Medicare Coverage For Mental Health and Alzheimer's Care

Modern medicine recognizes that many mental and				care plan.
emotional problems are in fact physical illnesses or				Psychological care. Psychological counseling is not
related to them. So, with either Medicare Part A				technically medical care. But under some
hospital insurance plus Medicare Part B medical				circumstances, Medicare Part B or Medicare Part C
insurance, or with a Part C Medicare Advantage				managed care will cover counseling by a clinical
managed care plan, participants have extensive				psychologist. The person's doctor must prescribe the
coverage for treatment of mental or emotional illness,				treatment. The psychologist must be certified by
including depression, Alzheimer's disease, and other				Medicare. And the psychological care must relate to a
forms of dementia. This includes both inpatient and				problem -- such as depression or anxiety -- arising out
outpatient care, and treatment not only by doctors but				of a medical condition for which the doctor is treating
also by other Medicare-certified healthcare providers.				her. If she's suffering emotionally from the strain of a
The amount of coverage Medicare provides depends				physical illness, suggest that she discuss the problem
on the kind of hospital where the person receives				with her doctor. If she and the doctor believe she might
care.				benefit from psychological counseling, Medicare Part B
- Care in a general hospital.If the inpatient care she				or her Medicare Advantage managed care plan might
receives is in a general, nonpsychiatric hospital that				cover the care. The office of the psychologist she's
treats patients for all types of illness, the rules of				referred to can find out in advance from Medicare
coverage are the same as for any other hospital stay.				whether it would cover her treatment there. Adult
That is, under Medicare Part A, she must pay a				daycare. In general, adult daycare provides personal
deductible, plus daily co-payments for a stay of more				monitoring and attention with structured activity in a
than 60 days within any one benefit period. If she's in				secure environment. Medicare usually considers this
the hospital for more than 90 days in any one benefit				type of care "custodial" rather than medical and so
period, Medicare Part A pays part of the cost of up to				usually doesn't cover it. Medicare can cover services
60 more once-in-a-lifetime "reserve days". However,				from an adult daycare center only in very limited
there's no lifetime limit on the number of hospitalizations				circumstances. Medicare might cover actual mental
that Medicare Part A will pay for. If she has a Part C				health treatment, prescribed by a physician, provided at
Medicare Advantage managed care plan, it pays for				an outpatient mental health clinic. If this clinic is also an
at least this same amount of inpatient care, and some				adult daycare center, the patient can get the benefit of
plans pay more of the cost.				the center's other care services while receiving
- Care in a psychiatric hospital.If she's an inpatient in a				treatment there. Medicare will cover this kind of care
psychiatric hospital -- meaning one that accepts				only if, and for as long as, it involves actual medical
patients only for mental health care -- the rules of				treatment -- administration and monitoring of
payment are the same as for a general hospital but				medication, for example, or help with recovery from a
the total amount of coverage is different. Medicare				medical crisis. Also, some Part C Medicare Advantage
Part A covers only a total of 190 days in a patient's				managed care plans offer limited adult daycare
lifetime for inpatient care in a psychiatric hospital.				coverage as part of their comprehensive home care
Nursing facility care. The single most important thing to				services. Medicare doesn't require that these plans
understand about Medicare and nursing facilities is that				offer this, so the nature and extent of what they
Medicare does not pay for long-term care. However,				cover depends entirely on the plans themselves. Finally,
under limited circumstances and for a short time,				Medicare partners with Medicaid to sponsor what's
Medicare Part Aor a Medicare Advantage managed				called the Program of All-Inclusive Care for the Elderly
care plan can cover a stay in a skilled nursing facility				(PACE). This provides comprehensive home and
while the person is recovering from a severe mental				community care, including adult daycare, for frail elders
health episode that landed her in the hospital. The				who would otherwise require nursing home care.
nursing facility stay must follow, within 30 days, a				PACE is only available in certain states, however. And
hospital stay of at least three days. And the nursing				in those states, it may be available only to those who
facility stay must be medically required and prescribed				are eligible for both Medicare and Medicaid. See
by her doctor to provide her with daily skilled nursing or				Medicare's official website at medicare.gov for a list of
rehabilitation services while she's recovering from the				PACE programs.
medical event that put her in the hospital. The				Therapeutic services for Alzheimer's patients. For a
coverage can last for up to 100 days, with Medicare				long while, Medicare didn't consider various therapies
paying the full amount for the first 20 days and your				for people who had been formally diagnosed with
family member having to make a co-payment of				Alzheimer's disease medically necessary, and so did
$133.50 (in 2009) per day for days 21 through 100. For				not cover them. This policy has changed. If the person
more details about Medicare Part A nursing facility				in your care has been diagnosed with Alzheimer's,
coverage, see our article Understanding Medicare Part				Medicare Part B can now cover physical, occupational,
A (Hospital Insurance). Home care. Home care is				and speech therapy for her, as well as psychological
available under Medicare Part A, Part B, or Part C				counseling and other mental health services. Her
(managed care) if it's medically necessary for any				doctor must prescribe the treatment, however, and it
illness or condition, including mental illness, Alzheimer's,				must be provided by a Medicare-certified therapist or
and other forms of dementia. But the rules under				mental health provider. Medications for mental health
which Medicare coverage is available for home care				conditions.Any medication administered to someone
are quite strict, and coverage usually lasts only a short				when she's a hospital or nursing facility inpatient,
time. The key thing about Medicare coverage for				whether or not she's an Alzheimer's patient, is covered
home care is that it applies only to home healthcare.				by Medicare Part A. Any medication given to her at
That means your family member must need skilled				her doctor's office or at any outpatient health facility is
nursing care or rehabilitation therapy while she's				covered by Medicare Part B. Things get much trickier
confined to home because of an injury or illness. It				with prescription drugs taken at home. The only
doesn't cover assistance with the activities of daily				coverage Medicare provides for at-home medications
living such as dressing, bathing, walking, or eating unless				is through a Medicare Part D prescription drug plan.
these are provided incidentally, alongside required skilled				Coverage for specific drugs the doctor may prescribe
medical care. A doctor must prescribe the home care				for mental health issues depends on the formulary --
and it must be provided by a Medicare-certified home				the covered list of drugs -- that her plan maintains.
healthcare agency. If the person in your care qualifies,				There's a special prohibition, however, on certain drugs
Medicare pays 100 percent of the agency's costs. But				that are often prescribed to cope with mental health
the care can continue only as long as the skilled				issues. Medicare doesn't permit a Part D prescription
nursing or therapy is required, while she's actually				drug plan to cover any medication within the
recovering. Home healthcare is covered by Medicare				categories of barbiturates (certain sedatives) and
Part A following a hospital stay, or by Medicare Part				benzodiazepines (certain tranquilizers), even if a
Bif there has been no prior three-day hospital stay. If				physician has prescribed it. So if she's taking one of
she's enrolled in a Part C Medicare Advantage				these drugs, and she'd like to have coverage from her
managed care plan, that plan provides home care				Part D drug plan, ask her doctor whether a similarly
under the same rules, except that the home care				effective drug might be available that does not
agency must be associated with the specific managed				technically fall into either of these categories.

Lapsi

Medicare Coverage For Mental Health and Alzheimer's Care