Q. I hear that Medicare will now cover mental health services, much like it covers care for medical and surgical conditions. Do you know anything about this?
A. Yes. Beginning January 1, 2014, Medicare began reimbursing the cost of outpatient mental health treatment services on a par with other Part B medical services.
Previously, Medicare beneficiaries who received mental health services faced a higher co-pay and were initially required to pay up to 50% of the approved amount for health services, whereas they only paid 20 % for most other outpatient medical services. Congress and many advocacy organizations found this practice to be discriminatory.
To address this disparity, in July, 2008, Congress enacted the “Medicare Improvements For Patients and Providers Act” (“Act”). Under the Act, Congress charged the Centers for Medicare and Medicaid Services (CMS) with the task of implementing a phase-out of this disparity over a five-year period from 2010 to 2014. That phase out has now fully matured. As a result, effective January 1, 2014, Medicare will pay the same 80% of the Medicare approved rate for all covered mental health services, just like it does for medical and surgical services. By the way, if you have a Medicare supplemental policy, it may cover the additional 20% just as it does for the more traditional medical services.
The following are some of the mental health services that Medicare will now cover at 80% of the Medicare approved rate:
Visits to a psychologist or other professional counselor;
Family therapy, so long as the focus of therapy is on the Medicare recipient;
Substance abuse treatment;
Occupational therapy that is part of mental health treatment;
Prescription medicine that cannot be self administered;
Art, dance and music therapy if deemed necessary to prevent hospitalization.
Medicare will pay for services only if they are provided by a mental health professional who accepts Medicare assignment, so be sure to check with your health professional before you receive services.
Medicare also covers inpatient care in a general or psychiatric hospital. However, unlike with non-mental health services, Medicare puts a cap on coverage for inpatient psychiatric care and will only pay for up to 190 days of inpatient psychiatric hospital services in a lifetime.
Note: If you have a Medicare Advantage Plan, coverage rules may be different so check with your plan before receiving services. Also, if you need help paying the 20% co-pay for these and other Medicare covered services, there are Medicare programs that may help.
For more information on covered mental health services, visit www.Medicare.gov and download Medicare’s new guide entitled “Medicare And Your Mental Health Benefits“, or call 1-800-633-4227 and ask for a copy. For help with paying the Medicare co-pays, visit www.Medicare.gov and select “Get Help Paying Costs” under “Your Medicare Costs”, or call the 800 number just given.