Access to quality mental health care is a growing concern in the United States, particularly for older adults. While demand continues to rise, the Medicare behavioral health access issues are worsening, with a substantial number of behavioral health providers opting out of the program altogether.
Recent data from the Centers for Medicare & Medicaid Services (CMS) sheds light on this alarming trend. Nearly 43% of the 28,000 providers who opt out of Medicare are behavioral health professionals—those specializing in psychiatry, psychology, clinical social work, addiction medicine, and related fields. This stark disparity signals a systemwide misalignment and raises urgent questions about how Medicare is—or isn’t—serving the mental health needs of older adults.
Understanding Medicare Opt-Outs in Behavioral Health
According to CMS, when a provider opts out of Medicare, neither the provider nor the beneficiary submits any claim for reimbursement. Instead, the beneficiary pays entirely out-of-pocket—and Medicare provides no financial assistance for that care.
This policy applies to individual providers, not entire facilities, and disproportionately affects those in behavioral health disciplines. Of all opt-out providers:
- 16.9% are psychologists
- 15.1% are psychiatrists
- 10.7% are clinical social workers
The impact of these choices is significant: many seniors simply cannot afford the out-of-pocket costs for therapy or psychiatric care. This dynamic contributes to broader Medicare behavioral health access issues, particularly in rural or underserved areas where provider choices are already limited.
The Scale of the Problem
While around 124,400 behavioral health professionals accepted Medicare reimbursements in 2020 (the most recent complete year of data), that number is small when compared to the 1.4 million total Medicare-participating providers across all specialties.
The shortage is even more severe when you consider that behavioral health needs among seniors are increasing. Depression, anxiety, substance use, and social isolation are common and frequently underdiagnosed in older adults. Despite clear evidence that mental health care improves outcomes and reduces overall health costs, Medicare behavioral health access issues persist.
This is not just a problem of economics—it’s a crisis of care availability and infrastructure.
CMS Takes Notice
In early 2025, CMS took a step toward addressing these issues by issuing a Request for Information (RFI). The goal was to better understand why Medicare Advantage (MA) plans struggle to meet network adequacy requirements for behavioral health.
Medicare Advantage is the private insurance version of Medicare, used by more than 27 million Americans. CMS requires that these plans maintain adequate provider networks across various specialties, including behavioral health. Yet, CMS has publicly acknowledged that many MA plans are failing to meet these standards—despite implementing rules in 2020 requiring minimum provider numbers and encouraging telehealth.
This investigation is an important move, but the core Medicare behavioral health access issues remain deeply rooted in structural and financial barriers.
Why Are So Many Behavioral Health Providers Opting Out?
Low Reimbursement Rates
Medicare often pays less than private insurers for mental health services. This discourages providers from participating—especially those operating solo or in small practices.
Administrative Burdens
Submitting claims, dealing with audits, and navigating billing systems is cumbersome. Providers frequently cite Medicare as one of the most difficult insurers to work with.
Workforce Shortages
The behavioral health workforce is shrinking. Psychiatrists and other specialists are retiring at faster rates than new professionals are entering the field.
Growing Demand
As mental health needs rise, providers can be more selective about which payers they accept. Many choose to focus on private-pay clients or commercial insurance that offers higher reimbursement with fewer complications.
These forces combine to make Medicare an unattractive proposition for many mental health providers—thereby worsening the existing Medicare behavioral health access issues.
How It Affects Medicare Beneficiaries
For Medicare beneficiaries—especially those on fixed incomes—the implications are serious:
- Fewer in-network therapists, psychologists, and psychiatrists
- Long wait times for initial and follow-up appointments
- The need to travel further for care
- Higher out-of-pocket costs if they seek care from an opted-out provider
- Greater likelihood of untreated conditions
Older adults are at increased risk of depression, isolation, and suicide, yet are the least likely demographic to receive timely mental health support. These Medicare behavioral health access issues can lead to higher emergency room usage, hospitalization, and even premature death.
Telehealth: Helpful but Incomplete
Telehealth has grown rapidly as a tool to expand behavioral health services, and CMS has championed its use in both traditional Medicare and MA plans. For many, it has reduced travel time and increased convenience.
However, telehealth alone cannot resolve the broader Medicare behavioral health access issues because:
- Many seniors lack the technology or skills to access remote care
- Not all behavioral health concerns are well-suited to virtual formats
- The provider shortage persists regardless of delivery method
Ultimately, telehealth is a helpful supplement—not a replacement for robust, in-person behavioral health networks.
What CMS and Policymakers Can Do
To fix the persistent Medicare behavioral health access issues, systemic reforms are required. These may include:
Raise Reimbursement Rates
Making Medicare payments more competitive with commercial insurance can attract more providers.
Simplify the Billing Process
Reducing paperwork and delays in reimbursement would ease the burden on providers and incentivize participation.
Expand the Workforce
Invest in education, training, and loan forgiveness programs to grow the pipeline of behavioral health professionals.
Incentivize Medicare Participation
Offer financial incentives or bonuses for providers who accept Medicare or serve underserved populations.
Support Telehealth Expansion
Ensure that telehealth services remain reimbursed at parity with in-person care and offer digital literacy programs for seniors.
A Public Health Imperative
Behavioral health is health—full stop. Yet the structure of the current Medicare system reflects outdated priorities that fail to fully integrate mental health care. With so many providers choosing to work outside of Medicare, millions of older adults are being left behind.
Addressing Medicare behavioral health access issues is not only a policy concern—it’s a moral imperative. Failing to act will widen health disparities, increase costs elsewhere in the system, and worsen the mental health crisis among seniors.
Looking Ahead
The opt-out trend among behavioral health providers should be a wake-up call. CMS’s investigation is a promising start, but it must be followed by real policy change that makes it feasible and attractive for providers to participate in Medicare.
As we age, our mental health needs don’t disappear. In fact, they often become more complex. Seniors deserve access to the same standard of behavioral health care as any other group—without excessive costs or impossible wait times.
Tackling Medicare behavioral health access issues requires attention from policymakers, collaboration with providers, and urgency from regulators. If Medicare is to serve the comprehensive needs of the aging population, behavioral health must be treated as a priority—not a footnote.
