It may be “harder for older adults to try to navigate the treatment system,” Dr. Parish said.
Uneven Medicare coverage also presents obstacles. Federal parity legislation, mandating the same coverage for mental health (including addiction treatment) and physical health, guarantees equal benefits in private employer insurance, state health exchanges, Affordable Care Act marketplaces and most Medicaid plans.
But it has never included Medicare, said Deborah Steinberg, senior health policy attorney at the Legal Action Center, a nonprofit working to expand equitable coverage.
Advocates have made some inroads. Medicare covers substance use screening and, since 2020, opioid treatment programs like methadone clinics. In January, following congressional action, it will cover treatment by a broader range of health professionals and cover “intensive outpatient treatment,” which typically provides nine to 19 hours of weekly counseling and education. Expanded telehealth benefits, prompted by the pandemic, have also helped.
But more intensive treatment can be hard to access, and residential treatment isn’t covered at all. Medicare Advantage plans, with their more limited provider networks and prior authorization requirements, are even more restrictive. “We see many more complaints from Medicare Advantage beneficiaries,” Ms. Steinberg said.
“We’re actually making progress,” she added. “But people are overdosing and dying because of lack of access to treatment.” Their doctors, unaccustomed to diagnosing substance abuse in older people, may also overlook the risks.
In an age cohort whose youthful drinking and drug use have sometimes provided amusing anecdotes (a common refrain: “If you can remember the ’60s, you weren’t there”), it can be difficult for people to recognize how vulnerable they have become.
“That person may not be able to say, I’m addicted,” Dr. Humphreys said. “It’s a Rubicon people don’t want to cross.”
A joke about dropping acid at Woodstock “makes me colorful,” he added. “Crushing OxyContin and snorting it is not colorful.”
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