Mental Health Costs to Drop After Override of Medicare Veto

Medicare patients' copays for psychiatric care will fall from 50% to 20% by 2014.


There's some little-noticed good news for patients in the Medicare Improvements for Patients and Providers Act of 2008 that became law with Congress's override of President Bush's veto on Tuesday: Medicare beneficiaries in need of mental health services will soon face lower coinsurance payments and will have improved access to certain medications.

"We're going to save lives with this bill," says Nada Stotland, president of the American Psychiatric Association. The new law reduces the out-of-pocket cost for outpatient mental health services from the current 50 percent coinsurance payment to a 20 percent copay—matching the copay required for other types of medical care—by the year 2014. The reduction in beneficiaries' out-of-pocket costs will be phased in. Medicare recipients will continue to pay a 50 percent copay until 2010; in 2010 and 2011, they'll pay 45 percent; in 2012, 40 percent; in 2013, 35 percent; and in 2014, they'll have a 20 percent copay.

Because people often report that cost is an issue when considering whether to seek mental health services, reducing Medicare recipients' copayments might mean the difference between patients seeking care and going without it, experts say. Financial concerns are the leading barrier to getting mental health care, according to a joint American Psychological Association-Harris Interactive poll, the results of which were released this month. Forty-two percent of those polled said that concern over cost was a barrier to seeking out such services; 52 percent said lack of insurance was an issue.

In the past, Medicare recipients considering seeking mental health services have had to "sit down and say, 'Do I really want to do this? Do I really need to do this?' For someone who may be hesitant, this all too often becomes an insurmountable burden," says Peter Newbould, director of congressional and political affairs for the American Psychological Association.

The new law also calls for coverage of benzodiazepines and barbiturates—medications used to treat psychiatric problems and other medical conditions—starting in January 2013. The medications were previously excluded from coverage under Medicare's drug program unless a doctor provided specific clinical justification. And the law also includes provisions that ensure that vulnerable patients have access to the medications they need, including antipsychotics and antidepressants.

The changes allow mental health professionals to "offer people what they tell us they want, which is to lead a life functioning and going to work every day like everyone else," Stotland says. "In order to do that, we want to have the full choice of medications that can help these people."

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