Understanding Medicare’s Mental Health Benefits

Original Medicare offers mental health benefits to beneficiaries needing mental health services. Here is a quick overview of those benefits:

Outpatient Services

Medicare Part B will pay 80% (once the Part B deductible is met) for outpatient counseling services. The remaining 20% would be the co-insurance paid by the patient (or a MediGap plan, if the patient has a supplemental plan).

Medicare allows its beneficiaries the option of getting treatment through a variety of mental health professionals such as psychiatrists, psychologists, clinical social workers and clinical nurse specialists.  Most of our clients prefer to find a provider who accepts Medicare and takes assignment. If a provider doesn’t accept assignment then Medicare will not pay for the services or reimburse a beneficiary for amounts paid to non-participating providers. The Licensed Clinical Social Workers at Mindful Transitions are all certified Medicare providers and take assignment.

Mental Health Screenings

In addition to psychotherapy, Medicare covers yearly depression screenings that must be done in a primary care doctor’s office or primary care clinic. This can help with appropriate diagnosis, treatment and follow-up. There is no cost for this screening. If your doctor hasn’t talked to you about your mental health, you can always request a screening.

Inpatient Psychiatric Services

The benefits for inpatient psychiatric services are paid by Medicare the same way that general hospital services are paid. There is a $1,340 deductible for each benefit period, $0 coinsurance for the first 60 days, and $335 co-insurance for days 61-90. Medicare pays for 80% of all mental health services provided while the patient is in the hospital. Medicare limits the number of psychiatric hospital stays to 190 days per lifetime; after those days are used up, the patient must pay for inpatient psychiatric care privately.  

Partial Hospitalizations 

Partial hospitalization programs (PHPs) are structured programs provided as an alternative to inpatient psychiatric care. They are more intense than traditional therapy, are provided during the day, and  do not require an overnight stay. Medicare helps cover partial hospitalization services when they’re provided through a hospital outpatient department or community mental health center (assuming that the doctor and the partial hospitalization program accept assignment). 

Medications

Medicare usually covers medications used to treat mental health conditions under the Part D prescription drug benefit. The Part D formularies may limit which medications are covered and should be checked. Each Part D plan creates its own list of approved and covered drugs. The open enrollment period is a great time to review your plans’ formulary and to possibly switch to a new plan.

Medicare Advantage Plans

Medicare Advantage Plans also offer mental health services, but there are limits to their services. They have a narrow network of providers.  Each plan has to be explored individually to learn what they will provide.

Finding Providers

To locate a provider in your area that accepts Medicare assignment, use Medicare’s online tool at medicare.gov/physiciancompare. Type in your zip code, or city and state, then type in the type of profession you want locate, like “psychiatry” or “clinical social worker” in the “specialty” box.

The Licensed Clinical Social Workers at Mindful Transitions are Medicare providers and take assignment. In addition to providing psychotherapy, we also provide comprehensive clinical social work services to each of our clients, ensuring that they are connected to important services in the community and that their care is coordinated between all providers. Taking this holistic perspective that incorporates the whole system is important for the well-being and optimal functioning for each of our clients. We provide psychotherapy and so much more!

There’s No Way He’d Talk to a Therapist

Your dad’s assisted living community just recommended psychotherapy for your dad. His wife died 5 weeks ago.  He now rarely comes out of his apartment. When you visit, you have noticed that his clothes are getting looser, his demeanor gruffer, and his desire to sleep stronger. Once a jovial, outgoing guy, he is now grumpy and difficult to approach.

He does seem depressed.

When the nurse suggested a therapist you immediately scoffed. “Sure, he’s depressed. Who wouldn’t be?”  His move to the assisted living was hard. He only agreed because your mom needed so much care. He realized he couldn’t do it any more at home. Now, he also needs a lot of care; and losing mom was really difficult.  It’s been a tough transition.

But he’d never talk to a therapist.

“Therapy is great–I even have my own therapist I’ve been seeing for years. But my dad would never see a therapist.”  Many older adults, especially men, have spent decades keeping their feeling closed off. Vulnerability is akin to weakness, they think. Or talking about problems doesn’t make anything better

He might talk to us.

You’d be surprised by how many individuals are willing to talk to a therapist. When we engage our clients with a kind, genuine, open manner that expresses compassion and acceptance, they feel their suffering acknowledged, their pain validated.  And in that is healing and a powerful therapeutic relationship.  Many clients, whose families thought they would never talk to us, have agreed to meet with us and have effectively connected with our clinicians.  

The Clinical Social Workers at Mindful Transitions work exclusively with older adults, most of whom live in independent living or assisted living communities.  We are experienced in working with clients that have never been in therapy before, and we approach each client with gentleness and acceptance.  If you think your loved one would never see a therapist, give us a call anyways. You might be pleasantly surprised.

To learn more about the social work services at Mindful Transitions, please contact us at inquiry@23.21.76.49 or (678) 637-7166.