Medicare Advantage And Commercial Prices For Mental Health Services
Abstract
In 2014, insurers paid an average of 13-14 percent less for in-network mental health services in their commercial and Medicare Advantage plans than fee-for-service Medicare paid for identical services-despite paying up to 12 percent more than Medicare when the same services were provided by other physician specialties. However, patients went out of network more frequently for mental health services than for comparison services, which increased their average cost-sharing payments.
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Third-party payers seldom pay appropriately for time-consuming ADHD services.
“Unfortunately, third-party payers seldom pay appropriately for these time-consuming services.5,6”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [5]
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Subcommittee on Attention-Deficit/Hyperactivity Disorder, S. C. O. Q. I. A. M. (2011) · Pediatrics · doi:10.1542/peds.2011-2654 · Cited by 2,185 · see citing works
Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., et al. (2019) · Pediatrics · doi:10.1542/peds.2019-2528 · Cited by 1,410 · see citing works
“Unfortunately, thirdparty payers seldom pay appropriately for these timeconsuming services.(5,6)”
- Authors
- Pelech, D., & Hayford, T.
- Affiliations
- Congressional Budget Office (US)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2019-02
- Volume
- 38
- Issue
- 2
- Pages
- 262-267
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- OpenAlex
- W2913513850
- Cited by
- 43
- References
- 0
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 8 · 2023: 6 · 2022: 5 · 2021: 7 · 2020: 6 · 2019: 6
- FWCI
- 7.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- Medicare Advantage, commercial health insurance, mental health services, cost sharing, fee-for-service Medicare, insurance premiums, mental health care costs, physician specialty comparison
- MeSH terms
- Commerce, Humans, Insurance Carriers, Mental Health Services, United States, Cost Sharing, Fee-for-Service Plans, Medicare Part C
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