The Impact Of Medicare's Mental Health Cost-Sharing Parity On Use Of Mental Health Care Services

Health Aff (Millwood). 2020 May;39(5):819-827. doi: 10.1377/hlthaff.2019.01008.


Before the implementation of cost-sharing parity in Medicare, beneficiaries faced higher cost sharing for mental health services than for other medical services. The Medicare Improvements for Patients and Providers Act of 2008 phased in cost-sharing reductions in Medicare for outpatient mental health services in the period 2010-14. Using data for 2006-15 from the Medical Expenditure Panel Survey and difference-in-differences analyses, we assessed whether this reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. We compared people with Medicare and with private insurance before and after parity implementation. Medicare beneficiaries' use of psychotropic medication increased after the implementation of cost-sharing parity, but we did not detect a change in visits. Changes in the use of psychotropic medications were greater among people with probable serious mental illness and among Medicare beneficiaries who did not report having supplemental coverage. The increased medication use could signal improvements in mental health care access among Medicare beneficiaries, especially among the subgroups most likely to benefit from the policy change.

Keywords: Behavioral health care; Cost sharing; Depression; Health conditions; Health policy; Medical Expenditure Panel Survey; Medicare; Medicare savings programs; Pharmaceuticals; mental health.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cost Sharing
  • Female
  • Humans
  • Medicare
  • Mental Health Services*
  • Mental Health*
  • Parity
  • Pregnancy
  • United States