Marci's Medicare Answers
I know that usually Medicare covers outpatient mental health services at 60 percent. How does Medicare cover inpatient mental health services?
Your out-of-pocket costs are the same in a psychiatric hospital as they are in any hospital. Part A covers the cost of your care after you meet the $1,156 deductible in 2012. You can get inpatient mental health care either in psychiatric hospitals (hospitals that only treat mental health patients) or in general hospitals. Your doctor should determine which hospital setting you need.
If you receive care in a psychiatric hospital, Medicare helps pay for up to 190 days of inpatient care in your lifetime. After you have reached that limit, Medicare may help pay for mental health care at a general hospital.
If you enter a psychiatric hospital within 60 days of being an inpatient at a different hospital, you are in the same benefit period and do not have to pay the deductible again. A benefit period begins the day you start getting inpatient care and ends when you have been out of the hospital or skilled nursing facility for 60 days in a row.
Will Medicare pay for my osteoporosis screenings?
Maybe. Medicare may cover the full cost of bone mass measurement screenings every two years if your doctor says you are at risk for osteoporosis and one of the following applies:
- You are an estrogen-deficient women who is at risk for osteoporosis based on her medical history and other findings
- You have vertebral abnormalities that were shown on an x-ray
- You have received daily steroid treatments for more than three months
- You have hyperparathyroidism
- You take an osteoporosis drug
Medicare will also cover follow-up measurements or more frequent screenings if your doctor prescribes them.
I have high drug costs but my income is too high for Extra Help. What can I do?
Good question. Remember, you should apply for Extra Help even if you don’t qualify because some income is disregarded. However, if you know you don’t qualify for Extra Help, there are other programs that can assist you. Many states offer a state pharmaceutical assistance program (SPAP) to help their residents pay for prescription drugs. Each program works differently.
Many states coordinate their drug assistance programs with Medicare’s drug benefit (Part D). If you do not have Part D, but qualify for your state’s SPAP, you will have the chance to sign up for Part D, and you may be required to enroll in a Part D plan. If a drug is covered by both your SPAP and your Part D plan, both what you pay for your prescriptions plus what the SPAP pays will count towards the out-of-pocket maximum you must reach before your Medicare drug costs go down significantly. Your SPAP may also help pay for your Part D plan’s:
- copayments; and/or
- coverage gap. (Many SPAPs give you coverage during the Part D prescription drug coverage gap, or doughnut hole.)
Many states have reduced their SPAPs in 2012, so they may not offer all of these services. However, SPAPs can still be a valuable in helping you pay for high drug costs. Call your State Health Insurance Assistance Program (SHIP) to see if you qualify for your state’s SPAP.
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Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to “Dear Marci,” MRC’s free educational e-newsletter, click here.
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