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First-of-its-kind research article details substance use disorder prevalence among Medicare beneficiaries and the treatment barriers they face

According to data from the National Survey of Drug Use and Health, 2015−2019, of the estimated 1.7 million Medicare beneficiaries who have a substance use disorder (SUD), only 11% received treatment

RESEARCH TRIANGLE PARK, N.C. — A new study, conducted by RTI International, a nonprofit research institute, in partnership with the Legal Action Center, concludes that few Medicare beneficiaries who need substance use disorder treatment receive it, and that reducing Medicare coverage gaps and stigma can help meet this need.

Key data points include:

  • Approximately 1.7 million Medicare beneficiaries were estimated to have past-year SUDs (8% of Medicare beneficiaries aged <65 years and 2% aged ≥65 years).
  • Of those beneficiaries who had past-year SUDs, only 11% received treatment for their condition.
  • Common reasons for not receiving treatment included financial barriers (33%) and concern about what others might think (24%).
  • Medicare beneficiaries with SUDs were more than twice as likely to have past-year serious psychological distress compared to those without SUDs (44% vs 21% for those aged <65 years and 14% vs 4% for those aged ≥65 years).
  • Percentages of past-year suicidal ideation were also much higher among Medicare beneficiaries with SUDs compared to those without a SUD (24% vs 6% for those aged <65 years and 7% vs 2% for those aged ≥65 years).

“Unfortunately, this study suggests that a low rate of Medicare beneficiaries are receiving much-needed treatment, which means many of them are facing the serious ramifications of an untreated substance use disorder,” said William Parish, Ph.D., a health economist at RTI and lead author of the study. “Our findings point to a need for a multi-pronged approach that focuses on closing coverage gaps and reducing stigma.”

Ellen Weber, Sr. Vice President for Health Initiatives at the Legal Action Center and one of the article authors, explains, “There is growing recognition that substance use disorders are prevalent and increasing among Medicare beneficiaries, yet Medicare’s coverage of SUD treatment is strikingly limited and out of sync with evidence-based models and the current care delivery system. This leads to the very financial barriers to care identified by this study.”

She adds, “It is unconscionable that nearly 90% of Medicare beneficiaries who would benefit from addiction treatment don’t receive the care they need. Amidst the escalating overdose crisis, it is critical that we expand access to care significantly and break down the barriers that impede peoples' access, including insurance barriers like those we see in Medicare.”

Read the full study

About the Legal Action Center
The Legal Action Center (LAC) uses legal and policy strategies to fight discrimination, build health equity, and restore opportunity for people with arrest and conviction records, substance use disorders, and HIV or AIDS. LAC seeks to end punitive responses to health conditions like addiction, mental illness, and HIV or AIDS, and to create equitable access to affordable, quality treatment. You can learn more about our Medicare Addiction Parity Project (MAPP), which works specifically to improve and expand access to substance use disorder treatment in Medicare by visiting www.lac.org/major-project/mapp.

About RTI International
RTI International is an independent, nonprofit research institute dedicated to improving the human condition. Clients rely on us to answer questions that demand an objective and multidisciplinary approach — one that integrates expertise across the social and laboratory sciences, engineering and international development. We believe in the promise of science, and we are inspired every day to deliver on that promise for the good of people, communities and businesses around the world. For more information, visit www.rti.org.