How Medicare covers Mental Health Care?

The Part B of Medicare covers 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.

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 ($147) is met.

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

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 are low Medicare reimbursement rates that do not justify often long time providers need to spend with patients.

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