Many seniors battle mental health issues, coupled with chronic pain, you have two medical conditions that tend to be in a constant battle against each other. It has been proven that pain can affect one’s mental state just as one’s mental state of mind can affect one’s pain and healing process. It is important to get medical attention for both conditions so you can function and perform normal act’s of daily living.

Are Mental Health Service Covered Under Medicare?

Mental health coverage is available under your Medicare Part A and Medicare Part B benefits.

Under your Part A benefits, hospitalization for psychiatric care is covered at 80%. If hospitalized at a general hospital, your mental health care, room and food as well as any other related care is covered. If hospitalized at a psychiatric facility, you receive the same benefits however, Medicare gives you a lifetime limitation of 190 days in this type of facility. 

Under your Medicare Part B benefits, your outpatient mental health visits are included. Any office visits with a psychiatrist, psychologist or clinical social worker would fall under your Part B coverage. Additionally, your Part B benefits may cover diagnostic testing ordered by a provider, annual depression screenings, partial hospitalizations (a structured outpatient program for mental health care rather than inpatient admission), individual and/or group psychotherapy as well as family counseling if medically necessary.

Regardless of whether you’re using Medicare Part A or Medicare Part B, both benefits are only covered at 80%. This leaves the beneficiary responsible for the remaining 20%. Additionally, your deductibles for Part A and B will be required to be paid in advance. You may also be responsible for copays and coinsurance not covered by Traditional Medicare. 

A Supplement Plan can help offset some of these out of pocket (OOP) costs, saving you thousands of dollars in the long run.There are 10 letter plans offered by the various private insurance carriers. Based on your individual needs one will be the right fit for you.

Keep in mind, most mental health conditions normally require prescription drugs for palliative care. Traditional Medicare does not offer medication coverage so you will also want to consider a Medicare Part D Plan. A Part D Plan (PDP) will provide coverage for most medications which could otherwise end up costing you hundreds of dollars each month in OOP costs.

Is Interventional Pain Management Covered by Medicare?

Interventional pain management is the practice in which medication is used invasively to treat pain as an alternative to surgery. Usually, injection based treatments are combined with NSAIDS (Non-Steroidal Anti-Inflammatory Medications), OTC  (Over The Counter) or opioid pain medications, physical or occupational therapy, durable medical equipment (DME) and a home exercise program (HEP). The practice of interventional pain management is given by a specialist and is considered a type of conservative care. Types of pain management include intramuscular, nerve, spine and major joint injections, stem cell treatments, Botox, physical medicine and rehabilitation.

Medicare Part B will cover most but not all, interventional pain management, as this is usually performed in a physician’s office or an outpatient surgery center. In some cases, a patient will be administered a procedure while being hospitalized in which case your Medicare Part A benefits will pick up coverage.

Regardless of inpatient or outpatient interventional pain procedures, Medicare Part A and Medicare Part B will only cover at 80%. This leaves the medicare beneficiary responsible for the remaining 20%. Additionally, you will be responsible for any deductibles, copayments and coinsurance not covered by Traditional Medicare.

Here is another instance in where a Medicare Supplement Plan can help with coverage not covered by your Traditional Medicare benefits. There are a number of plans available in which you can choose that are best suited to fit your individual health care needs.

Additionally, with pain comes required medications. Whether it’s a prescribed NSAID, muscle relaxer, nerve stabilizer, infusion drug, opioid pain medication or in some cases an injectable medication, Traditional Medicare does not offer prescription drug coverage. This is where a Medicare Part D, or a Prescription Drug Plan (PDP), comes in handy. This will include coverage of any oral and in some cases injectable medications.