Does Medicare Cover Mental Health Care?
Medicare Coverage for Mental Health
Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance), includes certain coverage for mental health care when the care comes from a Medicare-assigned health-care provider. Medicare Part A covers hospital inpatient mental health care, including room, meals, nursing, and other related services and supplies. This care can be received in a general hospital or a psychiatric hospital.
Medicare has a lifetime limit of 190 days of inpatient care in a psychiatric hospital. Medicare uses benefit periods for hospital coverage. A benefit period begins the day the patient is admitted as a hospital inpatient and ends when 60 days in a row have passed since you have received inpatient care.
Medicare Part A
Medicare Part A costs for mental health care are listed below. Please note that the deductible and coinsurance amounts may vary year to year.
- The Medicare Part A deductible – $1,408 in 2020 (the full deductible amount is applied for each benefit period)
- No coinsurance ($0) for days 1-60
- $352 coinsurance per day in 2020 for days 61-90
- $704 coinsurance in 2020 per “lifetime reserve day” after the 90th day. Lifetime reserve days are days that you remain an inpatient beyond the 90-day hospital stay that Medicare covers. Medicare pays for your covered costs, charging you a daily coinsurance amount, for up to 60 of these days in your lifetime.
- All costs after lifetime reserve days are used up
In addition to Medicare Part A costs, a patient may have some costs associated with Medicare Part B even when they are a hospital inpatient (for example, doctor services).
Medicare Part B
Medicare Part B covers mental health services usually given outside a hospital, including visits with health professionals such as doctors, clinical psychologists, and clinical social workers. Some of the other mental health services that Medicare Part B may cover include, but aren’t limited to:
- Annual depression screenings
- Psychiatric evaluation
- Certain diagnostic tests your provider orders
- Partial hospitalization (a structured program of outpatient psychiatric services as an alternative to inpatient mental health care)
- Individual and group psychotherapy by licensed professionals permitted by the state where therapy takes place
- Medication management
- Family counseling as part of your treatment
Medicare Part B costs for mental health care are listed below. Please note that the deductible and coinsurance amounts may vary year to year. The annual depression screenings are free from a Medicare-assigned health-care provider. For other mental health services:
- The Medicare Part B deductible – $198 in 2020
- 20% of the Medicare-approved amount of health-care provider services
- A possible additional copayment or coinsurance if services received as a hospital outpatient. The paid amount depends on the service provided but is generally 20% of the Medicare-approved amount.
For a mental health service provider, understanding insurance coverage is really important especially Medicare coverage. Keeping track of government and private insurance coverage could be difficult as coverage varies each year along with deductible and co-insurance. For accurate medical billing and maximum reimbursement taking assistance from E2E Medical Billing Services could be a great idea. Mental health billing is our expertise and our clean claim and reimbursement percentage are very high. To know more about our mental health medical billing services you can call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com