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Mental Illness and Medicare & Medicaid

Medicare helps cover mental health services

Medicare Part A (Hospital Insurance) helps cover mental health care if you’re a hospital inpatient. Part A covers your room, meals, nursing care, therapy or other treatment for your condition, lab tests, medications, and other related services and supplies.


Medicare Part B (Medical Insurance) helps cover mental health services that you would get from a doctor and services that you generally get outside of a hospital, like visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor. Part B may also pay for partial hospitalization services if you need intensive coordinated outpatient care. See page 10 of the article below for more information about partial hospitalization services.


Medicare (Part D) Prescription Drug Coverage helps cover drugs you may need to treat a mental health condition. 

Medicare may cover partial hospitalization

Part B covers: partial hospitalization in some cases. Partial hospitalization is a structured program of outpatient psychiatric services provided to patients as an alternative to inpatient
psychiatric care. It’s more intense than the care you get in a doctor’s or therapist’s office. This type of 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. As part of your partial hospitalization program, Medicare may cover occupational therapy that’s part of your mental health treatment and/or individual patient training and education about your condition.

For Medicare to cover a partial hospitalization program, you must meet certain requirements, and your doctor must certify that you would otherwise need inpatient treatment. Your doctor and the partial hospitalization program must accept Medicare payment. 

You pay: a percentage of the Medicare-approved amount for each service you get from a doctor or certain other qualified mental health professionals if your health care professional accepts assignment. You also pay coinsurance for each day of partial hospitalization services provided in a hospital outpatient setting or community mental health center. 

Medicare drug plans have special rules

Will my plan cover the drugs I need?
Most Medicare drug plans have a list of drugs that the plan covers, called a formulary. Medicare drug plans aren’t required to cover all drugs, but they’re required to cover all (with limited exceptions) antidepressant, anticonvulsant, and antipsychotic medications, which may be necessary to keep you mentally healthy. Medicare reviews each plan’s formulary to make sure it contains a wide range of drugs and that it doesn’t discriminate against certain groups (like people with disabilities or mental health conditions). If you take prescription drugs for a mental health condition, it’s important to find out whether a plan covers your drugs before you enroll. Visit Medicare.gov/find-a-plan to find out which plans cover your drugs.


Can my drug plan’s formulary change?
A Medicare drug plan can make some changes to its formulary during the year within guidelines set by Medicare. If the change involves a drug you’re currently taking, your plan must do one of
these:

  • Provide written notice to you at least 60 days prior to the date the change becomes effective.
  • At the time you request a refill, provide written notice of the change and a 60-day supply of the drug under the same plan rules as before the change. 

click the link below for a PDF on Mental Ilness and Medicare & Medicaid