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Older adults face Medicare hurdles for substance use treatment

Jessie Hellmann, CQ-Roll Call on

Published in News & Features

For the staff at the Senior Recovery Center in Maplewood, Minnesota, helping older adults overcome substance use disorders is a calling, said Christine Martinek, a licensed alcohol and drug counselor there.

But it’s a more challenging calling when the adults who need treatment are on Medicare.

“Every day, I get phone calls saying, ‘My dad is 70 years old and he needs help.’ But he’s got Medicare, and you don’t know how many times I have to tell people that we can’t help them,” Martinek said.

For the 52 million Americans 65 and older, Medicare is a life-saver, providing health insurance regardless of income, medical history or health status. But for the growing number of older adults who need treatment for an alcohol or drug use disorder, the federal program falls woefully short, according to experts, advocates and medical groups.

At least 2% of Medicare beneficiaries 65 or older — about 1 million people — had a past-year alcohol or drug use disorder between 2015 and 2019, according to a study published in the American Journal of Preventive Medicine in August of 2022. But only 6% received treatment. Of those who didn’t receive treatment, 38% cited financial barriers.

That may be because entire categories of care recommended by the American Society of Addiction Medicine aren’t covered by Medicare, putting it out of step with coverage typically offered by private insurance and Medicaid.

 

For example, Medicare doesn’t recognize independent substance use treatment facilities like the Senior Recovery Center — which offers six months of outpatient addiction care for $5,500 out of pocket — as a provider type eligible for payment.

While low-income people might qualify for Medicaid or other state programs and wealthier individuals can pay out of pocket, those covered by Medicare often find the center financially out of reach.

“If they can’t pay out of pocket, or they’re not low-income, then they’re in real trouble,” Martinek said.

Coverage gaps

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