Medicare Part A provides coverage for qualifying inpatient mental health services when medically necessary, as determined by a doctor. A qualifying person needs treatment at an inpatient facility.
Under Part A, coverage for psychiatric care includes room and board in a semiprivate hospital room and services such as talk therapy, lab tests, nursing care, and needed medications.
Services excluded from coverage include stays in a private room unless medically necessary, private nursing, in-room phones or televisions, and personal care that is not medically necessary.
Part A covers only 190 days of inpatient psychiatric care in a dedicated psychiatric hospital throughout a person’s lifetime, except when a person receives care in a Medicare-approved psychiatric unit within an acute or critical care hospital.
Does Medicare Advantage cover inpatient psychiatric services?
A person can sign up for Medicare Advantage (Part C), which is an alternative to Original Medicare (parts A and B).
These plans may offer the same coverage as Part A. Some plans may cover additional services related to inpatient psychiatric care that Part A does not cover.
Most people do not pay a Medicare Part A premium but must meet a $1,676 deductible. Once they do, Part A can fully cover their hospital stay and any needed care for the first 60 days.
The daily copayment is $419 between days 61 and 90. From day 91 until a person uses up their lifetime reserve days, this fee rises to $838. Afterward, a person has to pay the full daily cost.
Part C-insured people may face different premiums, deductibles, and copays based on their specific plan.
On Medicare.gov, a person can search for inpatient psychiatric care facilities in their area that accept Medicare by entering their zip code.
Before entering any facility, a person must speak with the staff and verify whether the facility is a participating provider. Some facilities may be nonparticipating providers, which means they may accept Medicare for some services but not others. This can affect a person’s out-of-pocket cost.
A Part C-insured person must check their plan’s specific network for a participating facility.