Counseling Medicare Beneficiaries With Disabilities

Medicare coverage isn’t only limited to people over the age of 65. Though many consider Medicare as a means of providing support and services for older adults, there are also many younger individuals who benefit from Medicare and may be served by counselors. The Centers for Medicare & Medicaid Services (CMS) reported in May that there are 67.1 million Americans covered by Medicare, and just over 7 million Americans under the age of 65 are covered because of a disability.  

CMS has also published a booklet titled Medicare & Your Mental Health Benefits that is available online and covers issues including Medicare eligibility, inpatient and outpatient benefits, prescription coverage, resources for help, and information for individuals with limited incomes. 

The Medicare program was created in 1965 to provide health insurance coverage for Americans aged 65 and older. A Kaiser Family Foundation report titled Medicare’s Role for People Under Age 65 With Disabilities is another helpful resource for counselors; for instance, individuals under 65 can qualify automatically for Medicare if they have end-stage renal disease (ESRD, or kidney failure), and since 2001, individuals with amyotrophic lateral sclerosis (ALS) also qualify for Medicare coverage.  

In addition to ESRD and ALS, the Social Security Administration website explains that individuals receive Medicare benefits if they qualified for Social Security retirement benefits and received Social Security Disability Insurance (SSDI) for 24 months due to a medical or mental health condition that is expected to last at least 1 year. The condition must significantly limit a person’s ability to perform basic work activities, such as sitting, standing, and remembering.  

Examples of health conditions that qualify individuals for SSDI include: 

• depression, bipolar, and related mental illnesses 
• Parkinson’s disease
• autism spectrum disorder
• multiple sclerosis
• Huntington’s disease
• cerebral palsy  

 According to the Centers for Disease Control’s National Center for Health Statistics, many Medicare beneficiaries reported symptoms of mental health conditions during the COVID-19 pandemic and a lack of access to needed mental health services. Its Household Pulse Survey, which began in April of 2020, also found high rates of mental health problems although the impact of the pandemic had significantly diminished.  
 
A 2023 Kaiser Family Foundation survey found that 30% of Medicare beneficiaries with disabilities reported fair or poor mental health status, and a larger percentage reported barriers to care availability and access to providers. The survey also highlighted that nearly 3 in 10 (27%) enrollees said that there was a counselor, treatment, or medication they needed that was not covered by Medicare.   

According to a peer-reviewed study by the American Psychological Association, nearly one-half (43.3%) of Medicare recipients with disabilities suffered from anxiety, and more than a third (36.8%) had symptoms of major depressive disorder. In addition, a significant portion (15.3%) of Medicare beneficiaries with disabilities said they needed counseling from a mental health professional but did not receive care.  

The traumatic experiences of the COVID-19 pandemic and their impact on mental health for many Americans will likely remain for a considerable period, especially for Medicare beneficiaries who have a disability and whose therapy needs remain unmet.   

The untreated prevalence of mental health disorders among Medicare beneficiaries with disabilities represents a major opportunity for mental health counselors to address the needs of a highly vulnerable population. As Medicare-approved providers, counselors will have the ability to diagnose and treat people with disabilities who are covered by the Medicare program for their mental health care needs.   

For example, many individuals living with Parkinson’s disease suffer from anxiety and depression disorders and often have debilitating clinical symptoms that profoundly impact their overall health, quality of life, and independence. According to The Michael J. Fox Foundation for Parkinson’s Research, up to 50% of all people with Parkinson’s disease suffer from a mental health condition at some point.  

Counselors possess unique skills, capabilities, and expertise that can better meet the needs of individuals with disabilities and mental health conditions, especially those who are also coping with medical conditions. An additional CMS report, Chronic Conditions Among Medicare Beneficiaries, found that many beneficiaries with disabilities and mental health conditions also have two or more chronic, comorbid conditions such as diabetes and hypertension.  

Moreover, early access to care for managing mental health disorders by counselors and working closely with primary care practices and specialists will improve care for Medicare beneficiaries with disabilities. Younger Americans with disabilities now have a new lifeline to more mental health providers because of Medicare recognition of mental health counselors.