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For some people with disabilities, Medicare may be their best resource for health care. But if they need mental health care, they’ll find that coverage is limited. Medicare will cover only 190 days of inpatient care in a lifetime and has other limitations.

The Original Medicare Plan is a fee-for-service insurance program managed by the Federal Government and is for:

• people age 65 or older,
  
• people under age 65 with certain disabilities, and
  
• people of all ages with a specific kidney disease
  

Medicare offers two types of plans to choose from:

1. Original Medicare Plan
   Hospital Insurance (Part A)
   Medical Insurance (Part B)
   Prescription Drug Coverage (Part D)
   Medigap Insurance
   OR
   
2. Medicare Advantage Plans like HMOs and PPOs (Part C) which can be combined with Part D.

Original Medicare Plan
Most people get their coverage through the Original Medicare Plan.

Part A (hospital)
Part A helps cover inpatient care in hospitals and some other facilities for those who qualify. .

• Most people pay no premium for Part A, because they paid Medicare taxes while working. Otherwise, those age 65 or older or disabled may be able to buy it. Premiums are up to $410 per month.
  
• For those with limited income and resources, their state may help pay for Part A and/or Part B.
  
• Medicare Part A covers inpatient care in a psychiatric hospital for only 190 days in a lifetime. (There is no lifetime limit on inpatient care given in general hospitals.). You'll pay a one time deductible of $992 for a hospital stay of up to 60 days in each 60-day benefit period.

Part B (medical)
Part B, which is optional, helps cover services of doctors' (inpatient and outpatient), clinical social workers, psychologists and nurse practitioners; partial hospitalization; occupational, group and family therapy; screenings and other medical services that Part A doesn't cover,

• Benefits for mental health services are not limited. You pay 50 percent for outpatient mental health care that is "medically necessary," after you've paid a $131
• You have your choice of doctors.
  
• Most people pay a monthly premium for Part B, which is based on income. For example, an individual earning $80,000 or less and a married person with a joint income of $160,000 or less will each pay $93.50 per month.
  
• Costs for services vary depending on the plan you choose. You may pay a coinsurance amount.
  
• You also pay a deductible each year before Medicare starts to pay its share. You may be able to get help from your state to pay this premium and deductible
  
• You may choose to have a Medigap policy that may pay some out-of-pocket costs.
  
• If you have limited income, there are programs that may help pay for some health care and prescription drugs.

Part D (Prescription Drug Coverage)
Plan D, which is optional, is available to everyone with Medicare, but most people will pay a monthly premium for this coverage. Premiums vary, but average $27 per month.

• Plans cover different drugs, but "medically necessary" drugs must be covered.
  
• You pay a copayment and, in some cases, a yearly deductible for prescription drugs. Charges vary by plan.
  
• Each Medicare drug plan has a list of covered drugs (a formulary). The list must include at least two drugs (and in some cases all drugs) in all classes of drugs most commonly prescribed to people with Medicare.
• If a specific drug is not on the list of covered drugs, another drug may be substituted. This may be a generic drug or a less-expensive therapeutic alternative (other brand-name drug).
  
• Medicare is not required to cover some drugs, such as benzodiazepines (which are prescribed for some anxiety disorders) or barbiturates, but some plans may choose to cover these drugs.
  
• Your doctor may request an exception to these restrictions, but it may not be granted.
  
• People with limited income and resources can qualify for extra help paying their Medicare Prescription Drug Plan costs.

Medigap Insurance Policy
You may purchase this private coverage (or an employer/union may offer similar coverage) to fill in gaps in Part A and Part B coverage. Costs vary.

OR

Part C Medicare Advantage Plans like HMOs and PPOs
This option combines Part A (Hospital) and Part B (Medical). Private insurers approved by Medicare provide this coverage. These plans generally offer extra benefits, and many include Part D drug coverage.

• Generally, you must see doctors in the plan.
  
• In many cases, premiums (average cost $24) or costs of services (co-pays) can be lower than for the Original Medicare Plan or the Original Medicare Plan with a Medigap policy.
  
• Mental health benefits vary by plan.

Part C + Part D
(Prescription Drug Coverage)
Most Part C plans cover prescription drugs. If they don't, you may choose to purchase Part D coverage. See above for details.

Where can I get more information?
Medicare or call 1-800-MEDICARE (1-800-633-4227
Social Security or call 1-800-772-1213.
Read an in-depth explanation of Medicare plans
Mental Health America
National Alliance of Mental Illness

Consumer warning:
AARP warns that some unscrupulous salespeople are peddling Medicare insurance. Do not buy from anyone who rushes you into deciding, has come to your home uninvited or tells you all doctors will accept the plan (Check for yourself.)

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