Mentally ill too often carry burden of Medicare costs

For 30 percent of Medicare beneficiaries, premiums may soon rise from $104.90 to $159.30 per month, a 52 percent increase. The spike is the result of Medicare's “hold harmless” provision.

Since Medicare provides insurance for citizens aged 65 and over, most people’s Medicare premiums are simply deducted from their Social Security benefits. The "hold harmless" provision means that an individual will never see their Social Security benefits decline from the previous year as a result of an increase in Part B Medicare costs.

Since oil prices crashed and caused deflation this year, Social Security’s cost of living adjustment is $0. This means that the increase in premiums is shifted entirely onto people who do not have the premium deducted from their Social Security check, as any deduction would cause a decline in the Social Security benefits of those who do collect checks.

There are three groups of people who generally fall into this category. The first is high-income individuals who don’t really need the protection. The second is low-income individuals who are dual eligible for Medicare and Medicaid; this does not directly affect the insured citizen, as the state Medicaid budget would pay the increased premium. The third group includes individuals over the age of 65 who delayed Social Security Benefits and are still working; these are often citizens who need to continue working because they did not have the savings necessary to retire comfortably.

Shifting the cost of increased Medicare premiums onto people who still have to work hits one group particularly hard: the mentally ill. Private health insurance is often incredibly expensive, and since mental health issues often arise in a person’s early twenties, the condition will often be classified as preexisting. A spike in Medicare insurance premiums could cause a person to forgo Medicare entirely, meaning they lose prescription insurance as well as medical care insurance.

Seeing a psychologist can be wildly expensive when co-pays become weekly necessities. Psychiatric medication can also be expensive because relatively little information exists about mental health treatment, and companies claim research and development of such treatment is extremely expensive. Without medical care, a person could lose their job due to an episode or difficulties related to losing mental health care; they could end up in the uncomfortable retirement they were working to avoid.

While the “hold harmless” provision is important to prevent Medicare from hurting people’s Social Security benefits, it is encouraging to see Secretary of Health and Human Services Sylvia Burwell say that she is exploring policy options to make sure this increase in premiums does not hurt working people of retirement age. However, more steps need to be taken to make sure that the mentally ill population is adequately cared for, and cost control remains in place to allow them to live comfortably despite mental illness.