Lowering the
Co-Pays for Mental Health Care Does Not Move Senior Citizens to Seek
Help
Seniors in
Medicare Advantage plans not motivated by rather large increases or
decreases in co-pays for outpatient mental health care
Feb. 8, 2011
Senior citizens with mental health conditions and enrolled in a managed
care plan Medicare Advantage are not enticed to seek mental health
care by lowering the co-pays required. The Affordable Care Act has
forced a lowering of outpatient mental health co-pays to the same as
required for other care in hopes of helping more seniors receive help.
Brown University
researchers find senior are not taking the bait.
Parity measures,
included in laws passed in 2008 and 2010, end an insurance industry
practice of charging higher co-pays for mental health care than for
other care. While the laws will allow many seniors who undergo treatment
to save money, said Amal Trivedi, professor of community health at Brown
University, the new findings suggest that co-pays are not the main
barrier to care.
Managed care
plans in Medicare are known as Medicare Advantage Plans and they include
HMOs, PPOs and others that may cover more services and have lower
out-of-pocket costs than the Original Medicare Plan. Some plans cover
prescription drugs. In some plans, like HMOs, patients may only be able
to see certain doctors or go to certain hospitals to get covered
services. Seniors do not need a Medigap policy if they are in one of
these plans.
In the study
published online in the journal
Medical Care, Trivedi and graduate student Chima Ndumele found that
seniors did not start mental health care when co-pays dropped and did
not quit when they rose.
Less than half
of people with a mental health condition actually seek mental health
services, said Trivedi.
The hope was
that insurance parity and reducing co-pays would increase the number of
people who would do so. We found thats unlikely to be the case. At
least for this population in managed care plans, rather large increases
or decreases in co-pays have no effect on the likelihood of receiving
any outpatient mental health care.
A measurable
non-effect
To perform their
analysis, Trivedi and Ndumele combed through 252 Medicare plans with
outpatient mental health services. They ultimately found 14 that raised
co-pay rates by more than 25 percent in the last year of a three-year
period, and that could be compared to plans that were similar except
that they held co-pay rates constant.
They also found
three plans that lowered rates by more than 25 percent in a third year
that could also be compared to comparable control plans that did not
change their co-pay.
Among enrollees
in the 14 plans that raised rates, an average of 2.2 percent used mental
health services both before and after the increase. In the case of the
plans that lowered rates, participation in mental health care held
steady at 1.2 percent of enrollees, despite the discount.
In both cases,
the plans that did not change co-pays averaged a 0.1-percent drop in
mental health service use. In short, mental health service use
essentially remained unchanged no matter what happened to the co-pay.
The non-effect
held true for almost every demographic breakdown of the enrollees,
except that black seniors seemed to be motivated by reduced co-pays,
increasing their participation in mental health care by almost a whole
percentage point.
Barriers
remain
Trivedi said at
least a partial explanation for the tiny effect of co-pay changes is
that other common insurance company policies may have a stronger effect
on limiting use of mental health services for most seniors. Those
policies include requiring prior authorization of care from primary care
doctors and the insurer, and restricted networks of doctors approved to
provide mental health care.
The people who
actually receive mental health services have already overcome these
additional barriers to use of services, he said. If the plan had prior
authorization or restricted network, it meant enough for them to go past
those barriers. Putting in another co-pay increase didnt dissuade them
from receiving services.
Similarly,
Trivedi said, these policies are probably more of a barrier to seniors
starting care than the level of the co-pay.
Enacting parity
is just one step in creating an environment in which individuals in need
of mental health services will seek care, added Ndumele. Our study
indicates that we must identify other steps beyond insurance parity to
promote the appropriate use of mental health services among the
elderly.
The study was
funded by the National Institutes of Health through a grant from the
Minority Opportunities for Research (MORE) Division of the National
Institute of General Medical Sciences.
About Managed
Care Plans in Medicare
Managed care
plans in Medicare are known as Medicare Advantage Plans and they include
HMOs, PPOs and others that may cover more services and have lower
out-of-pocket costs than the Original Medicare Plan. Some plans cover
prescription drugs. In some plans, like HMOs, you may only be able to
see certain doctors or go to certain hospitals to get covered services.
Seniors do not need a Medigap policy if they are in one of these plans.
Medicare
Advantage Plans Available in many areas. If you have one of these
plans, you dont need a Medigap policy. These plans include:
● Health Maintenance Organizations (HMO),
● Preferred Provider Organizations (PPO)
● Private Fee-for-Service Plans
● Medicare Special Needs Plans
● Medicare Medical Savings Account Plans (MSA)
These plans may
cover more services and have lower out-of-pocket costs than the Original
Medicare Plan. Some plans cover prescription drugs. In some plans, like
HMOs, you may only be able to see certain doctors or go to certain
hospitals to get covered services.
Keep up with the latest news for senior citizens, baby
boomers
Feb. 8, 2011
Senior citizens with mental health conditions and enrolled in a managed
care plan Medicare Advantage are not enticed to seek mental health
care by lowering the co-pays required. The Affordable Care Act has
forced a lowering of outpatient mental health co-pays to the same as
required for other care in hopes of helping more seniors receive help.