A newly published study highlights a significant healthcare crisis in Medicare substance use disorder treatment, affecting millions of beneficiaries across the United States. Despite an estimated 1.7 million Medicare recipients living with substance use disorders (SUDs) between 2015 and 2019, only 11% received any form of treatment, according to research from nonprofits RTI International and the Legal Action Center.
Using data drawn from the National Survey of Drug Use and Health, this research highlights how a vast majority of older adults and disabled individuals covered under Medicare are not accessing the vital treatment services they need. The implications are profound, as untreated SUDs can lead to severe physical health problems, mental health challenges, and a dramatically increased risk of premature death.
Barriers to Treatment: Financial Challenges and Stigma
The study goes beyond just statistics on treatment rates to explore why so few Medicare beneficiaries receive care. Among those who did not pursue substance use disorder treatment, 33% cited financial barriers as a key reason for avoiding care. These financial obstacles may include out-of-pocket costs, copays, or limitations in insurance coverage that leave patients bearing a significant financial burden.
Another significant barrier reported by 24% of respondents was fear of stigma—worry about how friends, family, and the community might judge them if they sought help for addiction. This concern reflects the ongoing social stigma surrounding substance use disorders, which often discourages individuals from seeking the care they desperately need.
William Parish, the study’s lead author and a health economist at RTI, summarized the findings in a recent statement:
“Unfortunately, this study suggests that a low rate of Medicare beneficiaries are receiving much-needed Medicare substance use disorder treatment, which means many of them are facing the serious ramifications of an untreated substance use disorder.”
He stressed the need for a multi-pronged approach that simultaneously closes insurance coverage gaps while addressing stigma to enable more patients to access Medicare substance use disorder treatment without fear or financial hardship.
Substance Use Disorders and Mental Health: A Dangerous Overlap
The connection between substance use disorders and mental health issues is well documented, and the study’s findings reinforce this relationship in the Medicare population. Medicare beneficiaries with SUDs were found to be twice as likely to experience serious psychological distress compared to their peers without SUDs. Even more concerning, suicidal ideation was more than twice as common among those with substance use disorders.
This alarming data underscores the fact that substance use disorder is often intertwined with broader mental health crises, including depression and anxiety. It also highlights the urgent need for integrated treatment approaches that address both addiction and mental health symptoms in tandem.
Community organizations like Acadia Healthcare have taken steps to meet these challenges by opening community resource centers that focus on both youth suicide prevention and opioid addiction treatment. These efforts are critical given that opioids are involved in approximately 20% of deaths by suicide, demonstrating the deadly link between addiction and mental health crises.
Medicare’s Outdated Coverage and Access Challenges
Ellen Weber, vice president for health initiatives at the Legal Action Center, was vocal in her criticism of Medicare’s limited and outdated approach to covering substance use disorder treatment. She called it “unconscionable” that nearly 90% of Medicare beneficiaries who could benefit from Medicare substance use disorder treatment are not receiving the care they need.
Weber emphasized the urgent need to expand access to Medicare substance use disorder treatment significantly in light of the escalating overdose crisis that continues to claim thousands of lives nationwide every year. She pointed out that current Medicare coverage policies create insurance barriers that make it difficult for patients to get effective treatment for addiction.
Breaking down these barriers will require policy reforms at the federal level, including expanding the types of treatment covered, reducing out-of-pocket costs, and simplifying the approval process for specialized addiction services. Without these reforms, many Medicare recipients will remain trapped without access to life-saving Medicare substance use disorder treatment.
The Cost of Untreated Substance Use Disorders
Failing to treat SUDs among Medicare beneficiaries not only harms individual patients but also has broader social and economic costs. Untreated substance use disorders increase the risk of hospitalizations, emergency room visits, and complications from chronic diseases like diabetes and heart disease.
Moreover, untreated SUDs lead to higher rates of mental health crises and suicide attempts, placing additional strain on healthcare and social services systems. Providing timely, effective Medicare substance use disorder treatment can reduce these costly consequences, improve quality of life, and save lives.
Moving Forward: Solutions to Improve Access and Outcomes
Addressing the treatment gap for Medicare beneficiaries with substance use disorders will require a coordinated, multifaceted strategy:
- Closing coverage gaps by expanding Medicare benefits to cover a wider range of evidence-based Medicare substance use disorder treatment options, including medications and counseling, with minimal patient cost-sharing.
- Reducing stigma through public education campaigns and provider training to normalize seeking addiction treatment and reduce discrimination.
- Implementing integrated care models that combine mental health and addiction services to treat co-occurring disorders comprehensively.
- Increasing funding for community resource centers and peer support programs that provide accessible, culturally competent care.
- Advocating for policy reform to improve reimbursement rates and simplify access to specialized Medicare substance use disorder treatment.
By taking these steps, policymakers and healthcare providers can help ensure that Medicare beneficiaries no longer face insurmountable barriers to getting the Medicare substance use disorder treatment they need.
This study serves as a crucial wake-up call about the state of Medicare substance use disorder treatment. With millions affected and the majority still untreated, the time for action is now to improve coverage, fight stigma, and save lives.
