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Medicare insures a growing number of individuals who may benefit from mental health services. Medicare mental health provider policy, last updated in 1989, excludes a significant proportion of the master's-level mental health workforce, resulting in what has been described as the Medicare mental health coverage gap (MMHCG;. Based on existing provider shortages in rural areas, Medicare provider policy may be particularly burdensome for accessing care in rural areas. The authors analyzed MMHCG data from 3,760 counselors, including 601 who reside in Health Resources & Services Administration-designated rural localities. A total of 78.0% (n ϭ 469) of rural counselors reported being directly impacted by the MMHCG, compared with 68.6% (n ϭ 2,167) of nonrural counselors ( 2 ϭ 21.47, p Ͻ .001, OR ϭ 1.63, 95% CI [1.32, 2.00]). Rural providers were more likely than nonrural providers to have referred an existing client ( 2 ϭ 27.37, p Ͻ .001, OR ϭ 1.59, 95% CI [1.34, 1.90]) or provided pro bono services ( 2 ϭ 11.05, p Ͻ .001, OR ϭ 1.35, 95% CI [1.13, 1.61]) due to the MMHCG. Based on these data, the MMHCG has an outsized impact on rural mental health providers and rural communities. Implications of the MMHCG for rural mental health care, including how it exacerbates barriers to mental health access and burdens rural mental health providers, are discussed.

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Mental health conditions are relatively common among Medicare beneficiaries. Yet, Medicare provider eligibility was last updated in 1989, raising concerns about beneficiaries' access to mental health care in the United States. Beneficiaries are currently restricted from accessing mental health services provided by licensed professional counselors and licensed marriage and family therapists. Little is known about the impact of this Medicare mental health coverage gap (MMHCG) on Medicare beneficiaries. Hermeneutic phenomenology was used to analyze semistructured interviews with 18 beneficiaries who had attempted to access mental health care but were limited due to the MMHCG. Three themes emerged: (a) exasperating experiences with the MMHCG, (b) the MMHCG compounds barriers to mental health care, and (c) Medicare as a flawed system. These findings suggest current Medicare mental health policy interferes with beneficiaries' access to needed mental health services. Implications for the counseling profession are described. K E Y W O R D Sgerontological counseling (aging), medicare, professional issues (advocacy)

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