This week’s Medicare Answers addresses if a Supplement plan covers charges incurred for outpatient mental healthcare. If you have a Medicare question, email AskRoger@SeniorMarketSales.com.
I have a client that recently incurred charges for outpatient mental healthcare. I am under the impression that the client is going to have to pay 35 percent of what Medicare does not cover. Would the Supplement cover all of the cost if the individual has Plan F?
According to the Center for Medicare Advocacy, the Medicare Improvement Act of 2010 changed the way in which Medicare paid for mental health services on an outpatient basis. Prior to that, Medicare only paid 50 percent of outpatient healthcare. Medicare began to increase the percentage that it will cover for mental health services as follows: 55 percent of expenses incurred in 2010 or 2011; 60 percent in 2012; 65 percent in 2013; 80 percent (the amount reimbursed for other Part B claims) in 2014 or in any subsequent calendar year.
All plans pay the Part B co-insurance amount, which is 50 percent of the Medicare-approved amount for mental health services. Plans C and F offer coverage for the Part B deductible. Plans F and G offer coverage for the doctor’s charge up to 115 percent of the Medicare-approved amount.
Medicare covers yearly depression screenings, designed to be completed by a doctor or other primary care provider to ensure you receive the correct diagnosis, treatment and follow-up. For Medicare to cover the annual depression screening, the screening must take place in a primary care setting. It wouldn’t be covered if you are screened in an emergency room, skilled nursing facility or as a hospital inpatient.
If you have original Medicare, you will not have to pay a deductible or coinsurances for the annual depression screening as long as you see doctors who accept assignment, meaning that they accept Medicare's approved amount as payment in full. If you have a Medicare Advantage plan, you will not have to pay a deductible, copay or coinsurances as long as you see network doctors.
Medicare will pay 80 percent of its approved amount for your initial visit to a mental health professional to determine your diagnosis and for brief appointments to manage your medications.
The services Medicare covers include:
- Individual and group therapy
- Family counseling to help with your treatment
- Tests to make sure you are getting the right care
- Activity therapies, such as art, dance or music therapy
- Occupational therapy
- Training and education (such as training on how to inject a needed medication or education about your condition)
- Substance abuse treatment
- Laboratory tests
- Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you
You can get mental health services in an outpatient hospital program, a doctor’s or therapist’s office or a clinic. Medicare will help pay for outpatient mental health services you receive from:
- general practitioners
- nurse practitioners
- physicians’ assistants
- clinical psychologists
- clinical social workers
- clinical nurse specialists
If you see non-medical doctors (such as psychologists or clinical social workers), make sure that these providers are Medicare-certified and take assignment. Medicare will only pay for the services of non-medical doctors if they accept Medicare and take participating providers.
Medicare will pay for the services of medical doctors (such as psychiatrists) who do not take Medicare assignment, but these doctors can charge you up to 15 percent above Medicare's approved amount in addition to the Medicare coinsurance.
Inpatient Mental Health Care: Part A covers inpatient mental health care services. These services can be given in hospitals, including specialized psychiatric units, or in specialized psychiatric hospitals. Medicare helps pay for inpatient mental health services in the same way it pays for all other inpatient hospital care.
Note: If you’re in a specialty psychiatric hospital, Medicare only helps pay for a total of 190 days of inpatient care during your lifetime.