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Medicare and Mental Health for Seniors: What’s Covered and How to Get the Help You Need

Does Medicare Cover Mental Health?

When you reach a certain age, you expect that your health may not be what it once was. Your bones may become brittle, you are more susceptible to accidents and injury, and it can take longer to recover from everyday illnesses, such as the flu or a cold, that never kept you down before. However, one thing you may not have considered is your mental health.

Geriatric Depression

Geriatric depression is a plague on our society. Issues such as limited mobility, financial hardships, and isolation can take a toll on your mental health, even if you’ve never shown signs of emotional distress before. Senior depression is often a disease of circumstance, but family history and naturally lower levels of norepinephrine and serotonin in the brain can make some seniors more susceptible to mental health issues.

Seniors suffering from depression present many of the same symptoms as everyone else. Feelings of worthlessness, unexplained crying spells, changes in appetite, and sleep disorders are common. According to the CDC, a depressed senior may also suffer from persistent aches and pains, experience extreme fatigue, or talk about suicide as opposed to natural death. If you find yourself experience any of these, it may be time to consider getting help.

Medicare Coverage

Basic Medicare provides coverage for a once-per-year depression screening. Seniors with basic coverage may also be eligible for individual or group therapy and family counseling. A psychiatric evaluation and other diagnostic tests may also be ordered and are usually covered by Medicare. Medicare Part B provides outpatient services for alcohol and drug treatment and other mental health care issues.

Medicare Part A and B only offer limited coverage for hospital and outpatient medical services, respectively. If you are at a higher risk of depression, you may wish to consider a Medicare supplement plan, which offers an elevated level of benefits for both physical and mental health care. The AARP explains that Medicare Part C is private insurance and is often organized as a PPO or HMO. As a general rule, seniors with a Part C plan have access to more providers.

Medicare Part D also provides significant drug coverage not available to original Medicare recipients. Medicare’s website provides a great deal of information, but it can be challenging to navigate for seniors who are not computer savvy. This helpful online resource can help take some of the mystery out of government-sponsored health care coverage.

Participating vs. Non-Participating Doctors

When looking for a mental health care services provider, there are two types of Medicare doctors: participating and non-participating. A participating doctor is one who accepts the amount of money Medicare is willing to pay for services. This dollar amount is called an “assignment.” Participating providers charge 20 percent of each benefit’s cost to the patient. Medicare then covers the remaining balance. For example, a therapy session that is given an assignment of $100 means that is the maximum dollar amount a participating provider can charge for that service. The patient pays $20 and Medicare, which is billed directly, covers the remaining $80. Non-Medicare recipients are charged differently and often at a much higher rate.

A nonparticipating provider is not required to accept Medicare patients but does accept payment from Medicare. They have the right to charge a 15 percent premium for services. This is known as a Medicare access charge and is paid directly by the patient.

Many healthcare clinics and individual providers elect not to accept Medicare payments. They’re free to charge whatever price they feel is appropriate for their services. Seniors choosing a treatment from this type of private service provider are responsible for 100 percent of costs.

How a Doctor Can Help

For many seniors, talking about mental health, even with their doctors, is uncomfortable. A doctor can listen for clues that a senior is depressed, however, even if he or she is unwilling to accept that their mental health is at risk. Most healthcare providers make a point to discuss mood, sleep patterns, and dietary habits and can assess from this information if the senior would benefit from mental health care services.

In addition to providing a referral, a primary care physician can help by encouraging a proper diet, social interaction, and other healthy lifestyle habits to improve overall well-being. Most physicians will discuss the physical and mental health benefits of physical activity with their elderly patients. HealthyPlace.com’s Natasha Tracy reports that exercise is a powerful antidepressant for elderly men and women. This is especially important for seniors who refuse to take antidepressants because of a perceived stigma.

The good news is that you don’t have to undergo vigorous training to reap the benefits of exercise, and Medicare has partnered with gyms across the country to provide free memberships for those over age 65. SilverSneakers.com has more information.

Choosing a Mental Health Professional

Choosing the right care is crucial to recovery. In addition to determining the provider’s relationship with Medicare, seniors should ask themselves what problems need to be treated and what type of treatment the provider offers. Extreme depression may require psychiatric hospitalization or inpatient residential mental health treatment. This will usually be followed up by outpatient treatment, which may include visiting a psychologist or counselor. Seniors suffering from substance abuse or other co-occurring conditions may also be referred to additional support programs. Additionally, alternative treatment methods such as meditation, acupuncture, or guided imagery may be recommended.

The mental health crisis in America is not limited to teenagers and young adults. As life expectancy continues to increase, more and more seniors will be treated for depression and other related disorders. And it’s vital these individuals receive prompt treatment since, according to Thomas Insel, the former director of the National Institute for Mental Health, mentally ill seniors experience an average life reduction of more than a decade.

If you are at risk of or are suffering from depression, don’t delay. Treatment is available and may be more affordable than you think. Talk to your doctor, and don’t be afraid to ask for help or use online resources to find a mental health care provider that accepts Medicare.

If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Resource Specialist can help you find expert mental health resources to recover in your community. Contact us now for more information on this free service to our users.

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Author Bio: Teresa Greenhill is the co-creator of MentalHealthForSeniors.com, which is dedicated to providing seniors with information on physical and mental fitness so that they can be active and happy in their golden years.


Photo by rawpixel.com from Pexels

The opinions and views expressed in this guest blog do not necessarily reflect those of www.rtor.org or its sponsor, Laurel House, Inc. The author and www.rtor.org have no affiliations with any products or services mentioned in this article or linked to herein.

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