America is aging rapidly, and concerns for health care, and particularly mental health care, are at the forefront of many seniors’ minds.
In today’s world, people are very lucky to have a national health insurance program like Medicare to provide them benefits after they retire. Before Congress enacted Medicare less than 60 years ago, senior citizens had little or no coverage. Often the cost of the medical needs fell on their children and families.
With the advent of Medicare in 1965, everything changed. Not only did Medicare provide inpatient hospital benefits, but for a premium of just $3/month back then, they could purchase outpatient medical insurance that would cover a majority of their needs for physician care.
Mental health care is included in these benefits too, and that’s very important. The Centers for Disease Control and Prevention has reported that an estimated 20% of people age 55 and over experience some type of mental health concern. This may include depression, anxiety, and schizophrenia, according to the American Psychological Association.
Medicare breaks benefits down into different parts. Let’s take a look at how mental health care is covered under the various parts of Medicare.
Inpatient Hospital Benefits: Part A
Part A of Medicare provides inpatient hospital stays, skilled nursing, blood transfusions and hospice benefits. This includes up to 190 days in an inpatient mental health care facility in your lifetime. Should you exhaust those benefits, it’s still possible that Medicare Part A may pay for mental healthcare delivered in a general hospital.
Your cost-sharing for hospital benefits under Part A is measured by Medicare in benefit periods. When you are admitted to the hospital, a benefit period begins. It continues until you leave the hospital and remain outside the hospital for 60 days or more.
You will pay a Part A deductible for each benefit period. In 2018, this deductible is $1340. Should you remain in the hospital for a long period of time, your cost-sharing increases. After 60 days, you’ll pay a daily copay of $335 per day. After 90 consecutive days, that daily copay increases to $670 per day, at which time your enter your lifetime reserve days.
If your stay reaches 150 consecutive days, you’ll pay for all costs related to your Part A inpatient hospital stay. Keep in mind that a stay of this many consecutive days is rare. If you enter the hospital and leave it for 60 days or more, a new benefit period begins and your benefits will start over.
Outpatient Medical Benefits: Part B
Part B of Medicare provides coverage for outpatient medical services. This includes doctor visits, lab work, diagnostic imaging, preventive care, x-rays, ambulance rides, durable medical equipment, chemotherapy, radiation, dialysis and more.
In the mental health care category, Part B provides for an annual depression screening by your primary care doctor. If diagnosed with depression or another mental health disorder, Part B will cover visits with a clinical psychologist or psychiatrist or even just a social worker. You can receive your therapy in an individual setting or a group setting. Family counseling is also sometimes approved as part of your treatment plan.
Part B benefits are particularly important when it comes to diagnosing and treating depression. Older adults with depression visit their doctor more often, take more medications and have more frequent emergency room benefits. Webmd.com reported that some older adults are chronically lonely and may visit their physician to feel socially connected.
In some cases, your physician may decide that you need a more structured psychiatric program on an outpatient basis. Medicare Part B allows for your physician to certify your need for this kind of treatment so that it will be covered 80% by Medicare.
Your cost-sharing under Part B includes an annual deductible ($183 in 2018) and then you pay the other 20% of your outpatient medical costs. There is no cap on your spending, so most people choose to enroll in either Medicare supplemental coverage or a Medicare Advantage plan to fill in the gaps.
Retail Drug Coverage: Part D
The newest part of Medicare was rolled out in 2006, and that’s the Medicare Part D drug coverage program. While Medicare has covered medications delivered in a clinical setting since the beginning, it’s only recently that Medicare beneficiaries finally gained coverage for their retail outpatient medications.
The Part D program is voluntary. Some individuals may not need it if they have drug coverage already such as through an employer insurance plan or through the VA. Since most people do not have this coverage, Part D was a welcome change to the Medicare program.
You enroll in a drug plan through an insurance company who offers Part D plans in your state. There are usually a dozen or more Part D drug plans to choose from in each state every year. However, all Part D drug plans have minimum requirements. They must cover most antidepressants and antipsychotics used in the treatment of mental health disorders.
Each drug plan has its own formulary, so you can check to make sure your important medications are included in the plan formulary before you enroll. Should you add a new medication mid-year and find that it is not covered, your doctor can help you file an exception request with the insurance company to add the drug to your covered medications list for that year.
During the Annual Election Period, which occurs each year in the fall between October 15th – December 7th, you can make changes to your drug coverage. The Medicare.gov website offers a handy Plan Finder Tool which you can use to see which drug plan will have the most cost-effective coverage for you in the upcoming year.
All in all, these 3 parts of Medicare provide adequate benefits for treating mental healthcare in retirement. Combined with the right supplemental coverage, you will have little out-of-pocket for your care.
Danielle Kunkle is the co-founder of Boomer Benefits, an agency that helps baby boomers navigate their entry into Medicare.