Medicare and Mental Health

Medicare pays for some mental health services. The following describes how and under what circumstances.

1. What and How Much Medicare Pays for Psycho-therapy

Medicare will pay 80 % for the initial mental health visit and only pay 50% of its approved amount for future visits. The same payment rate aplies to all approved mental health providers such as psychiatrists, psychologists and social workers.

Those individual therapists(such as psychiatrists, psychologists, and social workers) who take Medicare assignment agree to accept the Medicare-approved amount as payment in full for their services. Beneficiaries will have to pay a 50% co-insurance but no additional fees to the provider.

If the premiums are affordable a Medicare supplemental insurance policy(Medigap) will help. It will pay for the remaining 50% and most retiree coverage will also pay all or part of the 50% co-insurance.

2. Which Therapists Can Take Payment From Medicare.

Medicare will help to pay for outpatient mental health services from:

  • Clinical psychologists
  • Clinical nurses
  • Clinical social workers
  • General practitioners(medical doctors)
  • Nurse practitioners
  • Physicial assistants
  • Psychiatrists

Medicare will only pay for the services of those therapists if they are Medicare certified and take assignment(they must accept Medicare's approved amount as payment in full). Medicare will pay for the services of medical doctors who do not take Medicare assignment but they can charge up to 15% above Medicare's approved amount, depending on State law.

3. Which Outpatient Mental Health Services Medicare Covers

They include:

  • Individual and group therapy
  • Family counseling
  • Activity therapies
  • Occupational therapy
  • Training and education
  • Sustance abuse treatment
  • Laboratory tests
  • Prescription medications which the beneficiary cannot self-administer

4. Where Outpatient Mental Health Services Can Take Place

Medicare will pay for mental health serivces in an outpatient hospital, a doctor's or therapist's office, or a clinic so long as they are Medicare certified. These services can al;so take place in the home of a beneficiary.

5. How Medicare Pays for In-Patient Mental Health Services

Medicare pays for in-patient services in either a psychiatric or a general hospital.

Under Medicare Part A for each benefit period(in 2005) the beneficiary pays:

  • A one time deductible of $ 912 for days 1 to 60.
  • A daily co-insurance of $ 228 for days 61- 90.
  • A daily co-insurance of $ 456 after the 90 days of hospital coverage in a benefit period have been used

-After the 60 lifetime reserve days have been used Medicare will no longer pay for any coverage until a new benefit period has begun.
-A benefit period begins on admission to an in-patient facility(hospital or nursing home).
-A benefit period ends when the beneficiary has not received Medicare covered services for at least 60 straight days

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