Let’s hope it never happens, but there may come a time in your life when you need mental health care. Your Medicare covers a wide variety of such services, in both hospital inpatient and outpatient settings.
If you have Medicare Part A (hospital insurance), you’re eligible for mental health services when you’re admitted to a hospital as an inpatient. You can get these services either in a general hospital or a psychiatric hospital that only cares for people with mental health conditions.
If you’re in a psychiatric hospital (instead of a general hospital), Part A only pays for up to 190 days of inpatient psychiatric hospital services during your lifetime.
Medicare pays for inpatient hospital stays on the basis of “benefit periods.” A benefit period begins the day you’re admitted to a hospital as an inpatient. It ends when you haven’t received any inpatient care for 60 days in a row.
If you go into a hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible ($1,340 in 2018) for each benefit period.
There’s no limit to the number of benefit periods you can have. But remember, there’s a lifetime limit of 190 days for inpatient psychiatric hospitals.
After you pay the deductible, Medicare covers inpatient hospital care for the first 60 days with no coinsurance on your part for each benefit period.
For days 61-90, your coinsurance is $335 per day of each benefit period.
If you’re in the hospital beyond 90 days, your coinsurance is $670 per “lifetime reserve day” for each benefit period (you have up to 60 reserve days over your lifetime).
In addition, you’ll pay 20 percent of the Medicare-approved amount for mental health services you get from doctors and other providers while you’re a hospital inpatient.
Your Medicare Part B (medical insurance) covers partial hospitalization in some cases.
Partial hospitalization provides a structured program of outpatient psychiatric services as an alternative to inpatient psychiatric care. It’s more intense than care you get in a doctor’s or therapist’s office. This treatment is provided during the day and doesn’t require an overnight stay.
Medicare helps cover partial hospitalization services when they’re provided through a hospital outpatient department or community mental health center. Along with partial hospitalization, Medicare may cover occupational therapy that’s part of your mental health treatment and/or individual patient training and education about your condition.
Medicare only covers partial hospitalization if the doctor and the partial hospitalization program accept Medicare as full payment.
For Part B to cover a partial hospitalization program, you must meet certain requirements, and your doctor must certify that you would otherwise need inpatient treatment.
Under Part B, you pay a percentage of the Medicare-approved amount for each service you get from a doctor or other qualified mental health professional if they accept Medicare rates.
You also pay coinsurance for each day of partial hospitalization services provided in a hospital outpatient setting or community mental health center. The Part B deductible ($183 in 2018) applies as well.
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
All of the above applies to people with Original Medicare. If you’re in a Medicare Advantage (Part C) health plan, check with the plan for details of how it covers mental health care.
For more information on your Medicare mental health benefits, I recommend this Medicare-mental health brochure at . Look for it under the “publications” tab.
Greg Dill is Medicare’s regional administrator for Arizona, California, Nevada, Hawaii, and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).
The sharing savings program lets providers and hospitals earn a bonus if they meet spending and quality targets, in an effort to improve care coordination and lower healthcare costs. ACOs in the program now include about 10.5 million Medicare beneficiaries, an increase from 9 million in 2017.
“This growth is an encouraging sign that more ACOs are preparing to take on risk, but it’s vital to recognize all the time and effort for these ACOs to be ready to assume risk. We need to continue to improve the ACO program as a whole to provide the stability and demonstrated success necessary for ACOs to feel confident to enter into these risk-based ACO models.”
So far, results from ACOs have been mixed, but there have been notable successes. A recent analysis from the focusing on the first three years showed that most ACOs in the program reduced spending and improved care quality.
The report found that the groups cut spending by a total of $3.4 billion in the three years studied for a net reduction of nearly $1 billion, but also discovered large differences between an ACO’s success. About half of the reduction came from 36 ACOs, and three in that group were responsible for a quarter of that amount.
The inspector general report also found the highest performing ACOs usually have sicker beneficiaries and were more likely to include only physicians. ACOs also, on average, had better quality scores than fee-for-service providers in more than 80% of 33 individual measures.
The most improved quality measures were in areas like flu vaccines, depression screening, fall risk and body mass index, according to the report.
- Healthcare Finance News CMS: Medicare adds 124 ACOs for 2018
- Modern Healthcare More Medicare ACOs will take on risk in 2018
The Medicare Payment Advisory Commission, or MedPAC, says one of the two payment tracks set up under a new reimbursement system is too burdensome for physicians and won’t push them to improve care.
