Mental Health Care Coverage under Medicare
Health Care Coverage under Medicare
According to the World Health Organization, fifteen percent of Americans who are sixty years or older suffer from at least one mental health issue. The Centers for Disease Control and Prevention (CDC) say the most common mental health conditions in seniors are cognitive impairment from conditions such as Alzheimer’s, mood disorders, such as depression, and anxiety. Fortunately, Medicare recognizes the prevalence of mental disorders in the elderly and covers many mental health services. So let’s discuss medicare coverage for mental health care.
Outpatient Services for Mental Health Care
- Medicare Part B covers medically necessary outpatient services including many mental health outpatient services. Some mental health services Part B may cover are psychiatric evaluations, diagnostic tests, individual and/or group psychotherapy, and treatment for alcohol and or drug abuse. You can receive these services at your doctor’s office, an outpatient department at a hospital, or a mental health center.
- Part B covers mental health services and visits with these types of health professionals like Psychiatrists or other doctors; Clinical psychologists; Clinical social workers; Clinical nurse specialists; Nurse practitioners; Physician assistants.
- Part B offers a partial hospitalization program for those with mental health disorders that aren’t severe enough for inpatient admission but could use more structured care. The doctor and the hospital both must accept Medicare assignments for Medicare to cover them. For outpatient services like these, the Part B annual deductible is $185 as well as a twenty percent coinsurance. If the patient receives services at a hospital, they may owe a co-payment as well.
Preventive Care
Medicare Part B also has a preventive care benefit that includes mental health services. Some examples of preventive care that Part B offers are a yearly “Wellness” visit, a “Welcome to Medicare” visit, and a depression screening. The “Welcome to Medicare” visit and the annual “Wellness” visit include an assessment of risk for depression. Depression screenings are covered once per year and must be done at a primary care physician’s office.
Inpatient Services for Mental Health Care
- Seniors with more severe disorders such as schizophrenia or dementia may require hospitalization. Medicare will cover mental health care services in a regular hospital or a psychiatric hospital. When admitted to a hospital, Part A deductible of $1,364 will cover the first sixty days in the hospital. Days 61-150 will have a daily co-pay that starts at $341 and increases to $682. After 150 days, patients are responsible for all costs for Part A services.
- Once the patient been out of the hospital for at least sixty days, the benefit period ends. The Part A deductible is per benefit period. Therefore, if the patient starts multiple benefit periods in one year, they could end up paying the Part A deductible more than once. Although Part A will cover as many benefit periods as needed in a regular hospital, it will only cover up to 190 days in a person’s lifetime in a psychiatric hospital.
- Medicare Part A covers hospital stay, while Part B covers doctor services during stay. Therefore, the patient will have Part B cost-sharing amounts such as your deductible and coinsurance in addition to Part A cost-sharing amounts.
- To find out how many tests, items, or services will cost, the patient needs to talk to the doctor or health care provider. The specific amount may depend on several things, like another insurance patient may have; how much the doctor charges; whether the doctor accepts assignment; the type of facility; where the patient gets the test, item, or service.
- Doctors or other health care providers may recommend getting services more often than Medicare covers. On the other hand, they may recommend services that Medicare doesn’t cover. If this happens, the patient may have to pay some or all of the costs.
Proper understanding of Medicare coverage for mental health will increase your clean claim percentage as well as it will decrease denial percentage. You can contact patients in advance and give them an idea about covered and uncovered services and the cost associated with it. E2E Medical Billing Services is successfully providing mental health billing services for more than 05 years. To know more about our mental/behavioral health billing services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com