulfilling lives.

Impact on Medicare beneficiaries

The good news for Medicare beneficiaries is that these proposals are designed to improve your access to care, reduce out-of-pocket costs, and expand your coverage. Let’s take a closer look at how these changes would benefit you.

Access to care

One of the most significant changes is the expansion of telehealth services for behavioral health. This means you would have more options for receiving care from the comfort of your own home. 

In addition to telehealth services, the proposed behavioral health changes in 2023 would also increase access to in-person care. Expanding Medicare’s network of mental health providers would make it easier for you to find a provider who meets your needs – ensuring you receive the care you need when you need it.

Cost and coverage

Another important aspect of the proposed Medicare behavioral health changes in 2023 is the reduction of cost-sharing for certain services. For example, Medicare would be waiving the deductible for certain mental health visits, making it easier for you to access care without worrying about the cost.

The proposals would mean Medicare expanding its coverage of certain services, such as opioid treatment programs and partial hospitalization programs. This means that you would have access to more treatment options, helping improve your overall health and well-being.

By including behavioral health services in their care coordination programs, Medicare Advantage and Part D plans would help ensure that beneficiaries have access to the mental health and substance abuse services they need. This change would make it easier for beneficiaries to get the care they need and improve their overall health and well-being.

Conclusion

With the extra funding and research, lower costs, and increased access these proposed changes in Medicare coverage for behavioral health would be a significant- and welcome- step towards the comprehensive, person-centered care that Behavioral Health requires. If passed, Medicare’s whole-person care model would ensure you (or your loved one) had access to a wider range of services to help you manage your mental health and improve your quality of life.