It could also be “harder for older adults to try to navigate the treatment system,” Dr. Parish stated.
Uneven Medicare protection additionally presents obstacles. Federal parity laws, mandating the identical protection for psychological well being (together with habit remedy) and bodily well being, ensures equal advantages in non-public employer insurance coverage, state well being exchanges, Affordable Care Act marketplaces and most Medicaid plans.
But it has by no means included Medicare, stated Deborah Steinberg, senior well being coverage legal professional on the Legal Action Center, a nonprofit working to develop equitable protection.
Advocates have made some inroads. Medicare covers substance use screening and, since 2020, opioid remedy applications like methadone clinics. In January, following congressional motion, it’ll cowl remedy by a broader vary of well being professionals and canopy “intensive outpatient treatment,” which generally offers 9 to 19 hours of weekly counseling and training. Expanded telehealth advantages, prompted by the pandemic, have additionally helped.
But extra intensive remedy will be laborious to entry, and residential remedy isn’t lined in any respect. Medicare Advantage plans, with their extra restricted supplier networks and prior authorization necessities, are much more restrictive. “We see many more complaints from Medicare Advantage beneficiaries,” Ms. Steinberg stated.
“We’re actually making progress,” she added. “But people are overdosing and dying because of lack of access to treatment.” Their docs, unaccustomed to diagnosing substance abuse in older folks, may overlook the dangers.
In an age cohort whose youthful consuming and drug use have typically supplied amusing anecdotes (a standard chorus: “If you can remember the ’60s, you weren’t there”), it may be tough for folks to acknowledge how susceptible they’ve develop into.
“That person may not be able to say, I’m addicted,” Dr. Humphreys stated. “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.”