As mental health advocates applauded the release of final parity ruling for private and marketplace health plans, others were still concerned about of a group consumers who were not awarded the same consumer protections – Medicare recipients. The Mental Health Parity and Addiction Equity Act was originally written to provide consumers who have a mental health condition or substance use disorder with equal access to costs and coverage in comparison to someone who needs medical/surgical care. Individuals who were covered by Medicare and battled psychological conditions, often faced stricter lifetime limits on psychiatric hospitals and higher out-of-pocket costs. According to the final parity ruling, this would be considered a violation, unfortunately Medicare is specifically exempted from MHPAEA protections.
The Final Rule was meaningless to Medicare recipients, but in 2008 to combat the disparity in outpatient co-insurance for mental health and addiction treatment, Congress passed the Medicare Improvements for Patients and Providers Act. The goal of the Act was to improve preventive and mental health services as well increase the amount Medicare covers. In 2008, Medicare was responsible for 50% of the cost for behavioral health treatment and in 2013, covered 65% of patient costs. Beginning January 1st, Medicare has increased its portion of patient costs up to 80%, which matches the cost-sharing for primary care for Medicare recipients. Finally, Medicare recipients will have parity for outpatient treatment, but still face discriminatory limits and cost-sharing for inpatient behavioral health treatment.
Although this increase will benefit consumers, Dr. Gary Kennedy of the Montefiore Medical Center recommends an increase in mental health providers that specializes in working with older adults. Studies also highlight a negative trend in the number of psychiatrist willing to accept Medicare patients.
New York Attorney General Brings Justice for Behavioral Health Consumers
After careful investigation of denied behavioral health claims, New York Attorney General Eric T. Schneiderman finally announced that his office has reached a settlement with Cigna Corporation. The Attorney General’s Health Care Bureau dug deep into Cigna’s administration of mental health benefits after being contacted by a consumer in 2010. The family of a 14-year-old girl who suffers from anorexia nervosa became alarmed as Cigna rejected each of her claims for nutritional counseling. The insurer denied the young girl coverage since she had exceeded her limit of three visits per calendar year. Over 300 claims who demanded the same coverage were also wrongfully denied. The multi-billion dollar company is now responsible for reprocessing each claim and footing the bill for nutritional counseling for eating disorders. Schneiderman hopes that this recent settlement will serve as a warning to other insurance companies who are also denied coverage to those with mental health issues.