Medicare and Mental Health – What are Your Options?

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medicare mental health care

Did you know that more than 40 million American adults suffer from mental illnesses such as depression, bipolar disorder, anxiety disorder, and schizophrenia? Mental Health Awareness Month has been observed in May since 1949 in the United States. It was initially started by Mental Health America, which releases a toolkit of materials every year in March. The toolkit is useful as a guide for outreach activities.

According to Mental Health America, 56% of American adults with a mental illness do not receive the treatment they need. A large part of the problem remains this lack of access to the treatment that people need.

“In my work as a Clinical Psychologist, I have seen numerous improvements related to mental health and behavioral health over the years in a geriatric population,” said Dr. Kelly F. Trusheim, Clinical Director at Highland Rivers Health. “Namely, I have seen them benefit from regular screenings at annual ‘wellness’ visits, at which time early identification and treatment psychiatric symptoms and disorders was initiated.”

Mental Health Coverage Under Medicare

In honor of Mental Health Awareness Month, here’s what Medicare does and does not cover when it comes to mental health care.

Medicare Part A covers mental health services that you receive in a hospital that require you to be admitted as an inpatient. While this covers both general hospitals and psychiatric hospitals, Part A only covers 190 days of inpatient psychiatric hospital services during your lifetime. It does not cover a private nurse, a private room (unless medically necessary), a phone/television in your room, and does not cover personal items during your stay.

The deductible for each benefit period in Original Medicare is $1,316. There’s no limit on the number of benefit periods you can use when you get mental health care in a general hospital. You can have multiple benefit periods when you receive care from a psychiatric hospital as well, but there is still a lifetime limit of 190 days.

Medicare Part B covers mental health services and visits for outpatients with professionals such as psychiatrists, clinical social workers, clinical psychologists, clinical nurse specialists, nurse practitioners and physician assistants. It also covers outpatient mental health services under circumstances like a healthcare provider’s office, hospital outpatient and community mental health center.

Along with these services, Part B covers:

  • one depression screening per year when done in a primary care doctor’s office or clinic
  • individual and group psychotherapy with doctors or licensed professionals allowed by the state
  • family counseling
  • medication management
  • testing to see if you’re getting the services you need
  • certain prescription drugs
  • diagnostic tests
  • psychiatric evaluation
  • partial hospitalization
  • yearly “wellness” visit and a one-time preventive visit.

The costs for Original Medicare are 20% of the Medicare-approved amount for visits to a doctor or health care providers.

While the stigma attached to mental health issues has improved, there are still steps to take when improving the quality of life and access to help for those who struggle with mental health issues.

Dr. Trusheim notes she has seen people benefit from access to help. “While conducting individual psychotherapy, I have watched patients successfully cope with severe medical diagnoses and major transitions in life,” she said. “I have witnessed the benefits of psychiatric evaluation and medication management, including lessening depressive symptoms, reducing anxiety, promoting restful sleep, managing psychotic symptoms, and slow the progression of dementia symptoms. I have conducted assessments/testing that have clarified if a patient’s presentation is considered part of the normal aging process or is indicative of a psychiatric or neurological condition. In my work with families, I have assisted them in better understanding their loved one’s illness, as well as what they can expect and how to help the patient. The benefits of behavioral health treatment are too many to list.”

With respect to suicide, this is a rather important topic for patients of all ages. There are 25 attempts per every death by suicide per year, and the ratios are 4:1 for the elderly, according to the American Association of Suicidology. In addition, white males who are 65 years old or older are at a higher risk than the general population.

There are various misnomers about suicide. For example, talking about it does not increase the risk. In fact, asking about it earlier can assist in early intervention, treatment, and recovery. For more information on how you can learn how to ask your loved ones about suicide, visit the QPR Institute and the Suicide Prevention Resource Center.

If you or someone you know is in danger, call the National Suicide Prevention Line at 1-800-273-8255. You can speak to a counselor 24 hours a day. You can also text 741741 to talk to a trained crisis counselor for free 24/7.

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