Asclepios
Get Asclepios free by e-mail every week! Click here to subscribe.
Mental Health Parity for Medicare
October 4, 2007 • Volume 7, Issue 39Last month, both houses of Congress moved forward on key legislation to protect working Americans from excessive out-of-pocket costs for mental health care.
The Mental Health Parity Act of 2007, sponsored by Senator Pete Domenici, Republican of New Mexico, in the Senate, and Representative Patrick Kennedy, Democrat of Rhode Island, in the House, pushes private health insurance plans to set coverage—deductibles, copayments and coverage limits—for mental health services on par with the benefits of other outpatient medical services.
While the legislation took nearly two years of negotiations between Congress, industry representatives and mental health advocates, it now enjoys broad legislative support. Upon the bill’s introduction in February, representatives of Aetna released a message of support stating, “The federal legislation will create a national solution to inconsistent behavioral health care regulation, inconsistencies that can be a threat to Americans’ overall health.”
A George Washington University study described higher cost-sharing for mental health services as “a once common practice in commercial insurance products,” which has diminished due to “growing recognition that untreated mental illness can fuel overall health care spending.”
Like many of the private benefit packages Congress is seeking to improve, Medicare, a public program covering 44 million Americans, requires a higher out-of-pocket contribution for outpatient mental health services. People with Medicare must pay 50 percent coinsurance for outpatient mental health care, in contrast to 20 percent for nearly all other outpatient services. Although higher coinsurance rates were originally implemented to contain costs and prevent overuse, they also reflect a view that stigmatizes those who seek mental health care.
With mental health parity becoming the new norm, why should Medicare maintain an outdated and discriminatory copayment scheme?
Senators Olympia Snowe, Republican of Maine, and John Kerry, Democrat of Massachusetts, introduced the Medicare Mental Health Copayment Equity Act, which reduces Medicare mental health coinsurance rates to match those of other outpatient services at 20 percent. The Senate has yet to move on this legislation as it has on the Kennedy bill that affects only private health insurance.
The need for mental health parity is even greater for Medicare, however. Studies continually show that people with Medicare have a higher prevalence of mental illness, with 26 percent suffering from mental impairment compared to 21 percent of the general population.
Because of the higher coinsurance, people with Medicare with mental illness often receive diminished access to care. Many do not seek treatment or, when they do, require costly inpatient intervention. According to the George Washington University study, in 2001 fifty-six percent of Medicare mental health spending went to inpatient care, with 30 percent going to outpatient services. In contrast, half of mental health spending for the general population went to outpatient services, with only 24 percent going to inpatient care.
Recent studies show that some of the most common mental disorders among people with Medicare are related to anxiety and depression, which are usually treatable in outpatient or community settings. If left untreated, mental illness can contribute to a decline in overall physical health or well-being.
If, like in the private industry, payment parity were implemented for Medicare, many mental disorders could be treated before they required inpatient intervention, saving federal funds and, more importantly, improving the health of people with Medicare.
Medical Record
“Tragically, only about half of older adults experiencing a mental illness receive mental health treatment, due in large part to antiquated and discriminatory health coverage requirements such as the 50 percent coinsurance rate under Medicare. There is simply no reason for maintaining a discriminatory barrier to mental health care for America’s seniors and individuals with disabilities, particularly since these populations present a high incidence of mental health concerns” (Letter from the Medicare Mental Health Equity Coalition to Senator Max Baucus, September 28, 2007).
“We would all be outraged if Medicare beneficiaries with cancer were told that they are now responsible for half of the costs of their treatment, when other disorders are covered at 80 percent. So why is it reasonable to tell a 75-year-old man with major depression resulting from a devastating loss or terminal medical illness that he is now responsible for half of the cost of his mental health treatment? . . . It is only good care to treat mental and medical disorders the same, and Medicare should be about good care, not substandard care for America’s seniors” (Testimony of Dr. Stephen Bartels, president, American Association for Geriatric Psychiatry, “AAGP Supports Stark/Wellstone Medicare Mental Health Parity Bill ‘Medicare Mental Health Modernization Act of 2001,’” April 4, 2001).
“The passage tonight of the Mental Health Parity bill underscores our commitment to treat all patients facing all diseases with the dignity and respect they deserve. This new legislation will bring dramatic new help to millions of Americans who today are denied needed mental health care and treatment. This bill represents a major breakthrough for those with mental health needs, ensuring their access to fair and equitable health insurance” (Senator Edward Kennedy, “Domenici and Kennedy Celebrate Passage of Mental Health Parity Bill,” press release from Senator Edward Kennedy’s office, September 18, 2007).
* * * *
Medicare Part D Appeals Help for Advocates Is Here!
MRC’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
Register for a FREE copy of this great resource.
* * * *
Medicare Part D Monitoring Project
The Medicare Rights Center (MRC) would like to hear about your experience, or that of someone you know, enrolled in a Medicare private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.
Submit your story at http://www.medicarerights.org/partdstories.html.
* * * *
The Louder Our Voice, the Stronger Our Message
Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
* * * *
The Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
Visit our online subscription form to sign up for Asclepios at http://www.medicarerights.org/subscribeframeset.html.