Medicare and Mental Health

According to the World Health Organization, an estimated 20 % of adults above the age of 60 will suffer from a mental disorder. 6.6% of all disabilities among those over 60 years are directly attributable to mental and neurological disorders. Substance abuse is also a problem within this age group, yet it does not receive […]

According to the World Health Organization, an estimated 20 % of adults above the age of 60 will suffer from a mental disorder. 6.6% of all disabilities among those over 60 years are directly attributable to mental and neurological disorders. Substance abuse is also a problem within this age group, yet it does not receive the attention it requires. Additionally, there will be cases of misdiagnosis of the problem.
What may concern you is that the mental disorders may not be part of the normal aging that we all go through. The patients will suffer from symptoms such as depression, dementia, or anxiety, for which they will not seek help. It may be due to ignorance of the fact that it is manageable. It may simply be a desire not to seek medical help for a condition that they may feel is embarrassing. The stigma surrounding mental health conditions also makes it very difficult for people to seek medical advice.

Some of the patients may also worry that they will not be able to afford the costs of treatment. It is, therefore, fantastic to note that if the patient does decide to seek medical assistance, Medicare will cover such costs. Where they may be gaps, the patient has the option of supplement insurance policies to absorb some of the costs.

Understanding The Scope Of Medicare With Regards To Mental Health

Medicare became a lifesaver for seniors since its inception in 1965. Currently, we have over 50 million Americans enjoying the benefits of Medicare, with a significant proportion being those who have retired from active employment. Healthcare is costly, and many Americans are not able to afford health care. The situation becomes even more difficult if we are talking about people who have retired and do not have a steady source of income. Fortunately, Medicare covers mental health, which is an ongoing concern for many people.

Understanding The Scope Of Medicare

Medicare has several parts that you need to be aware of. These include:

Mental Health: Inpatient Coverage Part A

If you have to be in a hospital for inpatient care, Medicare Part A will cover the costs. You may also need skilled nursing care, blood transfusion, hospice benefits, among others. Medicare will cover 190 days of inpatient mental health care in a facility. You must, however, note that the 190 days is within your lifetime. If you need additional days, beyond the 190, in a psychiatric or General Hospital facility, Medicare will still cover that cost.

After the 190 days, you will begin a new benefit period, which will continue until your doctor discharges you from the hospital. If you complete 60 days outside of the hospital, then the period automatically resets.

You must, however, note that Medicare will only cover the cost of your stay, but no amenities. If you require certain things like private nursing, television, telephone, a private room, personal items, among others, you will have to pay for them yourself. If your doctor, however, recommends that you need them, then Medicaid will take care of that cost.

What Liability Must You Undertake For Part A Coverage?

Every time the benefit period resets, you will have to pay the deductible. As of 2018, the cost was $1340. You may pay a bit more if you have to spend more time in the hospital. If, for example, you exceed 60 days, your co-pay is $ 335. From day 61-90, you will co-pay $335 every day. After 90 days, you will have to pay $670 per day. During this time, you will be entering your lifetime reserve days. The reserve days refer to any days you will spend in the hospital after your 90 days are up. Now here is the tricky part, during your lifetime, you only get 60 reserve days.

To make it more digestible, here is a breakdown of the costs in summary form. The figures are based on 2018 amounts, and will vary year-to-year:

  • $1,340 Part A deductible for each benefit period.
  • $0 coinsurance for the first 1-60 days
  • $335 coinsurance for days 61-90
  • $670 coinsurance for days 91-beyond.
    *the rates are what you will pay per day

The more you stay in the hospital, the more you pay. If you reach 150 days, you will have to absorb all the costs you incur due to your inpatient hospital stay. It is, however, not very common for most patients to reach these number of days.

Mental Health Outpatient: Part B Coverage

Part B gives you coverage when you are no longer in inpatient care. You may, however, require services such as lab work, visits with a doctor, diagnostics, x-rays, preventive care, imaging, among others. It also takes care of transportation costs, whether ground or on-air, as well as chemotherapy, medical equipment, nursing, among others. You must, however, ensure that you receive treatment from a facility that accepts Medicare.

Medicare And Depression

Part B coverage is essential for the diagnosis and treatment of depression. It will take care of the costs associated with consultation, screening, and diagnosis of depression or any other mental health conditions. You can visit your preferred healthcare specialist, including clinical psychologists, psychiatrists, or social workers.

You also have flexibility with regards to therapy options, including group and individual counseling. The coverage will also take care of family counseling if that is what your therapist recommends.

Medicare and Substance Abuse

Substance abuse such as alcohol and drug abuse may lead to some mental health disorders. Medicare will take care of costs associated with alcohol misuse screening, where there is a determination that you are not dependent upon alcohol.

