Q. My mother, Sally, is 67, has chronic depression, and is in the early stages of Alzheimer’s. In the past, Medicare only covered 50% of the costs of her psychological treatment for her depression. I feel like this is discrimination, since mental health treatment covered by Medicare is not on equal footing with other medical and surgical services. I hear, however, that the amount covered has gone up. How much does Medicare cover now for mental health outpatient services and what services are covered? Also, does Medicare pay for the care that is needed by people suffering from Alzheimer’s disease or other types of dementia?
A. For decades, Medicare has effectively discriminated against older adults with psychological conditions, such as depression and anxiety, because these conditions have received unequal treatment under Medicare. Medicare has paid a smaller share of the bill for therapy from psychiatrists, psychologists or clinical social workers than it did for medical services and has imposed strict lifetime limits on psychiatric hospital stays.
In 2008, Medicare covered 50% of the cost of psychological treatment, while in 2013, it covered 65%. Beginning in 2014, Medicare will pay 80% of its approved amount for certain outpatient mental health services. Payment kicks in once someone exhausts an annual deductible of $147 per year. Covered services include:
- Individual and group therapy
- Family counseling to help with your treatment
- Tests to make sure you are getting the right care
- Activity therapies, such as art, dance or music therapy
- Occupational therapy
- Training and education (such as training on how to inject a needed medication or education about your condition)
- Substance abuse treatment
- Laboratory tests
- Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you
Medicare will pay for the services of medical doctors (such as psychiatrists) who do not take Medicare (non-participating providers), but these doctors can charge you up to 15% above Medicare’s approved amount. Some states have stricter limits on how much doctors can charge. Find out more about Medicare’s Mental Health benefits on the Medicare.gov website.
Since its inception, Medicare has also effectively discriminated against older adults in that Medicare does not pay for the type of care that is needed by people suffering with certain diseases; specifically, Medicare (and, for that matter, private health insurance) does not pay for the care that is needed by people suffering from chronic illnesses such as Alzheimer’s disease or other types of dementia, or other brain diseases that cause a diminished ability to function without assistance from others. When a family has a loved one with one of these “wrong types of diseases,” that family must become officially “impoverished” under federal and state Medicaid rules in order to gain access to basic long-term care.
It is a tremendous shame that our country’s social policy essentially discriminates against those who get these “wrong types” of diseases. I submit that it is unfair for Medicare to provide full coverage for most diseases but force those with the “wrong type” of disease to go broke financially in order to gain access to the basic care needed – care which our society calls “long-term care” instead of “health care.” It should be no surprise to anyone that most knowledgeable families seek legal methods to preserve the efforts of a lifetime in order to protect themselves from our country’s unfair social policy.
If you have a loved one who is nearing the need for long-term care or already receiving long-term care, please contact Farr Law Firm, P.C. as soon as possible at our Virginia Elder Law Fairfax office at 703-691-1888 or at our Virginia Elder Law Fredericksburg office at 540-479-1435 to schedule your appointment for our consultation.
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About Evan H Farr, CELA, CAP
