Jack's Blog on Medicare Plan Choices

As I have mentioned in a previous blog, more and more customers tell me that they experience or have experienced some type of anxiety or mental health episodes.  Mental health is a crucial aspect of overall well-being, and for many Americans, inpatient care is sometimes necessary. With this article, I hope to bring some clarity to the issue of inpatient care.

First of all, inpatient care is always covered by Medicare Part A. Inpatient mental health care services are no exception.  As expected, services must be received in a facility participating with Medicare.  This can be either a general hospital or a specialized psychiatric hospital

Coverage includes:

1. Room and board
2. Nursing care
3. Therapy and treatment
4. Medications administered during your stay
5. Lab tests and other diagnostic procedures

Important Limitations to Be Aware Of

1. 190-Day Lifetime Limit: Medicare imposes a 190-day lifetime limit on inpatient care in psychiatric hospitals. This limit does not apply to mental health services provided in general hospitals.

2. Benefit Periods: Coverage is divided into benefit periods. A benefit period begins when you’re admitted and ends when you haven’t received inpatient care for 60 consecutive days.

3. Coinsurance: While Medicare covers the first 60 days of a benefit period in full (after the deductible), you’ll be responsible for coinsurance for days 61-90 and beyond.

Out-of-Pocket Costs

1. Deductible: You’ll need to pay the Medicare Part A deductible for each benefit period.
2. Coinsurance: Increases the longer your stay extends beyond 60 days.
3. No coverage beyond 190 days in a psychiatric hospital in your lifetime.

Accessing Care

To receive coverage, you must:

1. Be admitted on a doctor’s order
2. Receive care in a Medicare-certified facility
3. Have your doctor certify that inpatient care is medically necessary

Medicare Advantage Plans

Medicare Advantage plans must cover at least the same level of inpatient mental health care as Original Medicare.  Medicare Advantage plans may replace coinsurance with set copayments.  Check with your broker or call me.

Conclusion

While Medicare provides significant coverage for mental health inpatient care, it’s crucial to understand the limitations and potential out-of-pocket costs.

Remember, mental health is just as important as physical health. Don’t hesitate to seek the care you need, and use your Medicare benefits to support your overall well-being.

Here is my disclaimer.  I gather most of my information from Medicare.gov and to the best of my knowledge, it is accurate.  Please use this information as a guideline.

Before choosing an Advantage or Supplement plan, ensure you have a thorough understanding of Medicare itself. When it’s time to explore your options, don’t fall for a sales pitch from a single company or an agent representing only one provider.

At “More Plans More Choices,” I can provide you with side-by-side comparisons from various insurance carriers. More carriers plus more plans equals more choices.

Call me toll free at (888) 883-6074