October is Depression Awareness Month, depression being a serious mental health disorder that is plaguing Americans now more than ever due to the pandemic, inflation, natural disasters and so forth.
In June 2020, 31% of U.S. adults reported struggling with symptoms of depression or anxiety and 26% reported symptoms of trauma or stressor-related disorders.
This is especially concerning as it relates to older generations, most of whom fall in the high-risk category, and are combatting social isolation as a result to protect themselves, fear for their friends and loved ones, and anxiety over their own health.
Given the strong link between depression and dementia in older adults, it’s important that seniors are aware of and know how to access behavioral healthcare. Medicare provides coverage for a variety of resources to diagnose and treat mental health conditions, which we’ll break down in this article.
Part A provides coverage for inpatient mental healthcare at either a hospital or psychiatric hospital. It will also assist with some of the cost for the room, meals, nursing, and other services. However, there is a 190-day limit on inpatient psychiatric care.
If you exceed this limit, there is a chance Medicare will still cover the cost of care at a general hospital. Another thing to note about inpatient mental healthcare, is the potential for Part B costs from doctor services.
Part B will cover most preventative, outpatient mental healthcare, including routine visits with clinical psychologists, psychiatrists, social workers, counselors, and/or other certified mental health professionals, whether in a therapist’s office or in a clinic.
While co-insurance will apply for these routine visits, Part B does provide free annual screenings for depression and alcohol abuse. Another benefit covered by Part B is activity therapy. This includes music, dance, or art therapy, but may require beneficiaries to pay out-of-pocket and then apply for reimbursement.
One thing to keep in mind though is that Medicare has annual limits for mental health provider services.
Medicare payments for outpatient mental health services, including the treatment of mental, psychoneurotic, and personality disorders for people not inpatient at a hospital, is limited to 62.5% of expenses in the calendar year.
This can impact how much beneficiaries pay in co-insurance based on the mental health professional seen since providers will want to make up the difference in cost.
Medicare Advantage plans are required to cover the same services as Original Medicare. However, how much of the cost of mental healthcare they cover is determined by the carrier of a beneficiary’s plan.
These carriers also determine which doctors are in-network. As a result, Medicare Advantage plans include less than 23% of psychiatrists on average.
There is an alarmingly low number of mental health professionals who accept Advantage plans. As a result, those who are pre-disposed to or currently dealing with mental health issues will have much more options for diagnosis, preventative care, and treatment with Original Medicare.
As with physical healthcare, Medicare Supplements will also cover the cost-sharing left over by Medicare after they pay for the mental health services received.
Each Part D plan has formulary, or a list of drugs, that the policy covers. Rest assured that all plans must provide coverage for all antipsychotic and antidepressant medications. These drugs are part of the six protected classes, and if you require a drug that is not available under your plan’s formulary, you have the right to an appeal.
It’s been a tough year for everyone, and there is no doubt it has taken a psychological toll on many. It’s important to educate yourself on the mental health resources available to you and know when to seek help.
Medicare provides beneficiaries with services to aid in diagnosis, preventative care, and treatment. Therefore, be sure to talk to loved ones when you’re struggling and find the right treatment plan for you. This could be regular therapy sessions, taking an anti-depressant, or simply speaking with a doctor to help with lifestyle changes to alleviate symptoms.
How often do you feel depressed? Has the pandemic increased your symptoms? What do you do to fight depression? Does your insurance plan cover the costs of treatment or therapy? Please share your experiences and observations.