What Medicare Mental Health Benefits Are Available Under Part A?
As people age, the risk for developing mental, neurological, and substance use disorders increases. Even though people of all ages can experience mental health issues, seniors can be more vulnerable because they tend to have more sources of stress in their lives. Things like loss of mobility, chronic pain, grief, a decrease in socioeconomic status, and less social contact can often lead to mental health problems.
A person’s mental health can have an adverse effect on physical health, and poor physical health can affect mental health. For example, seniors who have heart disease also have a higher risk for depression. And seniors living with untreated depression are more susceptible to heart disease.
In the United States, statistics show that older adults are also at higher risk for physical, verbal, and psychological abuse. In fact, the evidence suggests that one out of every six seniors has experienced some form of elder abuse.
Because the Medicare program takes mental health care very seriously, it is suggested that you talk to your physician or another health care provider if you have any of the following issues:
- Thoughts of suicide or self-harm
- Feelings of sadness, emptiness, or hopelessness
- Feelings that you’ve lost your self-worth
- Loss of interest in things that used to bring happiness
- No energy
- Difficulty concentrating
- Trouble sleeping
- A decreased appetite and/or weight loss
- Increased drug or alcohol use
If you or someone you are caring for has mental health issues, you should speak to a health care professional. Your Medicare mental health benefits can help you cover outpatient and inpatient mental health care services, here’s a look at how.
What mental health benefits are covered under Medicare Part A?
Original Medicare Part A, which is inpatient hospital insurance, covers mental health services that you get in a hospital once you’re formally admitted into a hospital or skilled nursing facility. These services can be provided at a general hospital or a psychiatric hospital that specifically cares for mental health conditions. Your benefits cover these services if the facility accepts Medicare assignment.
Part A benefits cover the following:
- A semi-private room and your meals
- Nursing care that isn’t custodial care
- Treatment or therapy for your condition
- Lab tests
- Medications you take while an inpatient
- Various other services and supplies
Medicare Part A doesn’t cover the following:
- A private room unless it’s medically necessary
- Private nursing care
- Personal items
- Telephone or television in your room
If you receive mental health care as an inpatient in a general hospital or a psychiatric hospital that accepts Medicare assignment, you are responsible for paying the following expenses:
The Part A deductiblefor the current benefit period. In 2022, the deductible is $1556.00 per benefit period. One benefit period begins on the first day of your admission as an inpatient and ends after 60 consecutive days of not receiving any inpatient hospital care. If you are re-admitted before 60 days have passed, you don’t pay another deductible because the original benefit period is still current. However, if you return to the hospital after 60 consecutive days of non-inpatient care have passed, you begin a new benefit period and must pay another deductible fee.
Medicare Part A doesn’t limit the number of benefits periods for mental health care in a general hospital. But it’s important to note that if you are getting care in a psychiatric hospital, you are limited to 190 lifetime care days.
Coinsurance for mental health benefits under Part A
Your Part A deductible covers your share of costs for inpatient hospital care for the days 0 through 60. From day 61 to day 90, you are responsible for paying $389.00 per day (in 2022).
After day 90, you pay $778.00 per day for lifetime reserve days (60 days). After you use your lifetime reserve days, you are responsible for 100 percent of the costs for every day of care as an inpatient.