How Medicare covers Mental Health Care – 2019?

UPDATED Jan. 13, 2019.  The Medicare Part B covers Medicare Mental Health Services on an outpatient basis when provided by a doctor, clinical psychologist, clinical social worker, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant in a doctor or other health care provider’s office. Medicare only covers visits when they are provided by a health care provider who accepts Medicare.
How Medicare covers Mental Health Care - 2019?

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US Government Sources

Medicare Mental Health Services – Benefits

Medicare Part B pays for the following outpatient mental health services:

  • One depression screening per year. The screening must be done in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals.
  • Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services.
  • Family counseling, if the main purpose is to help with your treatment.
  • Psychiatric evaluation.
  • Medication management.
  • Certain prescription drugs that aren’t usually “self-administered” (drugs you would normally take on your own), like some injections.
  • Diagnostic tests.
  • A one-time Welcome to Medicare visit. This visit includes a review of your possible risk factors for depression.
  • An Annual Wellness visit. Talk to your doctor or other health care provider about changes in your mental health. They can evaluate your changes year to year.

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Medicare Mental Health Services – Costs

Medicare Part A Costs:

  • $1,364 Deductible for each Benefit period .
  • Days 1–60: $0 Coinsurance per day of each benefit period.
  • Days 61–90: $341 coinsurance per day of each benefit period.
  • Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
  • Beyond Lifetime reserve days: all costs.

20% of the Medicare-approved amount for mental health services you get from doctors and other providers while you’re a hospital inpatient.

There’s no limit to the number of benefit periods you can have when you get mental health care in a general hospital. You can also have multiple benefit periods when you get care in a psychiatric hospital. Remember, there’s a lifetime limit of 190 days.

Medicare Part B Costs:

  • You pay nothing for your yearly depression screening if your doctor or health care provider accepts an assignment.
  • 20% of the Medicare-approved amount for visits to your doctor or other Health care provider to diagnose or treat your condition. The Part B Deductible applies.
  • If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional Copayment or Coinsurance amount to the hospital.

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Changes in How Medicare covers Mental Health Care

Historically, Medicare paid a smaller share for Mental Health Care than it did for Medical Services. For example, in 2008 Medicare paid just 50% of the Mental Health Care cost, and 65% in 2013.

On Jan. 1, 2014, the Mental Health Care coinsurance was finally brought in line with Medical Services. In both cases, the patient is responsible for 20 percent of the bill while Medicare will pay 80 percent. For Mental Health Care, as well as for Medical Services, Medicare starts payments after the annual Part B deductible ($185) is met.

This is obviously the good news, but many unresolved issues in How Medicare covers Mental Health Care remain.

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Unresolved issues in Mental Health Care for Seniors

Some issues related in still existing discrepancy between the ways Medicare treats Mental Health Care Services and Medical Services. For example, there is a 190-day lifetime limit on inpatient services in psychiatric hospitals. There is no similar cap on any other Medical Services provided by Medicare.

The even more serious issue is the very limited number of psychiatrists working with people having Medicare. Just over half of the psychiatrists (54.8 percent) accepted Medicare payments in 2010, and the number of psychiatrists willing to accept new patients covered by Medicare has declined by nearly 20 percent between 2005 and 2010. The major reason behind it is low Medicare reimbursement rates that do not often justify long time that providers need to spend with patients.

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US Government Sources

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