Medicare and Mental Health Treatment
While mental illness is just as much an illness as any other, today Medicare covers treatment for mental health issues differently than treatment for "physical" illness. These differences confuse many beneficiaries and their families. In some cases, this confusion can keep seniors needing mental health treatment from getting the help they need.
Initially, when the program first began, Medicare did not cover mental illness treatment at all. When coverage was expanded several years ago, program designers were concerned that providing full mental health coverage would obligate Medicare to pay for long-term institutional treatment of the chronically mentally ill. As this kind of broad coverage was simply unaffordable, mental health coverage was designed with certain caps to prevent costs from overrunning the system.
Today, we better understand that mental and physical illness often are intertwined. Treatment of one requires treatment of the other. With this understanding in mind, Medicare is slowly loosening some of the coverage caps on mental illness treatment.
This is how Medicare covers mental health treatment today:
Medicare covers all patients in a general hospital the same under Part A. Once the benefit period deductible has been satisfied, in-patient hospitalization in a general hospital is covered, whatever the diagnosis. Although there are "benefit period" limits, there is no lifetime limit on the number of hospital days a beneficiary may use.
Likewise, Medicare covers an inpatient stay in a psychiatric hospital under Part A. However, psychiatric hospitalization is restricted to a lifetime limit of 190 days. A psychiatric hospital is defined as an inpatient medical facility accepting patients only for psychiatric care.
Some mental health patients are referred to an outpatient day program for treatment. Medicare will cover this kind of treatment under some circumstances. Check with the prospective provider before enrolling a loved one in a partial hospitalization program.
Medicare covers outpatient mental health treatment in the same way it covers other outpatient medical services for the following:
Brief office visits for diagnosis, and to prescribe and monitor prescribed medications is covered at 80%, just as other medical outpatient charges are covered. Most Medicare supplement policies will cover the patient's 20% share.
Today psychotherapy is limited to 50% reimbursement by the "outpatient mental health limit." Psychotherapy services include individual therapy, family therapy directed toward helping the patient managea mental illness, group psychotherapy for the identified patient, therapeutic activities, and patient education.
Depending on the plan, a Medicare supplemental insurance policy will often cover the other 50%.
Beginning in 2010, the amount that Medicare covers for these services will increase gradually over a 5 year period. At the end of five years, mental health outpatient services are scheduled to be covered at 80%, just like all other outpatient medical services.
In 2010 and 2011 the patient's share of costs for outpatient psychiatric care will decrease to 45%
In 1012 the patient's share will be 40%
In 2013 the patient's share will be 35%
In 2014 and later the patient's share will be 20%
There does not appear to be any plan to increase the 190 day lifetime limit for psychiatric hospital inpatient care.
Who can charge Medicare for mental health services?
Medicare will cover services provided by physicians, psychologists, social workers licensed for independent clinical practice, psychiatric nurse specialists, and nurse practitioners with the equivalent of a master's degree in psychotherapy.
Mental Health Drugs
Medicare covers drugs prescribed for the treatment of mental illness the same as any other drug through the many independent Part D plans. Benzodiazepines ("tranquilizers") are excluded from coverage for all Medicare beneficiaries because of concerns about their safety when used by the elderly.
For more information: While we find the Medicare booklets to be rather vague and general, you can read what they have to say about mental health coverage in their booklet, "Medicare and Your Mental Health Benefits." Go to the Medicare website at http://www.medicare.gov and enter either the name of the booklet or ID number 10184.