Does Medicare cover eating disorder treatment? Yes, but certain restrictions apply

We often think of eating disorders like anorexia nervosa or bulimia as conditions that teenagers or young adults struggle with. The National Eating Disorder Association (NEDA) estimates that about 28.8 million Americans will suffer from an eating disorder at some point in their lives. Eating disorders have one of the highest illness and death rates amongst all mental illnesses, with anorexia having the highest death rate of all psychiatric disorders.

But it’s not just younger people that suffer from these conditions. Older adults are susceptible to eating disorders too. Research shows that about 4% of community dwelling women over the age of 60 have indications of an eating disorder, which suggests that this is a life-long issue. About 60% of those affected also have other concurrent psychiatric conditions, and more than 1 in 5 (21%) of older people die because of an eating disorder.

Eating disorders also affect physical health. A 2022 study found that Medicare beneficiaries with eating disorders had higher rates of other chronic conditions, including heart arrhythmias. arthritis, and thyroid conditions, compared to beneficiaries without eating disorders. Spending was higher for enrollees with eating disorders compared to those without ($29,456 vs. $7,418) regardless of health care setting. Many beneficiaries were eligible for both Medicare and Medicaid.

“While individuals under age 65 comprise roughly 16% of all Medicare enrollees, they represent approximately 42% of enrollees with any eating disorder diagnosis, a reflection of the extent to which many individuals with eating disorders are qualifying for Medicare due to disability status,” researchers found. However, about one-third of the study sample who had OSFED (36.5%) or anorexia nervosa (36.4%) were over age 75.

Unfortunately, many older adults often go undiagnosed or untreated because symptoms of eating disorders, like diarrhea, vomiting, or hair loss, might be attributed to medication side effects, or just the challenges of aging. There’s also still stigma associated with both eating disorders and with mental health treatment among some older people.

“Having an eating disorder is not a choice. It’s a serious and potentially life-threatening condition that can lead to heart attacks, kidney failure, osteoporosis, and electrolyte imbalances,” writes Amy Puccini, a dietetic intern at Oregon Health Sciences University.

Are eating disorders covered by Medicare?

Eating disorder treatments and therapies are considered mental health treatment, and are covered under Medicare’s mental health coverage. Medicare will pay for counseling and treatment, including short-term inpatient care, outpatient care, and psychotherapy or drug maintenance. A physician must demonstrate that treatment is medically necessary for therapy. Partial hospitalization, which is an alternative to inpatient care, is also covered when provided through a hospital’s outpatient department or community mental health center.

“The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)—a federal law that requires health insurers to provide mental health or substance use disorder coverage on par with physical medical diagnoses, excludes any other levels of care that are often required for mental health conditions like eating disorders,” according to Project Heal, a non-profit which addresses the stigma, systemic, financial, and access barriers to eating disorder treatment.

Medicare also does not cover medical nutrition therapy solely for eating disorders, but a bipartisan bill was reintroduced in the Senate in November, by Maggie Hassan (D-NH) and Lisa Murkowski (R-AK) would change that. The Nutrition CARE Act would expand access to medical care for Medicare beneficiaries with eating disorders by including coverage of outpatient medical nutrition therapy through Medicare Part B, which would provide patients with a more comprehensive, specialized approach to combating eating disorders than what is currently offered under Medicare. 

“It is critical that people on Medicare with an eating disorder can get the full help that they need,” Hassan said in a statement.

What traditional Medicare covers

Eating disorders are treatable, with the right care and counseling, according to Dr. Beverly Smith, CEO and executive director of the American Mental Health Counselors Association. New Medicare payment rules allow for licensed mental health counselors to accept Medicare assignment, increasing beneficiary access to thousands of additional trained mental health professionals, who can help coordinate care.

“Eating disorders are often discussed and treated in collaboration with other professionals to foster a wholistic approach to sustainable treatment. As mental healthcare professionals, we help the patient by trying to help discover the root causes, triggers and acquiring new skill and enhancing coping skills already developed,” Smith says. “A key piece of treatment is helping to establish accountability groups or partners as well as having open conversations about relapse with the awareness that it is ok not to be perfect.”

More help for eating disorders

If you or someone you love has an eating disorder, you can contact:

Source link

About The Author

Scroll to Top