by David Sayen
Mental health problems like depression and anxiety can affect anyone at any age. If you think you have a mental health condition, Medicare may be able to help.
Mental-health symptoms include feelings of sadness, emptiness, or hopelessness; a lack of energy; and difficulty concentrating or sleeping. You may lose interest in activities you used to enjoy, or have thoughts of ending your life. If you have any of these symptoms, talk to your doctor or other health care provider.
Medicare’s coverage of mental health includes outpatient and inpatient treatment, as well as prescription drugs. If you get your Medicare benefits through a Medicare Advantage health plan, check your plan’s membership materials.
If you have Original Medicare, Part A covers inpatient care and Part B covers outpatient care. Part D covers medications. Part A helps pay for mental health services given in a hospital that require you to be admitted as an inpatient. These services can be provided in a general hospital or a psychiatric hospital that cares exclusively for people with mental health conditions.
How much do you pay? Medicare measures your use of hospital services in benefit periods. A benefit period begins the day you go into a hospital and ends after you’ve had no hospital care for 60 days in a row. If you go into a hospital again after 60 days, a new benefit period begins, and you must pay a new inpatient hospital deductible.
There’s no limit to the number of benefit periods you can have in a general hospital. You also can have multiple benefit periods in a psychiatric hospital, but a lifetime limit of 190 days applies to inpatient psychiatric care. For each benefit period, you pay a $1,156 deductible (in 2012) and no coinsurance for days 1–60. For days 61–90, your cost would be $289 per day.
Medicare Part B helps cover services by doctors and other providers if you’re a hospital inpatient. You pay 20% of the Medicare-approved amount for such services. Part B also helps pay for outpatient visits to psychiatrists; clinical psychologists and social workers; and other professionals. (Make sure your provider accepts Medicare before you schedule an appointment.)
Outpatient services are covered by Part B, too. These include psychiatric evaluation; medication management; and individual and group psychotherapy with doctors or certain other licensed professionals.
For outpatient care, you must pay the Part B deductible ($140 this year). After that, how much you pay depends on whether the purpose of your visit is to diagnose your condition or to get treatment.
When you visit a doctor or other professional diagnostician, you pay 20% of the Medicare-approved amount.
For outpatient treatment such as psychotherapy, you pay 40% of the Medicare-approved amount in 2012. Many Medicare Advantage plans cover prescription drugs. If you have Original Medicare, you can join a Part D drug plan.
Medicare drug plans aren’t required to cover all drugs. However, they must cover all or almost all anti-depressant, anticonvulsant, and antipsychotic medications.
David Sayen is Medicare’s regional administrator for California. For more information, call
1-800-MEDICARE (1-800-633-4227).