People of all ages can experience mental or behavioral health challenges.
Here’s what’s involved in getting treatment under Medicare. It may be easier
than you think.
The Importance of Mental Health Care
Many people believe they should just “power through” mental or behavioral
health problems. But those problems can get so chronic and severe that they
endanger our physical health
and hurt our performance
at work, at school, or in our family. So it’s not smart to ignore them.
Types of Mental Health Issues
Mental and behavioral health conditions include:
• Anxiety
• Depression
• Eating disorders
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Substance use disorders
Any of these can profoundly affect our quality of life and physical health.
Luckily, there are many treatments that can make a huge difference.
Types of Mental Health Treatment
Medicare covers mental and behavioral health treatments such as:
• Individual therapy
• Group therapy
• Family counseling
• Medication
Types of Mental Health Therapies Covered by Medicare
The
Affordable Care Act
requires Medicare to cover mental and behavioral health treatments.
Medicare has four parts
and covers services differently depending on where they’re received.
• Part A covers hospital stays, skilled nursing care, home health visits, and
hospice care.• Part B covers doctor visits, outpatient services, and other medical
expenses.(Parts A and B are known as “Original Medicare.”)
• Part C,
Medicare Advantage plans, are offered by private insurance companies and include Part A, Part B, and
sometimes Part D coverage along with many extras.• Part D plans, also offered by private insurance companies, cover
prescription drug costs.
Another type of Medicare coverage is a
Medicare Supplement plan, designed to help pay for costs not covered by Original Medicare.
Outpatient Mental Health Treatment
Health services received in a doctor’s office are covered by
Medicare Part B, including:
• Individual and group psychotherapy
• Psychiatric (medication) management of mental health conditions
• Substance use disorder treatment
After members meet their Part B deductible, they pay 20 percent of the
Medicare-approved amounts for outpatient treatment. Treatment in a hospital
outpatient clinic may require additional copays or coinsurance.
Many Medicare Advantage plans have a network of mental and behavioral health
providers. Those plan members may not have to pay a Part B deductible when
seeing in-network providers and will have the same copays that apply to
other in-network specialist visits.
Inpatient Mental Health Treatment
Sometimes, people are admitted to hospitals for mental and behavioral health
treatment, especially when they need detoxification or 24/7 supervision.
Then, their treatment is covered by
Medicare Part A.
Care is usually much more costly when it’s received in a hospital instead of
an outpatient setting. Usually, a deductible must be met over the first 60
days, followed by a copay of more than $400 per day of hospitalization
thereafter.
Medicare Advantage plans typically have different inpatient cost-sharing
structures, which vary by plan.
Intensive Outpatient Program
Intensive outpatient programs (IOPs)
offer a level of care between outpatient and inpatient treatment and are
covered by Medicare Part B. After members meet their Part B deductible, they
pay a fixed percentage of the Medicare-approved amount for services received
in these programs. They also pay coinsurance for each day of services
received in a hospital outpatient setting or community mental health center.
Medicare Advantage plans may have a different cost-sharing structure.
Partial Hospitalization Program
Partial hospitalization programs (PHPs)
provide structured outpatient psychiatric services totaling at least 20
hours of therapy per week. Patients get treated during the day and don’t
have to stay overnight. Medicare coverage for PHPs works just like it does
for IOPs.
Mental Health Home Services
Some individuals are unable to leave their homes for treatment.
Medicare members classified as “homebound”
may be 100 percent covered for treatment inside their homes.
Telehealth and Medicare Coverage for Mental Health
Telehealth is health care received via phone or video conference. It’s well
suited for mental and behavioral health treatment. Telehealth services are
covered under
Medicare Part B
and work like in-person health practitioner visits: After members’ Part B
deductible has been met, they pay 20 percent of the Medicare-approved fee
for those services.
Some Medicare Advantage plans have no Part B deductibles and don’t require
copays or coinsurance for telehealth visits.
How to Find a Medicare-Covered Therapist
People should work with mental or behavioral health providers they feel
comfortable with. Otherwise, their treatment may not succeed. Different
treatment modalities and strategies may be more or less effective for one
patient than another.
When trying to choose a treatment approach and provider, it helps to:
• Read online reviews
• Ask for referrals from a primary care provider (PCP)
• Get recommendations from a local mental health facility
Sometimes it’s necessary to try more than one provider to find the right
fit.
Independence Blue Cross (IBX) Medicare members can locate in-network
therapists using the
Find a Provider
tool.
The Role of Primary Care Physicians in Mental Health Care
Before looking for mental or behavioral health providers, Medicare members
should check in with their PCP, who can provide initial assessments,
prescribe medications, and coordinate specialists’ care. They can also make
recommendations based on a patient’s needs.
PCPs also help screen for mental and behavioral health problems during a
patient’s first “Welcome to Medicare” evaluation and at each annual wellness
visit. These visits are covered 100 percent by Medicare.
Mental Health Prescription Drug Coverage
Medicare Part D prescription drug plans cover psychiatric medications just
like other prescription drugs — according to the tier those drugs occupy in
the plan’s formulary.
Questions? Contact the IBX Member Health Team
Medicare members have access to treatment for mental and behavioral health
issues. Medicare covers these treatments differently depending on where
they’re received. Medicare Advantage plans have their own cost-sharing
structures for these services.
IBX Medicare plan members may contact the Member Help Team at the phone
number on the back of their member ID card with any questions about their
benefits or how to access care.
People interested in IBX Medicare Advantage or Medicare Supplement plans can
shop here.
This content was originally published on IBX Insights.
