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Mental Health Coverage

Medicare Coverage for Mental Health Issues

Your mental health impacts your actions, thoughts, and feelings. It guides how you relate to others, handle common (and not-so-common) stress, and even the way you make decisions. Although researchers don’t know exactly what causes mental health issues, they do recognize certain contributing factors. These include biological conditions, such as brain chemistry; family history; and life experiences, such as abuse or trauma. In this post, we discuss common mental health issues and what Medicare covers.

Common Mental Health Issues

The most common mental health issues in adults are depression and anxiety disorders. The following basic information for each of these conditions comes from the National Institutes of Health.

What Is Depression?

Clinical depression can cause confusion because the word “depression” is commonly used to describe feeling sad. This leads many people to believe that people with depression could just “get over it” if they really wanted to. Add in the fact that people who have depression may occasionally smile, laugh, or appear happy, and it’s no wonder observers don’t always understand the condition.

Also known as major depression, the disorder is characterized by loss of interest in daily activities and persistent feelings of depression. Common symptoms include:

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What Is Generalized Anxiety Disorder?

Commonly abbreviated as GAD, generalized anxiety disorder is marked by feelings of anxiety, worry, or apprehension. The patient experiences these feelings most days for six months or more. Routine activities often make the sufferer feel anxious or frightened. Typically, the patient feels ashamed, discouraged, or otherwise unhappy at their inability to put things in perspective.

Symptoms of GAD include:

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What Is Panic Disorder?

People who have panic disorder experience panic attacks and apprehension without any real cause. The severity and frequency of these attacks varies widely from patient to patient. Some are triggered by an external object. For others, panic attacks are spontaneous or unexpected. The person may begin avoiding certain stimuli, which may lead to secondary conditions. The most common is agoraphobia (fear of crowded places or leaving your home).

The main symptoms of panic disorder are feelings of panic and apprehension without obvious threat.

What Is Obsessive-Compulsive Disorder?

Commonly referred to as OCD, obsessive-compulsive disorder typically includes both obsessions and compulsions, but may involve only one.

Obsessions are characterized as unwanted thoughts and urges entering the patient’s mind without external stimulus. Compulsions are repetitive thoughts or behaviors the patient feels compelled to perform. The compulsion can be overt, i.e. observable by others, or covert, i.e. a mental act not observable by anyone else.

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What Is Post-Traumatic Stress Disorder?

Typically referred to as PTSD, post-traumatic stress disorder is a fairly common condition affecting victims of trauma. Often associated with war veterans, the disorder also strikes victims of violent crime, natural disasters, abuse, life-threatening illness, and severe accidents.

Patients who have PTSD often re-experience the traumatic event in such vivid detail that it feels as though the event is reoccurring. Since the experience feels real, it is often accompanied by physical responses to the perceived threat.

Common symptoms of PTSD include:

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Medicare Part B and Mental Health

Original Medicare (Parts A and B) covers a variety of services to treat mental health issues. In fact, this coverage begins with your Welcome to Medicare visit, which includes a depression screening. Medicare Part B covers one depression screening per year. Your provider completes this screening during your yearly wellness exam.

Other outpatient services covered by Part B include:

  • Diagnostic tests
  • Family counseling (if related to your treatment)
  • Individual and group psychotherapy
  • Medication management
  • Psychiatric evaluation
  • Some prescription medications not considered self-administered, such as injections
  • Testing to determine treatment needs and efficacy

Medicare Part B may also cover partial hospitalization if you meet requirements and your provider certifies that the alternative is inpatient treatment.

Assuming your provider accepts assignment, Part B covers these services at 80 percent of the approved cost. You are responsible for the remaining charges and the yearly deductible also applies. For partial hospitalization services, you also pay coinsurance for each day.

Medicare Part A Mental Health Coverage

If your mental healthcare treatment requires an inpatient hospital stay, Medicare Part A covers both general and psychiatric hospital stays. You have the standard costs for these stays (please see our article, The Medicare Deductible Explained).

Please note that Medicare places no limit on general hospital stays to treat mental health issues. However, inpatient treatment at a psychiatric hospital is limited to 190 days during your lifetime.

Get Help Now

If you have any questions regarding your Medicare coverage, our licensed agents are here to help. Call us toll-free at 855-350-8101. However, if you are in crisis, do not hesitate to call 911. You can also call the Suicide Prevention Lifeline at 800-273-8255, or the Veteran Crisis Line at 800-273-8255, Option 1. You can also call these organizations if you fear for the safety of a loved one.

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