What is the Medicare-Approved Amount for Mental Health Services?

What is the Medicare-Approved Amount for Mental Health Services?

Why is Senior Mental Health Important?

Seniors often struggle to distinguish between normal aging-related changes and symptoms of mental health issues. Feelings of sadness or anxiety might be mistakenly accepted as a natural aspect of growing older, particularly in the face of health challenges or the loss of close ones. This can make it difficult to recognize when these emotions may actually indicate underlying mental health concerns. Seniors who are afflicted by mental health challenges often wonder: What is the Medicare-approved amount for mental health services?

The decline in physical health and the complexity of managing various health conditions can increase the likelihood of older adults experiencing mental health issues such as depression or anxiety. It’s important to remember that your mental health is a critical part of your overall well-being. Medicare acknowledges this and offers comprehensive coverage for a range of mental health services. This includes various forms of therapy, counseling, and even inpatient hospital care when necessary, providing a broad spectrum of resources to support and maintain your mental health.

Most Medicare beneficiaries understand the importance of establishing and sustaining positive mental health, but are unclear on what Medicare covers and how to access their benefits. Did you know that approximately one in four people on Medicare have a mental health condition, yet only 40% to 50% receive treatment? If you want to learn more about what is the Medicare approved amount for mental health services, what specifically it covers, and how to access your benefits, contact a My Senior Health Plan specialist and we can guide you through the complexities.

What Mental Health Services are Provided by Original Medicare?

Medicare Part A Mental Health Coverage

Medicare offers coverage for mental health care, encompassing both inpatient services under Part A and outpatient mental health care under Part B, which includes consultations and sessions with mental health professionals.

  • Medicare Part A includes coverage for mental health care during inpatient hospital admissions, applicable in both psychiatric and general hospitals. The financial terms for these stays mirror those of typical inpatient hospitalizations.

In 2024, the costs you’ll incur under Part A for inpatient mental health care include:

  • A deductible of $1,632 for each benefit period.
  • No coinsurance charges for the first 60 days.
  • Daily coinsurance of $408 for days 61-90.
  • Beyond 90 days, a coinsurance of $816 per day for each of your lifetime reserve days, up to a maximum of 60 days over your lifetime.

The benefit period starts upon your admission as an inpatient and concludes after 60 days without hospital or skilled nursing care. Notably, Medicare has a specific limitation for psychiatric hospital stays: a lifetime coverage cap of 190 days. Days in general hospitals for mental health care don’t count towards this 190-day limit.

Medicare Part B Mental Health Coverage

Medicare Part B encompasses non-hospital outpatient mental health services, such as those in a doctor’s office, outpatient hospital section, or community center. Important points to remember, Medicare Part B mental health coverage extends and is subject to:

  • Sessions with psychiatrists, psychologists, clinical social workers, nurse specialists, and more.
  • From January 1, 2024, licensed family therapists and mental health counselors, including addiction specialists, will also be eligible for Medicare reimbursement.
  • After meeting the $240 Part B deductible in 2024, beneficiaries pay 20% of the approved amount for these services.

Medicare Part B provides an annual depression screening at no cost if performed by a primary care provider who accepts Medicare’s approved amount. For more intensive treatment, Medicare covers partial hospitalization, which is suitable for those needing significant outpatient care but not overnight hospital stays. From January 1, 2024, Medicare will also support intensive outpatient programs for patients requiring 9-20 hours of treatment weekly, without the need for inpatient care certification by a doctor.

Medicare Part B also provides coverage for therapy services. This includes individual and group psychotherapy conducted by licensed professionals authorized by the state. Additional mental health services covered by Medicare Part B encompass an annual depression screening at no charge, various diagnostic tests, family counseling related to your treatment, management of medications, and psychiatric evaluations.

Where can you find Medicare Mental Health Providers?

Finding a mental health professional, particularly a psychiatrist, who accepts Medicare can be challenging with only about 60% accepting new Medicare patients as of 2022, compared to a higher acceptance rate among general physicians. To locate a psychiatrist or physician who takes Medicare, you can use the Medicare physician compare tool online. The expansion of telehealth services, especially during the COVID-19 pandemic, has improved access to mental health care and is expected to enhance availability further into 2024.

What about Mental Health Prescription Medications?

Medicare does provide coverage for mental health medications through either a separate Medicare Part D policy or via a Medicare Advantage plan. These plans detail all their covered drugs in formularies, including a required coverage of most anticonvulsant, antidepressant, and antipsychotic medications. The Medicare Plan Finder tool on the My Senior Health Plan website homepage is a useful resource to compare the costs of your medications across different Part D and Medicare Advantage plans, particularly useful during annual enrollment periods for plan selection or changes.

Medicare Supplemental Plans to Close the Potential Payment Gap

Purchasing a Medigap policy can assist in covering deductibles, copayments, or coinsurance costs under Medicare. Alternatively, Medicare Advantage plans, which include coverage for Part A and B services and often Part D, may have different out-of-pocket expenses. For example, these plans might charge a per-day copayment for initial hospital stays instead of a traditional deductible. Typically, these plans have networks that encompass mental health professionals. Starting in 2024, Medicare plans to introduce Outpatient Behavioral Health as a new coverage category, potentially including therapists and counselors.

How the My Senior Health Plan Team Can Help

Struggling to understand what is the Medicare-Approved amount for mental health services? The My Senior Health Plan Medicare advisory team are experts at navigating the complexities of Medicare coverage and stand ready to assist you to determine your mental health benefit eligibility and benefits. Contact us today for assistance!

Pete Blasi