Illinois bill could make mental health care more affordable
The Illinois General Assembly is considering a bill to increase reimbursement rates for mental health care providers, which supporters say would mean more affordable patient care.
The big picture: Private insurance companies reimburse physical health care providers 22% more on average than mental and behavioral health care providers, leading many of those providers not to accept insurance, according to RTI International. This forces patients to pay out of pocket or find a new provider.
By the numbers: About one-third of practicing psychologists don't take insurance, according to the American Psychological Association.
On the patient side, users went out-of-network 3.5 times more often for mental health and substance use needs than physical health needs, according to RTI.
How it works: The bill would direct commercial insurance companies to reimburse providers amounts equal to or greater than 141% of the Medicare rate for mental health or substance use disorder care.
Zoom in: " We have not received raises that honor inflation in 26 years," a Chicago therapist in private practice tells Axios.
Axios agreed to grant anonymity to the therapist because their contract with the insurance companies forbids discussing rates.
"Blue Cross Blue Shield (BCBSIL) reimbursement rates have increased $12.50 since 1999 and some years, our rates decrease," the therapist says.
For example, if the therapist charges $185 a session, the reimbursement could be about $130 or less but depends on the rates set by insurance companies, they tell Axios.
What they're saying: "I have to see six to seven people a day to make my bills. We are all burning out and I can't tell my clients I'm going out of network. No one could afford me, and my rates aren't even competitive. I'd lose everybody."
The other side: " BCBSIL is committed to expanding access to quality, cost-effective physical and behavioral health care across Illinois. We don't comment on proposed legislation," spokesperson Dave Van de Walle tells Axios.
"We have increased reimbursement for professional, inpatient, and outpatient behavioral health care providers consistent with multiple factors, including, among other things, Medicare reimbursement increases."
Zoom out: State Rep. Lindsey LaPointe (D from the Northwest Side), the bill's sponsor, tells Axios that she's heard from colleagues on both sides of the aisle about the necessity of accessible and affordable mental health care and she's optimistic about it passing.
What's next: Lawmakers are scheduled to discuss the bill Thursday at the House Mental Health and Addiction Committee.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Forbes
16 hours ago
- Forbes
Time For Medicare Advantage Leaders—Including Me—To Eat Our Own Cooking
Dr. Oz just turned 65 and became a Medicare beneficiary. Everyone who operates a Medicare plan ... More should be required to be one as well. In every industry, the best leaders live the experience of the customer. Car executives drive their own vehicles. Airline leaders occasionally fly coach. Restauranteurs eat from their own kitchen. But in healthcare—and specifically in Medicare Advantage (MA), which now serves more than 30 million Americans—the leaders designing these plans rarely, if ever, use them themselves. This disconnect breeds an empathy gap between decision-makers and the seniors whose lives and well-being depend on these products. It's time to close that gap. As Dr. Mehmet Oz turns 65 and qualifies for Medicare, he is in a unique position to lead the charge in fixing this blind spot. But I'm not letting myself off the hook either. As a current CEO of company that sells Medicare Advantage plans, I am proposing a standard that would apply to me and every other leader in this space: if you run a Medicare Advantage plan—or sit on its executive team that runs these plans—you should be required to enroll in that plan. No carve-outs. No executive-only exemptions. No platinum side-door coverage. For those of us under 65, the proposal would also require a structural change: expanding Medicare eligibility to allow MA plan executives early, voluntary enrollment in their own plans. We should not be allowed to claim ignorance or detachment simply because of our age. I want to be clear: if such an early-enrollment window existed, I would enroll myself. I should have to live under the same benefit design, customer service, and network constraints as every other member. Leaders like me—and my peers across the industry—must eat our own cooking.A Modest But Necessary Reform The proposal is simple but powerful: 1. All managed care CEOs and executive teams must enroll in their own MA plan. 2. Congress and CMS should create a new category of Medicare eligibility that allows executives under 65 to voluntarily enroll in their own MA plans in a 'test user' capacity. This is the only way for leadership to truly understand the member experience. 3. No waivers, no special coverage allowances. The goal is to force leadership to live the true plan reality: the prior authorizations, the formularies, the network restrictions, the call centers, the appeals It Matters—for Me, and for the Industry I don't make this proposal lightly—because it would apply to me, too. If this became law or industry standard tomorrow, I would sign up. And I believe most honest leaders would welcome the clarity and accountability it would bring. Here's why it matters:- Operational Truth: You only truly understand the friction points—customer service delays, billing errors, prescription denials—if you live them yourself.- Accountability: Plan leaders would no longer tolerate broken systems they themselves have to endure.- Culture Change: A company where the C-suite shares the same risks and frustrations as members cannot help but become more consumer-focused.- Public Trust: Medicare Advantage is under increasing scrutiny from policymakers and the public. This move would send a clear, ethical signal: we stand behind what we sell.- Policy Innovation: The best ideas for simplifying prior authorization, improving networks, and reducing out-of-pocket costs would come not from distant consultants—but from firsthand More 'Not For Me' Products Too much of healthcare is designed by people who never have to use it. Too many decisions are made in corporate conference rooms far removed from the lived experience of real patients. If Medicare Advantage is the future of healthcare for seniors—as so many believe—its architects must also live that future. That includes Dr. Oz. That includes every MA CEO. And that includes me. It's time for all of us to eat our own cooking.
