Medicare Insurance
What does Medicare cover?
As of March 2024, 65,748,297 people in the US were enrolled in Medicare, a joint federal and state-funded insurance provider. Like all insurance programs, Medicare is required to cover behavioral health issues like substance use disorders or mental conditions. In fact, Medicare and Medicaid are the single largest funders of mental health services. Not every behavioral health facility will accept Medicare, but the good news is we do!
Regarding behavioral health (mental health and addiction services), Federal law requires Medicare to cover most services like detox and therapy. Most Medicare-sponsored individuals will also acquire some kind of prescription drug coverage.
Services under Medicare Part A
If you are only eligible for Medicare Part A and want to seek treatment for mental health or substance use disorders, the best thing to do is contact a skilled nursing facility (SNF), such as one at Compassion Recovery. At first, the SNF team will submit a report on your situation after assessing you for a few days. This is referred to as a 5-day assessment.
- Mental Health Care Services
- Daily Medication Administration
This is decided after evaluating your condition, i.e. your overall physical and mental health, medical history, and how well you are carrying on with daily tasks.
Services under Medicare Part B
If you are only eligible for Medicare Part A and want to seek treatment for mental health or substance use disorders, the best thing to do is contact a skilled nursing facility (SNF), such as one at Compassion Recovery. At first, the SNF team will submit a report on your situation after assessing you for a few days. This is referred to as a 5-day assessment.
- Outpatient
- Intensive Outpatient Services
- Partial Hospitalization Program
- Clinical Psychologists
This is decided after evaluating your condition, i.e. your overall physical and mental health, medical history, and how well you are carrying on with daily tasks.
Comprehensive Coverage
Mental health treatment
Medicare is required to cover mental health procedures as well as physical health issues. Medicare will cover the following treatments for mental health.
- Skilled nursing facilities
- Psychotherapy
- Cognitive-Behavioral therapy
- Prescription of medications
- Counseling
Medicare will keep track of how often the hospital services are being utilized. If you are not using your days at the hospital but the doctor deems you a right candidate for nursing facilities, Medicare will be able to cover it. Medicare comprises “benefit periods.” One benefit period lasts for 60 days. After 60 days, another one starts, meaning there will be new deductibles for mental health services at every benefit period.
Comprehensive Coverage
Substance use disorder coverage
Medicare aims to cover psychiatric services like therapy and detox. It is supposed to cover the following treatments to an extent.
This means you can get:
- General nursing
- Medication-assisted treatment (MAT)
- Individual therapy
- Prescription drugs
The actual cost of the procedure varies according to your chosen plan. Medicare also has a limit on deductibles and copayments. Medicare Part A requires individuals to pay the same copayment as they would for any other procedure.
Our Program Defined
We believe recovery is always possible
We strive to offer the best treatment experience and believe that through our proven program, that we can help you not only overcome mental illness, but achieve a fulfilling life full of gratitude and compassion beyond what seems possible at the beginning of your path to recovery.
Treating comorbidity
Medicare Part A covers certain parts of behavioral health issues. This may include services for co-occurring mental health issues and addiction. 50% of those with mental health conditions also suffer from substance use disorders (SUDs). Since the two conditions negatively influence one another, it is recommended that the two be treated together. Medicare is here to the rescue. Contacting an in-network provider like Compassion Recovery can improve the quality of life.
This benefits you in several ways including:
- You treat the most pressing issues first and remove blockers for treatment;
- You’re treating holistically, with understanding that mental health plays into substance abuse and substance abuse exacerbates mental health issues;
- You’re given a program that understands your total health, mental health, and trauma and takes everything into account;
- You pay deductibles and coinsurance once which can greatly reduce costs over following a multiple-track treatment schedule.
What are your costs with Medicare?
There is a lifetime limit on how much Medicare will pay for behavioral health issues, i.e., 190 days. Regarding Skilled Nursing Facilities (SNFs), Medicare will cover the costs on a short-term basis. After you have utilized 190 days of care, you will have to pay additional fees. So, while there is no limit on benefit periods, there is certainly a limit on how much Medicare will help you.
- For every benefit period, there is a $1600 deductible;
- $0 co-insurance in the first 20 days of care (generally. It may change according to your plan);
- During 21 to 90 days, a co-insurance of $204 per day is charged;
- After 90 days, the coverage may cease.
The coinsurance per day after additional days (known as lifetime reserve days). You may utilize a total of 60 lifetime reserve days. In the case of SNF, the additional costs may follow after a time period. Medicare does not cover out-of-network providers. However, certain plans may allow you to take insurance-covered treatments. You should talk to the insurance provider to better understand the plan.
Recovery Awaits
Compassion Recovery is in network for Medicare
If you are Medicare-sponsored, Compassion Recovery is the right place for you. We offer a range of treatments for addiction and mental health conditions. You may manage behavioral health issues in any setting suited to your needs.
- Mental health treatment
- Outpatient detox
- Partial hospitalization programs
- Intensive outpatient programs
- Virtual outpatient programs
- Dual diagnosis treatment
- Aftercare
- Therapy
If you feel like there are many nuances to mental health treatments, it is better to contact a specialist and talk things out. To understand how things work at Compassion Recovery, call (877) 414-3007.
