Elderly To Pay Less For Mental Health Care

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Last week, Congress passed a bill over the president's objections that eliminated a pay cut for doctors — but what went almost unnoticed is that it cut the co-payment seniors pay for mental health services from 50 percent to 20 percent.

MELISSA BLOCK, host:

On Capitol Hill, the House and Senate are getting close to a resolution on an issue of health care disparity. Right now, patients pay more to treat mental illnesses than for physical illnesses, and the legislation would require insurers to cover both sorts of illness at the same levels.

Meanwhile, last week, Congress already made those changes for older patients. A little-known provision in the new Medicare law scales back what seniors have to pay for psychiatric care. That begins in 2010.

NPR's Joanne Silberner explains.

JOANNE SILBERNER: When 77-year-old Bryce Miller(ph) goes to his doctor for treatment of his diabetes, his Medicare co-payment is 20 percent. When Miller goes to his psychiatrist for treatment of his manic depressive disease, his co-payment is 50 percent.

Mr. BRYCE MILLER (Patient Advocate): I have not been happy about the 50 percent.

SILBERNER: Miller lives in Topeka, Kansas. He's an advocate for people with mental illness. His supplemental insurance policy takes care of his co-payments, but he says plenty of people in his bipolar support group and in his community struggle with the higher co-payments.

Mr. MILLER: I see them standing at the counter, checking into the mental health center, and they ask for their co-pay. And if they don't have it, you know - I came up here on the bus and I don't have more money.

SILBERNER: Mental health clinics often have to forgo the co-payments and provide services at a loss. Some doctors and mental health professionals can't collect the co-payments, and some simply don't treat people on Medicare.

Psychiatrist Allan Anderson of the American Association for Geriatric Psychiatry says one of the impacts of the higher co-payments for mental illness is that people don't come in for care, and that's bad because a lot of mental illness in older people goes unrecognized.

Dr. ALLAN ANDERSON (Member, American Association for Geriatric Psychiatry): Symptoms of mental illness may be placed on other reasons like getting older and the concept that people should be depressed when they're older and retired and not active or, perhaps, they're thought to be due - inappropriately due to medical problems.

SILBERNER: The new Medicare regulations that have just become law will drop the co-payments for the care of mental illness to 20 percent by the year 2014. And that's likely to affect a lot of people. The American Psychological Association estimates that the 50 percent co-pay was in effect for about 16 million office visits in 2006.

Bryce Miller thinks the change will help.

Mr. MILLER: It's going to change the attitude of many consumers and it's going to get people into treatment or get help when they need it.

SILBERNER: Mental health advocates have been pushing for the change for years. What they were pushing against is the cost. The Congressional Budget Office estimates that the change will cost the government about $600 million over the next 10 years.

Psychiatrist Allan Anderson doesn't see that as a problem.

Dr. ANDERSON: While it may cost more money, it will improve the lives of the elderly with mental illness. And studies have shown that that also may lead to decreased medical costs. So that when we effectively treat severe depression in the elderly, we reduce E.R. visits, hospitalizations, lengthy hospital stays, and overall improve the general medical quality of life of those patients.

SILBERNER: And patient advocate Bryce Miller hopes it takes care of one more problem, the feeling many people with mental illness have that they're second-class citizens.

Joanne Silberner, NPR News, Washington.

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