Yahoo
a day ago
- Yahoo
The cost of staying alive could become a lot more expensive for millions of Americans because of Trump drug tariffs
Americans would likely pay more for necessary everyday prescription drugs, such as insulin, painkillers, chemotherapy, or antibiotics, if President Donald Trump were to enact tariffs on pharmaceuticals, experts warn. In an effort to incentivize drug manufacturers to bring production back to the United States, Trump has proposed tariffing pharmaceuticals made overseas – which account for an overwhelming majority of everyday medicine used in the U.S. 'We're going to be doing that,' Trump said of pharmaceutical tariffs in April. 'That's going to be like we have on cars. You know we have a 25 percent tariff on cars, we have a 25 percent tariff on steel and aluminum, and that's what the [pharmaceutical] category fits right now.' 'The higher the tariff, the faster they come,' Trump said. But experts say that's not necessarily true and there would be tangible consequences to such action, from higher brand-name drug prices to generic drug shortages. 'If tariffs were applied to prescription drugs, one of the most immediate consequences could be price increases — on prices that we already pay way in excess of other countries,' Dr. Mariana Socal, an associate professor at the Johns Hopkins Bloomberg School of Public Health, said. The U.S. imports a majority of its branded prescription drugs – or medications that are patented with a brand name such as Viagra, Wegovy, or Zoloft – from high-income countries. Dr. Jeromie Ballreich, an associated research professor at Johns Hopkins Bloomberg School of Public Health, said much of the manufacturing comes from Ireland, Germany, and Switzerland because they have favorable tax policies for companies. As a result, adding a tariff would only make it more expensive for pharmacies and insurance companies to keep them in supply. 'We would expect pharma to pass the costs onto the insurers and we would expect insurers to pass the cost onto the individual patients,' Ballreich said. 'So, if there is a 50 percent tariff on your insulin product because it's coming from Ireland, patients in Mississippi who get insulin – they will either be faced with a higher cost when they go up to the pharmacy to fill their insulin or they're going to face a higher indirect cost because the premiums of the insurance plan are going to go up,' he said. Ballreich said a tariff on countries that produce high quantities of branded drugs would put 'pressure' on public insurers like Medicare or Medicaid and private insurers. However, branded drugs only account for roughly 10 to 15 percent of prescriptions. A majority of Americans, up to 90 percent, use generic drugs, often manufactured in India and China, because they're cheaper. Making branded drugs less accessible through tariffs would only increase reliance on generic drugs, which could exacerbate shortages that already impact millions of Americans. '[Shortages] can have very significant implications in day-to-day clinical practice,' Socal said. 'For example, if you are administering chemotherapy for an oncology patient, that may have significant consequences even for the prognosis of that case moving forward.' In 2024, the U.S. experienced a shortage of more than 300 drugs – 70 percent of which were generic prescriptions. Socal said that when patients are not able to access a more affordable version of their prescription, it means they may put their health at risk by skipping a dosage, taking a lower dosage, or not filling their prescription at all. Otherwise, they're forced to turn to the more expensive branded version. 'Those more expensive drugs are not always the best,' Socal said. 'Very frequently, and we saw this with chemotherapy shortages, the available drugs are second-line drugs.' The president has indicated that any negative impact from tariffs may be temporary and worth it to bring manufacturing and jobs back. 'We're doing it because we want to make our own drugs,' Trump said. But Ballreich and Socal are more skeptical. 'Tariffs are a very blunt instrument to incentivize domestic U.S. manufacturing of the branded drugs we use,' Ballreich said. Given pharmaceutical companies have moved outside of the U.S. for tax purposes, Ballreich says tax policy may be a better way to incentivize them, especially since many of those drugs are more difficult to manufacture. 'It's not just a very simple chemical plant; these tend to be very complex,' he said. Socal suggested a better strategy would be to understand where drugs are being manufactured and which ones would make more sense to bring to the U.S. — since even those manufactured locally often rely on certain imported ingredients and materials. 'Having tariffs on pharmaceutical products coming from abroad can actually also hurt our domestic manufacturers,' he says. While the president has not officially implemented any tariff policy on pharmaceuticals yet, he said, in April, that the plan would take effect in the 'not too distant future.'
