ArticleJournal of general internal medicine2026
Mental Health Service use and Expenditures among Medicare Beneficiaries with Depression, Diabetes and Heart Disease after Cost-sharing Parity.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDepression is common among Medicare beneficiaries with chronic diseases yet only a fraction receive depression treatment. Cost is a key barrier.
interventionThe Medicare Improvements for Patients and Providers Act of 2008 reduced cost-sharing for outpatient mental health services from 50% to 20%, creating parity with equivalent medical care in 2014.
objectiveWe assessed outpatient mental health service use and out-of-pocket expenditures after parity among beneficiaries with depression and comorbid diabetes and/or heart disease. MAIN MEASURES: Measures included mean outpatient mental health service use, proportion of beneficiaries with any use, intensity of use (i.e., mean use among users), and out-of-pocket expenditures.
designWe used an interrupted time series design and estimated linear and two-part regression models using weighted Medical Expenditure Panel Survey data from 2008-2019.
participantsThe analytic sample included 2,701 Medicare beneficiaries aged ≥ 65 years with depression and comorbid diabetes and/or heart disease, which corresponded to a nationally representative sample of 33,466,007 beneficiaries. KEY
resultsMean use increased significantly after parity from 0.19 visits annually (95% CI: 0.06, 0.31) among beneficiaries with depression and diabetes to 0.80 visits annually (95% CI: 0.69, 0.92) among beneficiaries with depression, diabetes and heart disease. The latter group also experienced the largest increase in intensity of use after parity of 0.91 visits annually (95% CI: 0.16, 1.66). Out-of-pocket expenditures didn't increase significantly.
conclusionsParity was associated with increasing outpatient mental health service use among Medicare beneficiaries with depression and comorbid diabetes and/or heart disease without increasing patient costs. Beneficiaries with multiple comorbidities exhibited greater sensitivity to price reductions and cost-sharing equivalence for medical and mental health care. Policymakers should consider how beneficiaries experience barriers to mental health care differently and at different steps in the care continuum and collaborate with providers to implement complementary policies and clinical practices that effectively address them.
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