Medicare Mental Health Copayment Equity
Background
Under current law, Medicare requires beneficiaries to pay
a 20 percent copayment for Part B services. However, the 20
percent copayment is not the standard for outpatient services.
For these services, Section 1833(c) of the Social Security
Act requires patients receiving outpatient treatment for mental
disorders to pay a copayment of 50 percent.
AAGP has always opposed Medicare’s blatant discrimination
against persons with mental disorders. Medicare beneficiaries
are not required to pay more than the customary 20 percent
copayment for any services other than outpatient psychiatric
services. The 50 percent copayment requirement is unfair to
seniors, who must pay for one-half of their psychiatric services.
Despite widespread mental disorders among older people, many
seniors do without needed mental illness treatment because
of the high copayment. In addition, current law discriminates
against the non-elderly disabled Medicare population, many
of whom have severe mental disorders.
In 2000, via Executive Order, mental health parity coverage
was initiated for Federal employees and their families who
are covered under the Federal Employees Health Benefits Plan.
Medicare beneficiaries deserve the same treatment. It is now
time to end this last bastion of Federal health care discrimination
and repeal Medicare’s 50 percent copayment requirement
for the treatment of mental disorders.
Two bills were introduced in the 108th Congress to end the
historic discrimination against Medicare beneficiaries seeking
outpatient treatment for mental illness. It is anticipated
that they will be reintroduced in the 109th Congress. AAGP
supports both approaches.
Senators Olympia Snowe (R-ME) and John Kerry (D-MA) introduced
the “Medicare Mental Health Copayment Equity Act of
2003,” S. 853, which would repeal Section 1833(c) of
the Social Security Act, thereby eliminating the discriminatory
50 percent copayment requirement. Once phased in over a six-year
period, patients seeking outpatient treatment for mental disorders
would pay the same 20 percent copayment required of Medicare
beneficiaries seeking treatment for any other illnesses.
The “Medicare Mental Health Modernization Act of 2003,”
H.R.1340/S.646, was introduced by Representative Pete Stark
(D-CA) and Senator Jon Corzine (D-NJ), respectively. In addition
to equity in the copayment requirement, the Stark/Corzine
bill would end the arbitrary 190-day lifetime cap on inpatient
services in psychiatric hospitals and would also help to increase
access to effective and appropriate mental health treatment
by providing Medicare coverage for community-based services
such as psychiatric rehabilitation and substance abuse treatment
centers.
AAGP Position
Congress should end the statutory discrimination against Medicare
beneficiaries seeking treatment of mental disorders by passing
legislation to eliminate the 50 percent copayment requirement
and ensure that Medicare psychiatric outpatients incur the
same 20 percent cost-sharing requirement as patients seeking
treatment for all other illnesses. The time has come for the
Federal government to end government-sanctioned discrimination
against people seeking treatment for mental disorders by enacting
mental health parity legislation for all health plans, including
Medicare. AAGP will continue to advocate for prompt passage
of this legislation.
March 2005
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