rss subscribe email subscribe Tuesday, November 17, 2009
Medicare and Mental Health By Kurt Klauburg, D.O. For those of us who are covered under Medicare, we are well aware that Medicare discriminates against coverage for treatment of mental illness. When you visit your family physician, Medicare demands a copay of 20 percent from you or your supplemental insurance policy. However, if you see a mental health physician (Psychiatrist), that copay rises to 50 percent. Why this disparity? It originally dates back to the 1960s when President Lyndon B. Johnson first proposed Medicare coverage for indigent elderly patients. The reasoning at the time was that mental illness was under the control of the patient, and if the patient paid more for their care, they would get better faster. This way of thinking quickly spread into the health insurance industry, and the “Mental Health Copay” emerged. As time progressed, insurance companies used this “disparity” as a means to lower reimbursement for mental health services. On July 15, 2008, Congress enacted the Medicare Improvements for Patients and Providers’ Act of 2008. Among other things, this Act effectively paved the way for removal of this extra mental health charge. This has been referred to as “Parity” in the media, or an equalization of the coverage for mental health and medical health issues. Therefore, Medicare will eventually approach coverage the same, regardless of the type of care you receive. The mental health copay is scheduled to drop to 45 percent in 2010 and drop to 20 percent by 2014 and thereafter. This will eventually put mental health care payment on the same level with general medical care. If the past experience is any indication, the private health insurance companies will follow suit and eliminate this “disparity” in coverage from their plans, as well. (Dr. Klauburg, a Fellow in the American Psychiatric Association, is Clinical Director of Geriatric Services at Rolling Hills Hospital, Franklin, TN. For confidential assistance with behavioral health issues in older family members, you may dial 1-800-832-0388.) ###

Tuesday, November 17, 2009

Medicare and Mental Health

By Kurt Klauburg, D.O.

For those of us who are covered under Medicare, we are well aware that Medicare discriminates against coverage for treatment of mental illness. When you visit your family physician, Medicare demands a copay of 20 percent from you or your supplemental insurance policy. However, if you see a mental health physician (Psychiatrist), that copay rises to 50 percent. Why this disparity?

It originally dates back to the 1960s when President Lyndon B. Johnson first proposed Medicare coverage for indigent elderly patients. The reasoning at the time was that mental illness was under the control of the patient, and if the patient paid more for their care, they would get better faster. This way of thinking quickly spread into the health insurance industry, and the “Mental Health Copay” emerged. As time progressed, insurance companies used this “disparity” as a means to lower reimbursement for mental health services.

On July 15, 2008, Congress enacted the Medicare Improvements for Patients and Providers’ Act of 2008. Among other things, this Act effectively paved the way for removal of this extra mental health charge. This has been referred to as “Parity” in the media, or an equalization of the coverage for mental health and medical health issues. Therefore, Medicare will eventually approach coverage the same, regardless of the type of care you receive.

The mental health copay is scheduled to drop to 45 percent in 2010 and drop to 20 percent by 2014 and thereafter. This will eventually put mental health care payment on the same level with general medical care. If the past experience is any indication, the private health insurance companies will follow suit and eliminate this “disparity” in coverage from their plans, as well.

(Dr. Klauburg, a Fellow in the American Psychiatric Association, is Clinical Director of Geriatric Services at Rolling Hills Hospital, Franklin, TN. For confidential assistance with behavioral health issues in older family members, you may dial 1-800-832-0388.)

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