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Unfair Treatment
October 26, 2006 • Volume 6, Issue 43If a person with Medicare who has cancer goes to an oncologist for chemotherapy, Medicare will provide for 80 percent of the cost of treatment; the patient pays 20 percent.
If a person with Medicare needs to get an MRI at a doctor's office, Medicare pays 80 percent and the patient pays 20 percent.
But if a person with Medicare is suffering from severe depression, schizophrenia or another mental health condition and seeks the services of a psychiatrist, Medicare will only cover half-the patient must pay 50 percent.
Medicare's rules unfairly and unjustifiably restrict coverage for mental health care. Because of the payment limitation, older adults and people with disabilities who can't afford the higher costs of therapy and treatment end up without the care they need.
The results of leaving mental illnesses untreated are grim: a reduced quality of life and ability to function, poorer overall health and higher mortality rates. Untreated mental illness can also force individuals to become institutionalized, triggering greater costs to Medicare.
The lack of mental health parity under Medicare clearly does not match up with well-established medical need. One in five older adults and over half of people with Medicare because of a disability are living with a mental health condition. Older adults account for almost 20 percent of all suicides-the highest rate in the country-with depression as a major risk factor. Interventions such as psychotherapy and counseling are effective in treating mental illness.
Medicare's unequal coverage of mental heath services is based on an outdated understanding of mental illness as less legitimate and less important to treat than other ailments. Many other types of health insurance also continue to maintain antiquated rules for mental health care coverage, with one notable exception: the coverage offered to federal government employees. The health plan for federal employees was updated a few years ago to mandate equal coverage for the treatment of mental illnesses and substance abuse disorders.
That is the coverage all members of Congress have.
It's time that our elected representatives in the U.S. Senate and House also improve access to mental health care for people with Medicare. Congress must put Medicare payment for mental health services on par with its payment for other kinds of outpatient care.
In response to a survey conducted by the Medicare Rights Center ahead of the upcoming elections, candidates in various campaigns around the country have expressed their support for legislation to establish mental health parity in Medicare. These candidates recognize that people with Medicare in need of mental health treatment should be relieved of the disproportionate burden they face in paying for health care (Survey results).
The inequality in Medicare's coverage policy amounts to systematic discrimination against individuals with mental illnesses. Congress has the ability to improve Medicare coverage for those individuals, just as improvements were made to their own mental health care coverage.
Medical Record
“Ms. S is a disabled 49-year-old woman from Liverpool, NY, with Original Medicare and no supplemental coverage. She has lived with major depression for six years, but has only seen a therapist once to confirm her diagnosis. She did not return for therapy because she could not afford the 50% coinsurance for the visits" (Background Information for 2006 Congressional Survey, Medicare Rights Center, October 2006).
"Depression, one of the most common conditions associated with suicide in older adults, is a widely underrecognized and undertreated medical illness...Research has shown that certain types of short-term psychotherapy, particularly cognitive-behavioral therapy and interpersonal therapy, are effective treatments for late-life depression. In addition, psychotherapy alone has been shown to prolong periods of good health free from depression. Combining psychotherapy with antidepressant medication, however, appears to provide maximum benefit" ("Older Adults: Depression and Suicide Facts," National Institute of Mental Health, May 2003).
"OPM [U.S. Office of Personnel Management] has taken the lead in making mental health coverage more affordable and accessible for all Federal employees. Parity in the FEHB [Federal Employees Health Benefits] Program means that benefits coverage for plan mental health, substance abuse, medical, surgical, and hospital providers have the same limitations and cost-sharing such as deductibles, coinsurance, and copayments. Historically, health plans have applied higher patient cost-sharing and shorter day and visit limits to mental health and substance abuse services than they did to services for physical illness, injury, or disease" ("Mental Health and Substance Abuse Parity in the FEHB Program," U.S. Office of Personnel Management).
***** The Medicare Rights Center (MRC) needs to hear about all the problems with the Medicare Part D benefit, whether they happen to you or someone in your community. With this information, we will be armed with the needed evidence to push for a Medicare-administered drug benefit.
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Submit your story at www.medicarerights.org/partdstories.html
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