While I am not an insurance expert, I am a participating provider for Medicare and a large portion of my psychotherapy practice involves providing care for individuals with Medicare benefits. I can offer you some basic information and provide you with leads to resources that can offer you accurate and timely information about Medicare and mental health coverage.
Medicare Part B does provide coverage for mental health services including outpatient psychotherapy (the type that we usually think of involving office visits to a psychologist in the community), inpatient care (hospital-based psychiatric treatment) and medications for treatment of depression, anxiety and other mental disorders. Currently, there are two types of coverage: Original Medicare (the red, white and blue original Medicare card) and Medicare Advantage/Medicare Replacement plans (which usually have the word Medicare as well as the logo and name of a private insurance company on the card).
While many people think that Original Medicare and Medicare Advantage offer exactly the same benefits, this is often not true. For example, I am participating provider for Original Medicare, but I am unable to be reimbursed by many Medicare Advantage plans because they use Preferred Provider panels on which I do not serve. You must carefully consider whether the benefits and costs of Original Medicare are better or worse for you in your particular situation. With some Medicare Advantage plans you may lose the freedom to choose among the entire range of participating Medicare providers.
The official U.S. government site for Medicare is www.medicare.gov and that is an excellent place to start in gathering information. The Centers for Medicare and Medicaid Services also publishes an excellent brochure called “Medicare and your Mental Health Benefits” that you can access free online. This is the official government booklet that outlines what “Original Medicare” does and does not cover for mental health. It can be found at http://www.medicare.gov/Pubs/pdf/10184.pdf .
It is very important to note that if you get your Medicare benefits through a Medicare Advantage HMO or PPO or a “Medicare Replacement” plan offered by a private insurance company, this booklet will not apply to you. You will need to check your plan’s membership materials and call the insurer for details about how to get your Medicare-covered mental health benefits. There are frequently restrictions on benefits that may not be true of Original Medicare plans.
The National Council on Aging (NCOA) has a free website resource for dong a “benefits checkup” at no cost. Access the NCOA site at http://www.ncoa.org or call (202) 479-1200. The National Association for Area Agencies on Aging is another excellent national organization that has state offices in Colorado. For information, go to http://www.n4a.org/.
For additional information and free counseling about enrolling in Medicare and Medicaid plans and about the differences between types of Medicare coverage, you can contact the following Colorado agency. This agency will does not promote or attempt to sell you any type of insurance, but does provide individualized counseling services for consumers:
Senior Health Insurance Assistance Program (SHIP)
Toll-free: (888) 696-7213
Local: (720) 321-8850
Spanish: (866) 665-9668
TTY: (303) 894-7880
This is a confusing time for people trying to make decisions about health care coverage. Fortunately, there are excellent no-cost options for getting objective information and help with decision-making. The Medicare Open Enrollment period is coming up and lasts from October 15-December 7, 2013. Do your homework, know your options and make slow, well thought-out decisions to obtain the plan that is best for your individual needs and situation.