How Medicare Covers Therapy and Counseling for BFRBS

This is a post by Danielle Kunkle - the co-owner of Boomer Benefits, a licensed insurance agency that helps Baby Boomers navigate their entry into Medicare.

For decades, seniors in the United States had little access to affordable healthcare after they retired. The creation of Medicare in 1965 was a monumental step toward caring for older adults during their later years. Today millions of people depend on Medicare to provide their physical and mental healthcare during their golden years.

The World Health Organization website reported that over 20% of adults age 60 and older suffer from a mental or neurological disorder. Body-focused repetitive behaviors (BFRBS) are one such disorder.

BFRB disorders such as nail-biting, picking one’s skin or pulling one’s hair are harmful and can quickly progress into clinical conditions. Caregivers who are looking after an elderly loved one often notice disorders like skin picking and should immediately bring them to a doctor’s attention so that appropriate care can be found.

Access to behavioral therapy is important in dealing with BFRBs and all other mental health disorders as well. Fortunately, Medicare does recognize the need for mental healthcare as we age and provides coverage for inpatient and outpatient services as well as medications.

Mental Health Care under Medicare Part A

Medicare Part A benefits will cover up to 190 lifetime days of inpatient mental health care for a Medicare beneficiary. Part A pays for your hospital room and the care of nurses while you are being treated in a psychiatric care facility.

While Part A provides for care related to your inpatient stay, there are actually a number of services that may occur in a hospital that fall under Part B.

Mental Health Care under Medicare Part B 

Medicare Part B provides for healthcare that you receive on an outpatient medical basis. This includes preventive care, such as an annual depression screening each year. It also includes therapy with a psychiatrist or clinical psychologist.

Part B also pays for outpatient lab work, diagnostic imaging, individual and group therapy led by licensed mental health professionals, medication management training, and may even cover family counseling if your therapist recommends this.

It’s always important to verify that your mental healthcare providers participate in Medicare before you seek treatment.

What is your Cost-Sharing Under Medicare?

In addition to the premiums that a beneficiary pays for Medicare, there is also cost-sharing at the time of service.

Part A costs are generally measured in benefit periods. A new benefit period starts when you are admitted to a hospital. It ends whenever you have been out of the hospital for at least 60 consecutive days.

Beneficiaries are responsible for a Part A deductible upon entering a hospital. Currently, that deductible is $1340 per benefit period. Should you have a long hospital stay, you will also begin paying a daily copay on Day 61. Medicare Part A benefits run out on Day 150 and beneficiaries must shoulder the burden of all hospital costs after that time. 

Fortunately, there is no limit to the number of benefit periods that you can have. However, if the care is given inside an inpatient mental healthcare facility, then remember there is a lifetime limit under Part A of 190 days.

Part B also has a deductible, but it is considerably smaller – only $183 in 2018. After that deductible has been satisfied, then Medicare will pay for 80% of your covered services. You are responsible for the other 20%, which is called your coinsurance.

Since deductible and coinsurance can add up quickly, most people enroll in additional coverage to fill in the gap in Medicare such as Medicare supplements or Medicare Advantage plans.

Medicare Part D Drug Coverage

Part D was rolled out in 2006, and it is a voluntary prescription drug program. Drug plans and prices vary by state and insurance company. Each company offering a drug plan will have its own formulary of medications. Before enrolling in a plan, check the formulary to make sure it covers your medications.

Part D drug plans do cover nearly all antidepressants or antipsychotics that are commonly used to treat mental health disorders.

Filling in the Gaps

Medicare Supplements are individual health insurance plans that you can buy to pay for some or all of the gaps in your Medicare coverage. Also called Medigap plans, these policies pay after Medicare pays its share.

While a variety of Medigap plans are available, the benefits are standardized to make it easy for you to compare coverage. Medigap Plans G has been a popular plan in recent years because it covers almost all of the gaps in Medicare.

You can use your Medicare supplement with any doctor that accepts Medicare for payment. Since not all psychiatrists participate in Medicare, be sure to ask your counselor before you schedule a therapy session.

In recent years, another kind of coverage has also become popular, called Medicare Advantage plans. These are private insurance plans that pay for your covered services instead of Medicare. These plans usually have networks in a local or statewide area. All plans will have an online directory where you can search for a licensed provider.

The monthly premiums for Part C Medicare Advantage plans are often lower than the premiums for Medicare supplements. However, you’ll need to pay copays at the time of service. Click here for more information on these two Medicare plan options.