Yahoo
a day ago
- Yahoo
Ask Kerry: Readers weigh in on Medicare and more
My recent columns drew thousands of questions and comments, largely centered on rising medical debt and Medicare as well as retirement confusion on Social Security and health savings accounts, known as HSAs. The following is an edited sample of those 6,000-plus comments—good and bad!—and my take on them. As always, if you have a personal finance question, you click here to drop me a note. I'll try and answer in a future column. By subscribing, you are agreeing to Yahoo's Terms and Privacy Policy Here we go. Let's start with someone who wasn't too happy with me: While well intentioned, I was disappointed in your article. You neglected to mention that Medigap policies will cover all or most of what Medicare does not. Also: people you mention could likely be eligible for Medicare Savings Plans that will lower beneficiary costs. A Qualified Medicare Beneficiary or QMB is the most generous plan and covers all copayments and deductibles, the Part B premium, and also provides the extra help you noted. Kerry: Guilty. Regular Medicare does not come with built-in caps on a variety of out-of-pocket costs, so you don't want to be enrolled in it if you don't also have supplemental protection. The bills that lead to medical debt typically include routine healthcare services such as lab fees and diagnostic tests, dental care, and visits to the doctor, and long-term care services not covered by Medicare, according to KFF. And Medicare typically requires patients to pay out of pocket around 20% of their doctor bills. Many retirees can't. Now let's talk about Medigap health insurance. Not everyone has this coverage. These policies are sold by private insurance companies and, as you noted, pay part or all of some leftover costs, such as outstanding deductibles, coinsurance, and co-payments, and may also cover healthcare costs that Medicare does not cover at all like most medical care received when traveling out of the US. In most states, however, the guaranteed right to buy a Medigap is limited to the time when you first sign up for Medicare Part B. That's because Medicare does not permit Medigap plans from rejecting you or charging a higher premium because of a preexisting condition during that period. In most states, your premium, however, will vary depending on factors such as your age, gender, and where you live. The Medigap guarantee policy is also good if you joined an Advantage plan during your first year of Medicare but disenrolled within a year and switched to traditional Medicare. After that, though, Medigap plans in most states can flat-out reject you if you have a preexisting condition, such as diabetes. The exceptions are New York, Connecticut, Maine, and Massachusetts. There is help out there as I noted if you have a limited income, you might be eligible for Medicare's Extra Help, which covers Part D premiums and deductibles and caps drug costs. Free one-on-one counseling is available through state Health Insurance Assistance Programs (SHIP). The Medicare Rights Center offers a free consumer helpline: 800-333-4114. You can also contact Medicare directly at 800-633-4227. QMB, that you mentioned, is a Medicaid program that helps low-income Medicare beneficiaries pay for their Medicare costs, such as premiums, deductibles, and copayments. It's a secondary insurance, meaning it pays for Medicare cost-sharing after Medicare has paid its share. I'm 60 and super worried about future long-term care costs. What might these add up to? Kerry: One factor that plays into the rising healthcare debt for older adults is that traditional Medicare and Medicare Advantage do not cover the cost of long-term care in nursing homes and assisted-living facilities. An apartment in an assisted-living facility had an average rate of $74,148 a year in 2024, according to the National Investment Center for Seniors Housing & Care — and costs go up as residents age and need more care. Units for dementia patients can run more than $94,000. About 80% of those ages 65 and over will require some long-term care, with nearly 20% requiring high-intensity care for more than three years, Anqi Chen, co-author of a brief from the Center for Retirement Research at Boston College, told me Can one use the HSA contributions to pay for Medicare Part B & D costs or any other insurance plans they may have (Advantage, MediGap etc)? Kerry: Yes, you can tap your health savings account to pay for Medicare premiums and other qualified medical expenses, including those covered by Medicare Parts A, B, C (Medicare Advantage), and D (prescription drug coverage). But it's a hard no on using HSA funds to pay for Medicare Supplement (Medigap) plan premiums. Learn more: What is a health savings account (HSA)? My husband and I are retired, in our 