Does Medicare Cover Mental Health?

Mental health is one of most important facets of our overall health that is far too often ignored. Over the last few years, it has been cast into the limelight with the suicides of Anthony Bourdain and Kate Spade that forced the general public to have some uncomfortable conversations. Unfortunately, it can be expensive for sufferers of mental health issues to get necessary help if they lack coverage. If you’re a senior in need of mental health care, Medicare can help you find answers.

For the purposes of this post, we’ll be speaking about Original Medicare. If a beneficiary has a Medicare Advantage plan, they are likely to receive the same benefits through their plan and possibly additional benefits. Each plan is different, so beneficiaries should check their individual plan for specifics. Similarly, a Medicare Part D plan is necessary to cover any medications they may be prescribed as part of their mental health treatment.

Inpatient Mental Health Service Covered by Medicare

Inpatient mental health services are covered by Medicare Part A. This is applicable to services rendered in a psychiatric hospital or for mental health care given at a general hospital. The one coverage difference between a general hospital and a psychiatric hospital is that Medicare will only cover 190 days of inpatient care in psychiatric hospital throughout a beneficiary’s lifetime. Once these 190 days are used up, they will be responsible for the full costs at a psychiatric hospital.

While they are at an inpatient facility, most services will be covered by Medicare in some way. The big things that Medicare does not cover at all are private duty nursing, a private phone or television in their room, personal items (toothpaste, socks, razors), or, usually, a private room. In some cases, Medicare will cover a private room. If a private room is considered medically-necessary for the beneficiary’s condition, Medicare will cover it.

What Costs Will You Cover for Inpatient Care?

Medicare treats mental health like any other health issue. Under Medicare Part A, a beneficiary’s payments will be based around a benefit period schedule. For inpatient care, they will have a standard Part A deductible each benefit period. On top of that, they will have a coinsurance for each day of the benefit period that you’re at the inpatient facility. The costs and payment schedule are similar to standard inpatient costs.

For the first 60 days (days 1-60), there’s no coinsurance owed. The next 30 days (days 61-90) will cost $335 per day for the coinsurance. After day 90, the beneficiary will fall into the lifetime reserve days, which cost $670 per day. Once the 60 lifetime reserve days are up, they will cover the full costs covered by their coinsurance.

Outpatient Mental Health Services Covered by Medicare

Medicare Part B covers many outpatient mental health services, making it affordable to get beneficiaries the help they need. The services must be provided by a doctor or psychiatrist; a clinical psychologist, social worker, or nurse specialist; a nurse practitioner; or a physician assistant, and they must accept assignment from Medicare. These services can be given at qualifying outpatient facilities like a health care provider’s office, a hospital outpatient department, or a community mental health center.

The mental health care services covered by Part B are fairly wide ranging. A beneficiary’s Welcome to Medicare and annual Wellness visits both screen for mental health concerns, as does an annual depression screening that they are entitled to. Outpatient alcohol or drug abuse treatments are included in coverage. Medicare will also cover diagnostic tests or psychiatric evaluations, individual or group psychotherapy, or even family counseling. This is only a few of the outpatient services covered by Medicare Part B, though.

What Costs Will You Cover for Outpatient Care?

The Welcome to Medicare visit, Annual Wellness visit, and annual depression screening are all fully covered by Medicare (as long as the health care provider accepts assignment). Other costs are similar to anything else covered by Medicare Part B. They will be expected to pay for 20 percent of the Medicare-approved amount for their visit, up to their Part B deductible.

Beneficiaries should be aware that depending on where they get their outpatient treatment, they may have additional costs. Some hospital outpatient departments or clinics may require a copayment or coinsurance along with the standard Part B deductible and cost.

Mental health is important to a beneficiary’s overall quality of life, and it goes way beyond depression. Globally, 15 percent of adults aged 60 and over suffer from some form of mental disorder which can include hoarding, dementia, addiction, or even eating disorders. That wide range of threats need to be met with a wide range of solutions. Medicare coverage can help make these solutions affordable and available when beneficiaries need it most.

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