According to a new study from Research Triangle Institute, adding Substance Use Disorder (SUD) services to Medicare would almost neutralize Medicare costs and SUD treatment costs. SUD services include "residential programs, intensive outpatient programs, and licensed and certified counselors."
In 2020, about 3% of Medicare beneficiaries (1.7 million people) had SUDs. Only 11% of these beneficiaries received treatment. The main reason people did not receive treatment was because of a lack of SUD insurance coverage. Medicare does not cover all SUD services, more specifically, Medicare does not cover "intensive outpatient, partial hospitalization, specialty addiction outpatient clinics, and residential addiction programs, as well as by licensed professional counselors, certified addiction counselors, and peers." Medicare is not included in the Mental Health Parity and the Addiction Equity Act, therefore, the provider doesn't have to offer these services.
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"Among Medicare beneficiaries, alcohol and drug use disorders can lead to falls and other injuries, dementias, cardiac conditions, infectious diseases, depression, and anxiety," says Tami L. Mark, Ph.D., a Senior Fellow at RTI and lead author of the study.
The idea is that by providing these services, other expenses will be avoided like "treating medical conditions caused by SUDs, and SUD-related hospitalizations and emergency department visits."
Specifically, expanding Medicare coverage of SUD treatment would:
- "Incur an additional $1.9 billion annually to cover 75,637 residential treatment episodes, 116,029 intensive outpatient episodes, and 58,890 visits with counselors;
- Provide savings of $1.6 billion annually through reduced spending on treating medical conditions caused by untreated SUD and fewer SUD-related hospitalizations and emergency department visits; and
- Result in a net impact on Medicare spending of $362 million per year, or approximately 0.04% of the total Medicare budget. (Total Medicare spending in 2020 was $825.9 billion)."
"The lack of Medicare coverage for SUD treatment is penny wise and pound foolish," says Ellen Weber, LAC's Senior Vice President for Health Initiatives. "It leaves millions of beneficiaries without adequate treatment of their substance use disorder until their conditions become acute enough to require hospitalization. Medicaid and the VA both cover comprehensive SUD treatment. Why are our nation's older adults denied the opportunity to receive lifesaving healthcare? It's time for Medicare to cover the full range of SUD treatment services and providers – it just makes sense, both financially and in terms of promoting equitable access to quality care."
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