Medicare is a federal insurance program that serves: 1) adults who are 65 years and older, 2) young people with specific disabilities, and 3) people diagnosed with end-stage renal disease, which is permanent kidney failure (Medicare.gov, 2014).
Medicare can be understood in four parts:
Part A, known as hospital insurance, covers inpatient hospital stays and care in a nursing home, hospice, or sometimes in the home (Medicare.gov, 2014).
Part B, medical insurance, covers outpatient care, doctors' appointments, and medical supplies (Medicare.gov, 2014).
Part C is a Medicare Advantage Plan through a private insurance company that contractually provides Medicare Parts A and B benefits. It also includes Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, Medicare Medical Savings Account Plans, and, in most instances, will also provide prescription drug coverage (Medicare.gov, 2014). It is important to note that this is NOT original Medicare.
Part D provides prescription drug coverage under original Medicare, and to some Medicare Cost Plans, Medicare Fee-for-Service Plans, and Medicare Medical Savings Account Plans. As previously mentioned, the latter three plans are available through private insurance companies that have been approved by Medicare (Medicare.gov, 2014).
Now, let's take a few steps back and revisit Parts A and B...
Medicare Part A, hospital insurance, provides coverage for persons who must be admitted for mental health services in inpatient care at either a general or psychiatric hospital. If a person is admitted to a psychiatric hospital, Medicare will only cover up to 190 days of care in that setting during one's lifetime (Medicare.gov, 2014). While everyone who has Medicare is eligible to receive such services, the co-pays may add up. For example, under original Medicare, if a person is admitted for inpatient services, there is a $1,216 deductible per benefit period (Medicare.gov, 2014). A benefit period begins on the day of hospital admittance and ends 60 days after treatment has completed.
Here is the breakdown:
- Days 1-60, $0 copay per day of benefit period
- Days 61-90, $304 copay per day of benefit period
- Days 91-?, $608 copay per lifetime reserve day of benefit period
Lifetime Reserve Days are additional days that Medicare covers if you remain in the hospital longer than 90 days. Each person has 60 in their lifetime. During these days, Medicare will pay all costs EXCEPT copay.
Medicare Part B, medical insurance, covers outpatient mental health services. This means that visits with psychiatrists, clinical psychologists, clinical social workers, counselors, and other medical service specialists are covered. Actually, it means they are covered ONLY IF the helping professional accepts Medicare.
Here is a breakdown of the costs:
- $0 for a yearly depression screening if the helping professional accepts Medicare
- 20% of the Medicare-approved amount for visits to these helping professionals...but don't forget that deductible!
- 20-40% of the Medicare-approved amount in additional copayment if you treatment is in a hospital outpatient clinic or department
A little background on Medicare...
As of January 1, 2014, Medicare began covering 80% of the cost for therapy and mental health services, as part of the Medicare Improvements for Patients and Providers Act of 2008 (Medicare Improvements for Patients and Providers Act, 2008). Medicare has slowly increased the amount of coverage they provided for therapy services. In 2008, Medicare provided 50% coverage. In 2012, Medicare provided 65% coverage (Graham, 2013). Of course, there is still a deductible, but there's improvement!
Where are those accepted practitioners???
Unfortunately, despite the increases in mental health care coverage by Medicare, there are still very few practitioners accepted by Medicare to provide services for those with original Medicare or other offered Advantage plans. Actually, psychiatrists are much less likely to accept any insurance as compared to other specialist health practitioners (Pear, 2013). Medicare's expansion in coverage is certainly worth celebrating; however, the financial roadblock that hindered older adults' access to mental health care services is one in a series.
http://kalw.org/post/medicare-boosting-coverage-mental-health-issues
References
Graham, J. (2013 Dec 27). Medicare to cover more mental health costs. The New York Times. Retrieved from http://newoldage.blogs.nytimes.com/2013/12/27/medicare-to-cover-more-mental-health-costs/?_php=true&_type=blogs&_r=0
Medicare.gov. 2014. Retrieved from www.medicare.gov.
Medicare Improvements for Patients and Providers Act of 2008. (2008). Retrieved from http://www.gpo.gov/fdsys/pkg/PLAW-110publ275/pdf/PLAW-110publ275.pdf
Pear, R. (2013 Dec 11). Fewer psychiatrists seen taking health insurance. The New York Times. Retrieved from http://www.nytimes.com/2013/12/12/us/politics/psychiatrists-less-likely-to-accept-insurance-study-finds.html
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