The impact of excluded providers on Medicare beneficiaries’ mental health care

Abstract

Mental health conditions are relatively common among Medicare beneficiaries. Yet, Medicare provider eligibility was last updated in 1989, raising concerns about beneficiaries’ access to mental health care in the United States. Beneficiaries are currently restricted from accessing mental health services provided by licensed professional counselors and licensed marriage and family therapists. Little is known about the impact of this Medicare mental health coverage gap (MMHCG) on Medicare beneficiaries. Hermeneutic phenomenology was used to analyze semistructured interviews with 18 beneficiaries who had attempted to access mental health care but were limited due to the MMHCG. Three themes emerged: (a) exasperating experiences with the MMHCG, (b) the MMHCG compounds barriers to mental health care, and (c) Medicare as a flawed system. These findings suggest current Medicare mental health policy interferes with beneficiaries’ access to needed mental health services. Implications for the counseling profession are described.