Medicare and Mental Health in 2019

When you first become eligible for Medicare, there is so much information that it can be truly overwhelming. Gone are the days where your employer chooses your health plan for you. Now you have to learn how a national health insurance program works and also make decisions on what supplement coverage to buy to fill in the gaps.

Once you dive into the details though, you’ll see that Medicare covers most healthcare services, including inpatient, outpatient, and mental health care.

Medicare’s mental health coverage is really important because many people over the age of 65 find themselves in need of mental health care. This is a time when our bodies are changing and our children have grown and moved away, and so it’s common to feel some depression.

Let’s go over what you can expect from Medicare’s mental health benefits in 2019.

Therapy and Other Psychiatric Care

Many of the benefits for mental health under Medicare are covered by Part B, which is the part that covers outpatient medical care. In 2019, Part B has a $185 deductible, and it then will cover 80% of the cost of your covered services.

Part B covers many things for both outpatient medical and mental health.  Under medical needs, Part B provides for visits with your physician, lab testing, durable medical equipment, various types of outpatient surgeries, emergency care and more

Under mental health care, Medicare Part B covers similar types of outpatient services. This would include individual therapy, group therapy, appointments with a clinical psychologist and/or a psychiatrist.

Part B also provides a number of preventive care benefits at no cost to beneficiaries. An annual depression screening is one of these tests, and your primary care physician can administer it at no cos to you.  

While outpatient therapy is helpful for many people, some beneficiaries many benefit more from structured care. Part B provides a partial hospitalization benefit for individuals who need more structured and formal care in a community mental health center or outpatient hospital clinic. Your Medicare doctor must pre-certify you for this type of care.

Filling the Gaps in Outpatient Care

Covering 20% of all of your outpatient expenses could be a real burden to many people. Fortunately, there is supplemental coverage that you can purchase when you first become eligible for Medicare that will help to cover that 20% as well as some of your Medicare deductible and copays.

Medicare supplements are standardized policies offered by private insurance carriers in all 50 states. After Medicare processes and pays on your claim, it will send the remainder of the bill to your supplement company to pay some or all of the rest, according to which plan you enrolled in. companies. Most states in the U.S. have 10 standardized Medicare supplement plans that you can consider for your supplemental coverage. Medicare Supplement Plan F is one of the most comprehensive plans.

Hospital Care

Inpatient hospital care is also covered under Medicare Part A. Part A provides this for both medical and mental health.

Patients are allowed up to 190 days per lifetime of mental healthcare care in an approved psychiatric care facility. Medicare also provides for some inpatient mental health care. Essentially Part A pays for your room in the facility as well as any skilled nursing that you receive as part of your stay.

When you enter any hospital facility, you are subject to a deductible of $1364 in 2019. This will pay for your first 60 days of care in that hospital. Should your stay extend beyond 60 days, there are hefty daily copays that you will being to incur. Medigap plans, as discussed in the former section, also help with paying for these daily copays.

Part D Drug Benefits

For decades, Medicare did not offer any outpatient drug coverage. This changed in 2006 when Part D was rolled out. Now you can enroll in a Part D drug plan and it will help to reduce the costs of your outpatient prescriptions.

Each Part D plan has its own list of coverage drugs called a formulary. Some states have more than 20 plans to choose from, so the first step is always checking to see that the plan you are considering covers the medications you take regularly.

Medicare has guidelines for drug plans and part of this is that all plan must include both antidepressants and antipsychotics.  In addition, all plans must also include 2 or more medications in each therapeutic class.

When you head over to the retail pharmacy, you’ll show your Part D membership card and this tells the pharmacist who to bill for your prescriptions. The pharmacist will also collect your copay for the drug. Plans have 5 different tiers of medications ranging from preferred generics, which are generally inexpensive, all the way up to specialty drugs, which are pricey.

Fortunately, all Part D drug policies also have a catastrophic cap built into the plan. If your drug spending goes over a certain limit each year, then the insurance company must pay for 95% of your medications thereafter for the remainder of the calendar year.

It’s normal to feel concerned about your benefits for mental health care when you are joining a whole new type of coverage. Rest assured that Medicare does include benefits for your mental health.

Danielle Roberts is a Medicare insurance expert and the co-founder of Boomer Benefits, an licensed insurance agency that helps seniors with their Medicare supplement options.