Where the doctor feels that you will benefit from drug therapy, you can get coverage, but under Part D. We will look at that in more detail below.

Partial Hospitalization Program

There are some situations when your doctor may recommend that you get treatment in a more structured psychiatric program but on an outpatient basis. The formal program is known as the partial hospitalization program and is suitable for patients who may require supervision or a more specific type of treatment. The doctor will recommend it if he feels that sessions at his office may not be sufficient. In the same breath, the doctor will also determine that your case is not severe enough to require admission into a hospital for intensive treatment.

Treatment may occur at a hospital or a mental health facility, depending on what your therapist recommends. At the end of the session, you get to go home, and so you do not get transportation or meals from the facility. For Medicare coverage, your doctor will have to certify that you do indeed need this kind of treatment. You will then receive up to 80% coverage by Medicare under part B.

If, on the other hand, the doctor diagnoses alcohol abuse, and you require counseling sessions, Medicare will take care of the cost, but only up to four sessions. You also incur no charge for screening as it is part of the coverage.

Cost-Sharing Under Part B Medicare Coverage

There are many questions surrounding the cost implications of Medicare. Some people are under the mistaken assumption that it is free. Others know there is a cost, but they are not quite sure how much.
There are individual costs you will incur under the Part B Medicare coverage. You have an annual deductible, and you must also take care of 20% of the expenses you incur from outpatient treatment. You may spend a lot of money out of pocket because there is no maximum limit to what you can end up paying.
You may need to plan for a way to cover some of the gaps with regards to what Medicare can pay for. Some individuals will, therefore, opt for supplemental insurance coverage or the Medicare Advantage plan under Part C.

It is essential to note that the amount you will pay will vary from year to year. As of 2018 some of the costs you will have to take care of include:

  • $183 for the Medicare Plan B deductible
  • 20% of Medicare-approved health care provider services
  • Coinsurance or copayment, depending on whether you received your treatment as an outpatient. The rate could vary between 20%-40% of the cost of the service you receive.

Mental Health Coverage Part D: Retail Drugs

Before the Year 2006, Medicare did not have coverage for prescription drugs. However, it set up the Medicare health coverage, a voluntary service that will cover the cost of prescriptions.

When we say the coverage is voluntary, it means that if you have an alternative, you may not need it. The alternative could be from your employer’s insurance plan or VA. Part D coverage has, however, given very many people respite from the cost of buying drugs. The reality is that very few people have inbuilt coverage for such expenses. The range of coverage for prescription drugs for mental health is quite comprehensive. It will cover medicines that fall under the categories of anticonvulsants, antidepressants, and antipsychotics.

The Process Of Enrolling In Part D Medicare Coverage

You must find an insurance company in your home state that offers Plan D drug plans. You may not have a challenge accessing, such because there are quite several options available in every state. Your drug plan must, however, meet specific minimum requirements. You also have the option of changing your existing drug coverage from October 15 to December 7, during the Medicare annual election period. If you want to know the best plan for you, you should check out the Medicare website for more information or consult a qualified Medicare Insurance Agent.

What Else Does Medicare Cover Under Mental Health Care?

As we have mentioned above, there are certain situations when you may need to pay out of pocket with no cap on the limit. It can get very costly, and that is why you may need to get some insurance coverage. Medicare and Medigap insurance policies are supplementary plans that you can consider. They will help take care of some of the cost-sharing aspects when seeking mental health treatment. With the supplementary covers, once Medicare approves your claim, they will pay your share, while Medicare will take care of its part.

Most States have ten standardized Medigap policies to choose from. The Medigap Plan F seems to be the most popular option. It takes care of any gaps that you will find in Medicare Parts A and B. However, there are plans to do away with Plan F by 2020. It could, therefore, explain why Plan G is becoming more popular.

You can use the supplements at any health facility that accepts Medicare. Some psychiatrists do not, however, accept Medicare, and you must check with yours before you start treatment.

Part C Or Medicare Advantage

Part C or Medicare Advantage is another way of paying for treatment where there are gaps with regards to what Medicare will cover. Plan C is a private Healthcare policy which will take care of the bills instead of Medicare. To benefit from the policy, Your Healthcare provider must, therefore, be in that specific network. Most of the Medicare Advantage plans will also cover prescription drugs.

Medicare has been instrumental in ensuring that beneficiaries receive treatment for mental health conditions. It provides coverage for a wide range of services, including diagnosis, treatment, and any programs the patient may need to undertake for a full recovery. The patient also has access to both inpatient and outpatient care.

Contact Us Today

We understand that there are certain benefits with regard to Medicare coverage. You, however, have the option for Medicare supplement or Medicare advantage to help cover some of the costs associated with getting medical treatment. You may, however, need someone to guide you through the process of finding the right one for you. Contact us today for free assistance; someone on our team is always at hand to help you.

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