Health Care Spending, Use, and Financial Hardship Among Traditional Medicare and Medicare Advantage Enrollees With Mental Health Symptoms

Objective:We examined the differences in health care spending and utiliza-tion, and financial hardship between Traditional Medicare (TM) and MedicareAdvantage (MA) enrollees with mental health symptoms.Design:Cross-sec-tional study.Participants:We identified Medicare beneficiaries with mentalhealth symptoms using the Patient Health Questionnaire-2 and the Kessler-6Psychological Distress Scale in the 2015-2021 Medical Expenditure Panel Sur-vey.Measurements:Outcomes included health care spending and utilization(both general and mental health services), and financial hardship. The primaryindependent variable was MA enrollment.Results:MA enrollees with mentalhealth symptoms were 2.3 percentage points (95% CI: -3.4, -1.2; relative differ-ence: 16.1%) less likely to have specialty mental health visits than TM enrolleeswith mental health symptoms. There were no significant differences in totalhealth care spending, but annual out-of-pocket spending was $292 (95% CI:152-432; 18.2%) higher among MA enrollees with mental health symptomsthan TM enrollees with mental health symptoms. Additionally, MA enrolleeswith mental health symptoms were 5.0 (95% CI: 2.9-7.2; 22.3%) and 2.5 per-centage points (95% CI: 0.8-4.2; 20.9%) more likely to have difficulty payingmedical bills over time and to experience high financial burden than TM enrollees with mental health symptoms.Conclusion:Our findings suggest thatMA enrollees with mental health symptoms were more likely to experience lim-ited access to mental health services and high financial hardship compared toTM enrollees with mental health symptoms. There is a need to develop policiesaimed at improving access to mental health services while reducing financialburden for MA enrollees.(Am J Geriatr Psychiatry 2024; 32:739-750)