People With Medicare
Mental Health Coverage
Medicare does not view Alzheimer’s disease as a mental illness. It is a medical illness. Knowing this can help you understand Medicare coverage.
When a doctor treats you for Alzheimer’s, Medicare usually pays 80% of the doctor’s bill. This is because Medicare sees it as a medical service.
Sometimes, people with Alzheimer’s need mental health services too. Medicare provides a mental health benefit that lets you see psychiatrists, clinical psychologists, or social workers. Medicare will cover 65% (in 2013) of the amount it approves for a mental health service.
If you seek a diagnosis or treatment for Alzheimer’s from a mental health professional, Medicare will pay either 80% or 65% of the fee (in 2013). How much depends on the type of visit.
Example #1: Mr. Jones is showing signs of Alzheimer’s. He visits his psychiatrist to get a diagnosis. This service will be billed as a medical service because it involves a diagnosis of Alzheimer’s. Medicare will cover 80% of the fee. Mr. Jones will have to pay for 20%.
Example #2: In 2013, Mr. Smith seeks psychotherapy treatment for his bipolar depression. He does not suffer from Alzheimer’s. This is billed as a mental health service. Since he is getting treatment, he will pay 35% of the amount Medicare approves, and any remaining portion of his Medicare Part B deductible.
Note: If your mental health provider sees you briefly, just to check on your drugs, Medicare should cover 80% of the cost of your visit.
Medicare also covers services you get as an inpatient in a psychiatric hospital. Medicare only pays up to 190 days during your lifetime for such care. Usually you pay the hospital deductible when you are admitted and daily copayments after day 60 in the hospital.
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