DOUGLAS COUNTY, Ore. – Learning about Medicare can sometimes be confusing, but a program in Roseburg wants to help seniors learn more about it. The Senior Health Insurance Benefits Assistance Program is putting on a Medicare 101 seminar. According to the C
In The Road to Medicare for Everyone, Jacob Hacker is once again working to dissuade single payer healthcare supporters from demanding National Improved Medicare for All and use our language to send us down a false path. Hacker comes up with a scheme to convince people to ask for less and calls those who disagree “purists”. Hacker calls his “Medicare Part E” “daring and doable,” I call it dumb and dumber. Here’s why.
Hacker makes the same assertions we witnessed in August of 2017 when other progressives tried to dissuade single payer supporters.
He starts with “risk aversion,” although he doesn’t use the term in his article. Hacker asserts that those who have health insurance through their employers won’t want to give it up for the new system. Our responses to this are: there is already widespread dislike for the current healthcare system; people don’t like private insurance while there is widespread support across the political spectrum for Medicare and Medicaid; there is also widespread support for single payer; and those with health insurance can be reassured that they will be better off under a single payer system. It is also important to note that employers don’t want to be in the middle of health insurance. Healthcare costs are the biggest complaint by small and medium sized businesses and keep businesses that operate internationally less competitive.
Next, Hacker brings up the costs of the new system and complains that it will create new federal spending. He points to the failures to pass ‘single payer’ in Vermont and California. First, it must be recognized that the state bills were not true single payer bills, and second, states face barriers that the federal government does not, they must balance their budgets. Hacker ignores the numerous studies at the national level, some by the General Accounting Office and the Congressional Budget Office that demonstrate single payer is the best way to save money. Of course there would be an increase in federal spending, the system would be financed through taxes, but the taxes would replace premiums, co-pays and deductibles, which are rising as fast as health insurers can get away with. Hacker proposes a more complex system that will fail to provide the savings needed to cover everyone, the savings that can only exist under a true single payer system.
Hacker also confuses “Medicare for All” with simply expanding Medicare to everyone, including the wasteful private plans under Medicare Advantage. This is not what National Improved Medicare for All (NIMA) advocates support. NIMA would take the national infrastructure created by Medicare and use it for a new system that is comprehensive in coverage, including long term care, and doesn’t require co-pays or deductibles. The system would negotiate reasonable pharmaceutical prices and set prices for services. It would also provide operating budgets for hospitals and other health facilities and use separate capital budgets to make sure that health resources are available where they are needed. And the new system would create a mechanism for negotiation of payment to providers.
Finally, Hacker tries to convince his readers that the opposition to NIMA will be too strong, so we should demand less. We know that the opposition to our lesser demands will also be strong. That was the case in 2009 when people advocated for the ‘public option’ gimmick. If we are going to fight for something, if we are going to take on this opposition, we must fight for something worthwhile, something that will actually solve the healthcare crisis. That something is NIMA. We are well aware that the opposition will be strong, but we also know that when people organize and mobilize, they can win. Every fight for social transformation has been a difficult struggle. We know how to wage these struggles. We have decades of history of successful struggles to guide us.
One gaping hole in Hacker’s approach is that it prevents the social solidarity required to win the fight and to make the solution succeed. Hacker promotes a “Medicare Part E” that some people can buy into. Not only will this forego most of the savings of a single payer system, but it also leaves the public divided. Some people will be in the system and others will be out. This creates vulnerabilities for the opposition to exploit and further divide us. Any difficulties of the new system will be blown out of proportion and those in the system may worry that they are in the wrong place. When we are united in the same system, not only does that create a higher quality system (a lesson we’ve learned from other countries), but it also unites us in fighting to protect and improve that system.
Hacker succeeded in convincing people who support single payer to ask for something less in 2009 and we ended up with a law that is further enriching the health insurance, pharmaceutical and private healthcare institutions enormously while tens of millions of people go without care. Now, Hacker rises again to use the same scare tactics and accusations that he used then to undermine the struggle for NIMA. This is to be expected. The national cry for NIMA is growing and the power holders in both major political parties and their allies in the media and think tanks are afraid of going against the donor class. Social movements have always been told that what they are asking for is impossible, until the tide shifts and it becomes inevitable.
Our task is to shift the tide. We must not be fooled by people like Jacob Hacker. We know that single payer systems work. We have the money to pay for it. We have the framework for a national system and we have the institutions to provide care. Just as we did in 1965 when Medicare and Medicaid were created from scratch, and without the benefit of the Internet, we can create National Improved Medicare for All, a universal system, all at once. Everybody in and nobody out.
We know that we are close to winning when the opposition starts using our language to take us off track. “Medicare Part E” is not National Improved Medicare for All, it is a gimmick to protect the status quo and convince us that we are not powerful. We aren’t falling for it. This is the time to fight harder for NIMA. We will prevail.