Members with Anxiety, Depression Face Higher Out-of-Pocket Spending

Individuals with depression, anxiety, or both who are enrolled in large employer-sponsored health plans have higher out-of-pocket spending than individuals without such diagnoses, according to an issue brief from the Peterson-KFF Health System Tracker.

“These findings of higher health spending among privately insured individuals receiving treatment for depression and/or anxiety come at a time of rising health costs. Health insurance is already expensive for enrollees with private insurance, and treatment for mental health conditions can further escalate these costs,” the brief noted.

The researchers used large employer health plan claims from the 2021 MerativeMarketScan Commercial Database. Nine percent of adult, large employer-sponsored health plan enrollees had a depression or anxiety diagnosis or both.

Members with a generalized anxiety disorder (anxiety) diagnosis, a depression diagnosis, or both spent, on average, $1,501 per year in out-of-pocket costs. This was nearly double the $863 in average annual out-of-pocket healthcare spending that individuals without one of these diagnoses spent.

Moreover, total annual spending, including out-of-pocket healthcare costs, was 1.9 times higher for individuals with one of these diagnoses than those without one. Utilization was also twice as high for those diagnosed, who typically visited a provider’s office 7.4 times per year, while those without a diagnosis visited 3.2 times per year on average.

The most common service for individuals with anxiety or depression in 2021 was psychotherapy. On average, this service costs members approximately $348 in out-of-pocket healthcare spending, making it the most expensive outpatient service. The overall average annual cost was slightly more than $1,500 per enrollee.

Additionally, nearly three-quarters of individuals with depression, anxiety, or both had one or more prescriptions for antidepressants or anxiolytic medications. On average, enrollees paid $6 in out-of-pocket costs for a single month’s supply of antidepressants or anti-anxiety medication.

The researchers also investigated the prevalence and contributions of telehealth in 2021 out-of-pocket healthcare spending. Six out of ten psychotherapy visits occurred through telemedicine. Two-thirds of all psychiatric office visits also occurred via telemedicine as well as over half of all mental health office visits.

The average annual out-of-pocket healthcare spending rose based on the severity of a diagnosis.

Of the three categories of depression diagnoses—mild, moderate, and severe—individuals with severe diagnoses saw 40 percent higher out-of-pocket healthcare spending than those with mild diagnoses. Those in the severe category saw out-of-pocket spending trends that were 124 percent higher than those without a diagnosis.

Individuals with severe depression spent, on average, $17,546 in annual, overall healthcare spending. They also spent more on outpatient mental health than individuals with mild depression.

One area in which spending trends were similar between those with and without a relevant diagnosis was outpatient spending. For individuals with depression and/or anxiety, outpatient costs comprised 78 percent of out-of-pocket spending, compared to 75 percent for individuals without a diagnosis.

Enrollees with a relevant diagnosis paid, on average, 20 percent for outpatient mental healthcare costs and 13 percent of outpatient non-mental healthcare costs.

However, most outpatient care for individuals with depression, anxiety, or both was related to physical care, the researchers noted. Physical health and mental health are strongly linked, as claims data and payers’ efforts demonstrate.

The researchers noted one important limitation of this issue brief. Not all mental healthcare utilization can be covered under employer-sponsored health plans, but this brief’s data source only covers employer-sponsored claims. As a result, the brief probably underestimates the overall utilization and costs of mental and behavioral health.