One of several public health issues of utmost importance are mental health disorders, which are quite commonplace. In the United States, millions of adults suffer from psychological distress, which can significantly impair their ability to carry out major life activities.1 Given its impact, patients, clinicians, and policymakers alike have all prioritized the improvement of mental healthcare, but upon further analysis, there is a sense of uneasiness, being that there are various access and coverage gaps in Medicare program for individuals experiencing psychological distress.
Mental health coverage gaps in Medicare and Medicare Advantage
Being eligible for Medicare at the age of 65 has proven to help boost access to healthcare among the US population, but participation in Medicare among mental health professionals is on the decline. This—in combination with the fact that traditional Medicare and Medicare Advantage often lack coverage for critical mental health services like psychiatric rehabilitation, assertive community treatment, and peer support—makes it not as shocking as one might expect that only 55% of psychiatrists see adults that registered for Medicare, compared with 86% of physicians in other specialty areas.1
There is little research revolving around how Medicare eligibility (at the age of 65) impacts the use of mental healthcare, general healthcare, and acute care services among US adults with psychological distress, so a cross-sectional study published in JAMA Health Forum1 sought to investigate this further.
Key Takeaways
- Medicare eligibility at age 65 is linked to reduced outpatient mental health service use among adults with psychological distress, including fewer mental health visits and lower psychotropic medication use.
- General healthcare use remains unchanged, while acute care services—such as hospital admissions and emergency department visits—increase after Medicare eligibility.
- These patterns highlight gaps in Medicare’s mental health coverage and point to the need for targeted policy reforms to improve access for older adults with mental health challenges.
Study design: Using MEPS Data to measure healthcare utilization
Powered by publicly available data—including data from the 2009-2019 Medical Expenditure Panel Survey (MEPS)—the study used a regression discontinuity design to measure the association of Medicare eligibility at the age of 65 with healthcare use among adults experiencing psychological distress. It also followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines for observational studies.
Utilizing data that were analyzed from March 2023 to February 2025, along with various several sensitivity analyses, healthcare use among adults ages 59 to 64 and those ages 66 to 71 with psychological distress was defined as those who scored 3 or higher on the 2-item Patient Health Questionnaire or a 13 or higher on the 6-item Kessler Psychological Distress Scale.
Key findings: How Medicare affects mental and acute healthcare use
The study population featured 3,970 adults with psychological distress (mean [SD] age, 64.0 [3.6] years; 59.7% [n = 2370] female). Becoming eligible for Medicare at age 65 was linked to a reduction in outpatient mental health visits with healthcare providers (adjusted change of −3.4 percentage points [95% confidence interval, or CI, −5.4 to −1.4 percentage points]), no change in mental health visits with psychiatrists (−0.7 percentage points [95% CI, −4.1 to 2.6 percentage points]), and a decline in psychotropic medication fills (−5.3 percentage points [95% CI, −10.3 to −0.3 percentage points]) among adults experiencing psychological distress.
There was no change in general healthcare use, including all outpatient visits (0.6 percentage points [95% CI, −5.4 to 6.5 percentage points]) and prescription drug use (0.1 percentage points [95% CI, −2.2 to 2.5 percentage points]). In contrast, Medicare eligibility was associated with increases in acute care use, such as inpatient admissions (5.5 percentage points [95% CI, 2.2-8.9 percentage points]) and emergency department visits (8.1 percentage points [95% CI, 3.3-13.0 percentage points]) among adults with psychological distress.
“This cross-sectional study found that Medicare eligibility at age 65 years was associated with a decrease in outpatient mental health visits with healthcare professionals, no change in psychiatrist visits, and a decrease in psychotropic medication fills among adults with psychological distress,” the study investigators concluded. “In addition, there was an increase in inpatient admissions and emergency department visits associated with Medicare eligibility. These findings highlight the need for policies that address gaps in mental healthcare in the Medicare program, although further research is needed to determine whether policy responses should differ between traditional Medicare and Medicare Advantage.”
Reference
1. Park S, Koh KA, Liu M, Wadhera RK. Medicare Eligibility and Health Care Use Among Adults With Psychological Distress. JAMA Health Forum. 2025;6(5):e251089. doi:10.1001/jamahealthforum.2025.1089
