Medicare will start covering mental health at the same cost as other medical conditions beginning Jan 1, 2014. Although this may seem to be a huge victory for seniors 65 and over, there is still a disparity in care, as well as seniors may find it difficult to access care.

Lower Mental Healthcare Costs for Seniors

The Medicare Improvements for Patients and Providers Act has helped lower costs for seniors 65 and over and on Medicare, and for the first time ever on January 1st seniors will only pay 20% of their out-patient mental health costs (seniors paid 50% in 2008, and 35% in 2013).

Senior Mental Healthcare Disparity

Medicare puts a lifetime cap of 190 days on in-patient care for mental issues for seniors -no other health issue with Medicare have this cap. And, even though all health plans for those under 65 must treat mental health the same way as other medical issues, this does not apply to Original Medicare.

Seniors May Find a Lack of Access to Care

Medicare pays a very low reimbursement rate to psychologists and psychiatrists, therefore only 54% of mental health professionals are willing to take Medicare assignment. This can make it pretty difficult for Medicare beneficiaries to receive medical care for mental health.

How to Get the Best Senior Mental Healthcare

Your retiree benefits, VA health care, Long Term Care policies, and/or employer’s health plan may help cover costs of mental health. You will want to check with your policy to learn how you are covered. However, If you are ineligible for one of these policies or if you find you’ll receive better senior healthcare coverage through a Medicare Supplemental policy, Medigap will cover your mental health benefits in the following ways:

  • If you have a Medigap policy you won’t pay anything out of pocket for out-patient mental health (after you meet your Part B 2014 deductible, if applicable).
  • Medigap also extends hospitalization stays up to 365 days, which, according to the Center for Medicare Advocacy, the NAIC* does not distinguish a difference between regular medical hospitalization and psychiatric hospitalization.
  • Medigap only covers your care if Medicare is accepted. So, unfortunately, Medigap will not be able to help you find access to more healthcare professionals.

*NAIC stands for the National Association of Insurance Commissioners. This information is to the best of our knowledge, as mental health policies are changing we will update this article accordingly.

To learn more about your mental health benefits call the number above or contact