You’ve taken a great first step to improve your mental health just by coming to this page. Whether you’re here for yourself or a loved one, rest assured Blue Cross and Blue Shield of Kansas is ready to walk you through the maze of Medicare’s mental health coverage for 2022 and beyond. Our services are custom-tailored to the unique needs of Kansans.
Mental health care in Kansas
Kansas faces unique struggles when it comes to mental health care for senior citizens on Medicare, including:
Many Medicare patients cannot keep up with the exorbitant costs of health care. To address this issue, The Inflation Reduction Act of 2022, which provides much-needed assistance for limiting the cost of critical drugs like insulin, was signed into law earlier this month. The Kansas state budget increased funding over two years to support the mental health needs of the state.
Kansas Medicare patients: mental health by the numbers
Mental health challenges can feel isolating, but you or your loved one are not alone. Nearly 13% of Kansans over 65 have been diagnosed with some level of depressive disorder, and 19.8% of Kansas Medicare recipients are treated for depression, according to the most recent data from 2018. With the pandemic, that number is surely higher.
Kansas takes part in the National Suicide Prevention Lifeline, which offers immediate help for mental health emergencies simply by dialing 988. The 988 Lifeline is open 24/7.
What does “mental health coverage” mean?
Some ailments aren’t always seen as directly correlated to mental health. You might have a mental health condition if you experience:
Don’t write off these conditions as a normal part of the aging process. A simple check-up can answer a lot of questions. Listen to those who encourage you to get help.
Does Medicare cover mental health treatment?
There are mental health coverage options and more on the way with new legislation. The three barriers to getting mental health support are patient reluctance to ask for help, misdiagnosis of mental health disorders and lack of timely mental health provider access.
Medicare has an extensive list of services for mental health support, and the Mental Health Access Improvement Act of 2021 could remove some of the barriers, should it pass Congress. In 2021, a new bill in Kansas reformed mental health care that was 30 years in the making, infusing $74 million into mental health facilities yearly.
NOTE: All information provided falls under the umbrella of “If the provider accepts the Medicare assignment.”
As the Kansas Insurance Department details, there are several mental health support options for those using Medicare. Patients have three options per year, and all of these are free with no deductible:
How much does mental health care cost?
Depending on your type of Medicare coverage, there are the costs of your deductible and co-insurance to consider.
Under Medicare Part B, most outpatient needs are covered. This applies to:
Does Medicare cover mental health counseling?
Medicare’s mental health coverage covers counseling in two ways: counseling for those caught in the cycle of drug or alcohol misuse and counseling for other health conditions requiring therapy.
NOTE: As of mid-2022, Medicare does not cover therapy related to family or marriage counseling unless it’s directly related to an illness or injury. There is a plethora of legislation hoping to reverse course and cover family and marriage counseling as part of the standard Medicare plan.
More than one-third of Kansas Medicare recipients are taking some form of opioid each day to manage pain. New research from August 2022 shows that 1.7 million Medicare beneficiaries have been formally diagnosed as having a substance abuse problem.
Coverage for alcohol or medication misuse counseling
As the opioid epidemic reaches staggering new highs nationwide, there are several ways this can impact people over 65:
Medicare covers medications, drug testing, and therapy or counseling. Counseling services are permitted in-person or virtually.
Alcohol counseling is available to beneficiaries who have been diagnosed with an alcohol misuse condition. Four sessions a year are permitted, but they must be completed in-person. With a mental health condition like depression, virtual counseling is available.
Assuming you’re using a Medicare-approved provider for alcohol or drug misuse diagnoses and counseling, there is no cost to you.
Coverage for other mental health-related counseling
The pressure point on the limit of Medicare mental health counseling is that it must be related to an injury or illness. Kansas now allows out-of-state providers who meet all the training and education requirements to offer counseling services to Medicare beneficiaries.
A clear line of distinction exists when it comes to counseling or therapy. You’re only covered if you have a licensed professional who accepts and is approved by Medicare. Attending group therapy at a community center or doing one-on-one counseling with your pastor are two examples of mental health support that are not covered.
What is the Medicare-approved amount for mental health services?
Unless you’re going for a yearly check-up and one of the therapy sessions mentioned above, you’re likely going to first have to pay your deductible and then 20% of the total costs. Any out-of-pocket limit would be case-dependent, so check with your plan provider to be sure.
For mental health services that require a hospital visit (inpatient or outpatient), you could experience an additional co-insurance charge.
Inpatient mental health support
Medicare Part A, or an inclusive Advantage plan, is what helps cover the costs of mental health care in a traditional or psychiatric hospital. In a psychiatric hospital, however, Part A only covers 190 days (7 months) per lifetime, not per year.
A stay in a hospital constitutes what’s called a “benefit period,” and you have no limit on the number of benefit periods.
Each “benefit period” has an average deductible of $1,408.
A benefit period ends when you haven’t been admitted to a hospital in two months. Should you return to a hospital, the benefit period – and deductible – resets.
COST: You’ll pay 20% of the cost for hospital inpatient services related to mental health care unless you have Medigap coverage.
Does Medicare cover mental health-related medications?
Medicare Part D provides a drug list of the medications that are covered. While this list is extensive, it’s also easily searchable. Medicare drug plans are mandated to cover antidepressants, anticonvulsants and antipsychotics, with very few exceptions.
Should a medication you take be removed from the drug list, you’ll get at least 30 days’ notice. If your doctor prescribes a medication that isn’t approved, you have the right to appeal a coverage determination or exception. Medicare also allows a medical provider or loved one to advocate for you in the determination process.
What other potential mental health costs are NOT covered by Medicare?
Medicare, in all its variations, has coverage limitations. Here’s a list of mental health services not covered by Medicare:
Help is on the horizon: learn more about Medicare and mental health coverage From Blue Cross and Blue Shield of Kansas
You’re only one click or phone call away from getting the help you need from a Kansas-approved provider to support your mental health. Blue Cross and Blue Shield of Kansas is committed to making Medicare simple and efficient. Our staff can help, whether you’re the beneficiary or a concerned loved one.
The Kansas state flag proudly states, “Ad Astra per Aspera,” which translates to “to the stars through difficulties.” It embraces our state’s pioneering spirit and the challenges we overcome while turning the impossible into reality. Let Blue Cross and Blue Shield of Kansas help you on your journey to mental wellbeing – even in your golden years.
CALL NOW: You can reach a representative at 1-800-432-3990, or dial 988 if this is a mental health emergency.