70s and living in Mexico. My husband has a HSA he set up through his work probably 15 years ago. Can he use it for medical and similar expenses outside the US? Can we continue to contribute to the existing HSA? Kerry: Yes, you can use your HSA to cover medical costs when you live outside the country as long as the expenses are qualified medical expenses under US law. You, however, might be docked a 1%-3% transaction fee if you are accessing your account with a credit card. As for amping your account up, for now, you can't contribute more money to an HSA at your age. Contributions are kaput once you are eligible for Medicare, typically starting on the first of the month you turn 65. A current bill before the Senate right now might tweak this eligibility if it becomes law. I am about to retire and am planning to live in Canada. If I work and receive a salary of about 50K in Canada, am I bound by the Social Security Income limitations Receipt work limitation? Kerry: This is one to take up with a Social Security officer directly. In general, if you live and work in another country, your Social Security income limits usually remain the same as if you were working in the US. Here's how it works: The earnings test applies only to people who are collecting Social Security between age 62 (the earliest age of eligibility) and their full retirement age, which is between 66 and 67, depending on the year you were born. On the face of it, you're allowed to claim Social Security retirement benefits while working, and the withheld benefits are not lost. Social Security recalculates monthly benefits when you reach full retirement age to credit back the withheld benefits. In general, the way the earnings test works is if you're between age 62 and your full retirement age and earn over $23,400 (the limit is adjusted annually) and collecting Social Security, the administration will withhold $1 for every $2 over that limit. For people hitting their full retirement age in 2025, the annual exempt amount is $62,160. This higher exempt amount applies only to earnings made in months prior to the month you hit your retirement age. The good news is that the earnings test goes away at full retirement age. But nothing is simple here. There is another method called the foreign work test. With this method, your income could impact your current benefit. If you are receiving Social Security benefits and are younger than full retirement age, SSA will withhold your benefits for each month you work more than 45 hours outside the United States and you are not subject to US Social Security taxes. It does not matter how much you earned or how many hours you worked each day. Check out How Work Affects Your Benefits (Publication No. 05-10069). I'm 69 years old and plan to work until at least 72 or 73. My Social Security Income (SSI) benefits will be the bulk of my income upon retirement, and I am currently $40,000 in debt with a repayment plan that will eliminate all or most of the debt before I retire. The caveat is that I will need to claim my SSI benefits to support this payment plan. I turn 70 in September 2025 and would like to know when I can apply for my Social Security Income benefits to maintain the 8% increase until I reach 70 years old. Is it on my birthday in September, or do I need to wait until October 1st? Kerry: To receive the maximum 8% increase in your Social Security benefit, you should apply for your benefits the month before your 70th birthday. This will ensure your benefits start the month of your 70th birthday, and you receive the full 8% increase for each year you delayed taking benefits after your full retirement age. It typically takes at least a month, or 30 days, to receive your first Social Security check after your application is processed. It could be 45 days in some cases. The precise timing of your check delivery relies on processing times at the Social Security Administration. Read more: When will I get my social security check? During a recent operations meeting in April at SSA, an official from the agency reported that the field offices 'are struggling right now to keep pace with the timeliness this year.' The fact that they are aware of this is a good thing, and, if they take action, the SSA will have this under control by the time you apply for your benefit. In general, I recommend applying up to four months before you want to start receiving benefits. Kerry Hannon is a Senior Columnist at Yahoo Finance. She is a career and retirement strategist and the author of 14 books, including the forthcoming "Retirement Bites: A Gen X Guide to Securing Your Financial Future," "In Control at 50+: How to Succeed in the New World of Work" and "Never Too Old to Get Rich." Follow her on Bluesky. Sign up for the Mind Your Money newsletter Sign in to access your portfolio
