Does Medicare Cover Mental Health Care In America?

 

 

Mental health and well being in older adults are as important as what it is in other ages. To help raise Mental Health awareness, the medicare providers in pennsylvania have taken a major step to lift up the consciousness of the older adult population about mental health issues and the coverage that they should be taking advantage.

Medicare has been around for a long time in America. But does all of our beneficiaries know that Medicare covers mental health care? Do they know that options, such as Medicare Supplement plans, are also helpful in covering mental health care needs? There’s a lot to learn and there’s more help needed than what it seems. So read on to gain knowledge about the issues and coverage you should be using to gain more understanding of mental health.

The Mental Health Of Boomers

Mental health should never be taken for granted at any age, but right now let’s take a closer look at the older adult population or the Boomer generation.

Boomers make great contributions not just in their family but also in their workplaces, and communities. They are usually an active participant and volunteers of the society. However, while most in this generation have good mental health, many are at risk of developing mental health disorder, substance abuse, neurological disorders aside from other diseases they may have.

According to the World Health Organization, more than 20% of adults aged 60 and above suffer from a mental or neurological disorder. While 6.6% of all disability of this age group is attributed to mental and neurological disorders. The most common mental and neurological disorders in this age group are dementia and depression. Unfortunately, substance abuse problems among older people are often  overlooked

Risk factors

We may encounter various risk factors all throughout our life, older adults are not exempted. Despite being on retirement age, risk factors and stressors are still surrounding Boomers. Here are the common risk factors for mental disorders for this age group:

Stressors – Older adults experience additional stressors aside from what is common to most ages. Stressors at this age that may affect their mental health include (but are not limited to) decline in health and functionality, unfortunate experiences such as the death of loved ones, and change on socio-economic status. These stressors can result in loneliness, isolation or even psychological distress.

Health conditions – health conditions have an impact on mental health and so is mental health to physical health.

Abuse – 1 in 6 older adults experience elder abuse. Abuse can cause not only physical problems but also long-term psychological effects that may lead to depression and anxiety.

Dementia and Depression

Dementia is a general term for a group of symptoms that describe deterioration in thinking, memory, ability to do daily tasks and behavior. Alzheimer’s disease is the most common form of dementia and is the 6^th leading cause of death in the US.

According to Alz.org, there is about 5.8 million Americans of all ages have Alzheimer’s disease in 2019, and about 5.6 million belong to age 65 and older.

Depression, on the other hand, may impair one’s daily functioning and cause great suffering.  Gallup and Healthways found out that people in their 50s and 60s are more susceptible to depression. One in seven baby boomers says they are currently being treated for depression, which is a higher rate than among other generations of adults.

The two conditions may cause a remarkable social and economic issues brought about by the cost of medical, social and informal care. In addition, families and caregiver may experience great emotional, economic and physical pressures which may require support from social, legal and health systems.

Does Medicare Cover Mental Health Care?

Yes, Medicare cover mental health care both out-patient and in-patient services. Mental health care requires certain treatments and more personalized care depending on the condition of a person. It is a good thing that Medicare can help you with your healthcare needs.

However, Original Medicare doesn’t cover everything and have limitations on mental health care coverage. You or the patient may have to shoulder some parts of the care expenses.

Here’s a quick rundown of Medicare coverage and what you will pay out-of-pocket:

Medicare Part A mental health coverage

Medicare Part A covers your inpatient or hospital mental health care needs either in a general or a psychiatric hospital. Coverage includes room, meals, nursing, and other services and supplies related to your condition. Also, you’ll have a lifetime limit of 190 days of inpatient care in a psychiatric hospital.

What you will need to pay:

• $1,354 (2019) Medicare Part A deductible. The full deductible amount is applied for each benefit period.
• $341 (2019) coinsurance per day for days 61-90 hospital stay. You will not pay coinsurance on your first 60 days.
• $682 coinsurance (2019) per “lifetime reserve day” starting on the 91st day of your hospital stay for only up to 60 days.
• You will have to shoulder the full amount of expenses once you used all the “lifetime reserve days”.

Medicare Part B mental health coverage

Medicare Part B covers outpatient mental health services. Including psychiatric evaluation, some diagnostic tests, partial hospitalization, Medication management, individual and group psychotherapy by a licensed professional allowed by the state and family counseling.

There is one time “Welcome to Medicare” preventive visit which includes a review of your possible risk factors for depression and free annual depression screening that you can take advantage every year.

What you will need to pay:

• Part B deductible ($185 in 2019) for all the services.
• You will have to shoulder 20% of the payment for doctor’s visits either in an individual, group or family counseling.
• There may be 20% or more copayment for out-patient facility care.

Medicare Supplement and mental health coverage

Mental health should be addressed with the utmost care and attention. Thus, if ever you need therapy or require much intensive care, a Medicare Supplement plan may provide supplemental coverage to your Original Medicare.

Additional coverage will minimize the financial burden and avoid additional stress in your shoulder. With this plan, you won’t have to beat yourself up and worry about piling out-of-pocket expenses due to seeking mental health care.

Medicare Supplement plans, also known as Medigap insurance, will help reduce or diminish the out-of-pocket cost of Medicare Part A and Part B. Depending on which type of Medigap plan, it will pay all or part of the Medicare approved amount after Medicare pays its share.

Why raise Mental health awareness?

The stigma surrounding mental illness still lingers aggressively around us. Despite the available support system and mental health care coverage,  it is the stigma of mental illness that prevents people from seeking care and getting the help they need.

The major contributing factor of the stigma is the misinformation about mental illness and those who suffer from them. The survey made by mentalhelp.net,  clearly demonstrates that we still have a lot of working to do to eradicate stigma in our society.

Here are some notable results of the survey that struck me hard:

• 15% of the respondent’s label people with mental illness as a burden to society.
• 67% of people polled believe there are insufficient existing services for people with mental illness.
• 56% say they’d be uncomfortable talking to friends and family about it. 84 percent say they’d be uncomfortable talking to their employer.