The Centers for Medicare and Medicaid Services (CMS) offer several health insurance plans for older adults in need of health care coverage. Medicare Part A provides some reimbursement for home health visits, surgeries, hospital and skilled nursing facility (SNF) admissions, lab testing, and hospice care. Medicare Part B grants coverage for outpatient services such as doctor’s visits, rehabilitative services (speech therapy, occupational therapy, and physical therapy), and durable medical equipment such as walkers and wheelchairs.

There are even optional plans that further extend a subscriber’s benefits. Medicare Part C is known as the Medicare Advantage Plan (MA or MA Plan), which provides private insurance coverage for services that traditionally fall under the scope of Parts A and B. Individuals who choose to enroll in Medicare Part D will receive some assistance with the cost of prescription medications.

However, substance use disorder (SUD) reimbursement is one area Medicare has not extended coverage to. This is a major issue, since many individuals in this age group struggle with substance use disorders and related conditions. Approximately 1 million adults over the age of 65 are living with an active substance use disorder. These rates do not even include younger seniors, as substance use disorders in those aged 50 and over were expected to jump from 2.8 million (in 2006) to 5.7 million by 2020. With this age group being overlooked in the mental health/substance use disorder treatment arena and the number of older adults growing each year, quality SUD coverage for this population is paramount. 

Due to the risk that untreated SUD poses to older adults, many people are wondering why Medicare hasn’t made the shift to extend their offerings. New research shows it would cost CMS a mere 0.04% of their $825.9 billion annual budget to add SUD coverage to their plans. This figure is especially low, since the study also indicates profits from SUD coverage offsets the vast majority of costs this addition incurs.

If this change were to be adopted, it would greatly decrease health disparities and improve access to care. Insurance companies would also need to further extend their provider network to include quality psychiatric providers and substance use disorder treatment programs. 

It is wise for insurance companies to begin widening their infrastructure now so their provider network is prepared for a potential surge in new subscribers. The best way to extend your reach is by completing a provider network analysis with the industry-leading platform through TOG Network Solutions.