Explaining Medicare's coverage and payment policy for mental health services to your patients can be difficult and time consuming. To assist you in your conversation with patients about mental health coverage under Medicare, we have created the article below. This article explains the types of mental heath services that are covered by Medicare Parts A, B and D. The flyer also includes information regarding who can deliver the Medicare covered mental health services and what the patient's out-of-pocket cost for these services may be.

Payment of Mental Health Benefits in the Original Medicare Plan

What parts of Medicare cover mental health services?
Medicare Part B (Medical Insurance) helps cover mental health services received outside of a hospital, including visits with a doctor, psychiatrist or other doctor, visits with a clinical psychologist, or clinical social worker, and lab tests ordered by a doctor. Medicare Part B may also pay for partial hospitalization services, if need intensive coordinated outpatient care is needed.

Medicare Part A (Hospital Insurance) helps cover mental health care when a patient is in receiving hospital inpatient care. Medicare Part A covers the room, meals, nursing and other related services and supplies.

Medicare Part D (Medicare prescription drug coverage) helps cover prescription drugs needed to treat a mental health condition.

What the Original Medicare Plan covers
If a patient has the Original Medicare Plan (Medicare Part B for Medical Insurance), Medicare helps cover visits with these types of health professionals:

• A psychiatrist or other doctor
• Clinical psychologist
• Clinical social worker
• Clinical nurse specialist
• Nurse practitioner
• Physician’s assistant

It’s important to know that Medicare only covers these visits when they are given by a health care professional who accepts Medicare payment. Medicare Part B helps cover outpatient mental health services. This includes services that are usually given outside of a hospital (like in a clinic, or doctor’s or therapist’s office), and those that are given in a hospital’s outpatient department. Medicare helps cover the following services:

• Individual and group therapy with doctors or certain other licensed professionals allowed by the state to give these services
• Family counseling if the main purpose is to help with a patient's treatment
• Testing to help find out if the patient is receiving the right services and if treatment is helping
• Psychiatric evaluation
• Medication management
• Occupational therapy that is part of the mental health treatment
• Certain prescription drugs that aren’t usually self-administered, like some injections
• Individual patient training and education about a patient's condition
• Diagnostic tests
• A screening for mental health conditions during the one-time ‘‘Welcome to Medicare’’ physical exam (Note: This physical exam is only covered if within the first 6 months you have Medicare Part B.)
  o Partial hospitalization may be covered

What a patient has to pay
After you have satisfied the yearly Medicare Part B deductible ($155 in 2010), the amount of coinsurance you will owe for mental health services will depend on the kind of service received. For visits to a doctor to diagnose a mental health condition or to monitor or change drug prescription for mental health conditions, each patient will generally pay 20 percent of the Medicare-approved amount. Effective January 1, 2010, the amount you will pay toward these services will change.  Medicare will begin paying a larger share of these services, and your share will be less.  These changes in payments are a result of changes in the law and will be phased in over a 5-year period, from 2010-2014.

Payments for these services will change as follows:

If you receive services in a hospital outpatient clinic, or in an outpatient department of a hospital, you will pay a separate copayment or coinsurance amount to the hospital. This amount will vary depending on the service provided. Medicare will send you a notice showing the amount you owe.

Who should I contact for more information?

• You can call (800) MEDICARE ((800) 633-4227) for more information