Action Alerts: Medicare Coinsurance
November 29, 2007
Contact Your Senators Today In Support of Eliminating Medicare’s Coinsurance for Outpatient Mental Health Services
Executive Summary
Current law imposes a 50 percent coinsurance rate for most mental health services under Medicare Part B instead of the usual 20 percent coinsurance for outpatient services. This requirement dates back to the inception of Medicare in 1965 and reflects outmoded benefit design, but it currently represents a serious barrier to care for some of the nation’s most vulnerable populations. Congress is expected to consider legislation to reform Medicare in the coming weeks, presenting the opportunity to eliminate this disparity.
Action Needed
The National Council urges all members to contact their Senators today and ask them to support the removal of the discriminatory 50 percent coinsurance from Medicare outpatient mental health services with their planned Medicare reform legislation.
To find your Senators, go to: www.senate.gov. You can reach all members of Congress by contacting the Capitol Switchboard at 202-224-3121 and asking to be connected to the office you wish to contact.
What Should You Say?
Once you are connected to your Senator’s office, let them know you are calling to support a fix to Medicare’s discriminatory coverage of mental illnesses in any future Medicare reform bill.
Talking points
- Medicare beneficiaries are required to pay a 50 percent coinsurance for outpatient mental health services, more than twice as much as the usual coinsurance.
- This fundamentally unfair policy creates a serious barrier to care for the 44 million older adults and people with disabilities that depend on this program.
Please let the National Council know if you contact your Senators on this issue. Contact Allison Fort at AllisonF@thenationalcouncil.org to let us know you participated and share the response you received.
Background
The Medicare program was established to guarantee health care coverage for all older adults and for people with serious disabilities. Despite an elevated need for mental health services among Medicare beneficiaries, the 50 percent coinsurance for mental health services remains as a harmful barrier preventing many from accessing services they need. In a 2006 review of prevalence data, researchers at the George Washington University found that 26 percent of Medicare beneficiaries have mental disorders, compared to 21 percent of the general population. In addition, 59 percent of Medicare beneficiaries with disabilities had a mental disorder, and 37 percent of them have serious disorders. The consequences of not getting treatment can be serious. According to the Centers for Disease Control and Prevention, adults over the age of 65 have a suicide rate of 14 per 100,000, compared to the overall U.S. suicide rate of 11 per 100,000. Tragically, only about half of older adults experiencing a mental illness receive mental health treatment, due in large part to antiquated and discriminatory health coverage requirements such as the 50 percent coinsurance rate under Medicare.
