Mental health care (partial hospitalization)
Medicare Part B (Medical insurance) may cover partial hospitalization services you get through a hospital outpatient department or community mental health center, if you meet certain requirements and your doctor or other qualified mental health professional certifies that you would otherwise need inpatient treatment
Description
Partial hospitalization provides a structured program of outpatient psychiatric services as an alternative to inpatient psychiatric care. It's more intense than care you get in a doctor’s or therapist’s office, and your care plan must state that you require at least 20 hours of therapeutic services per week. You get treatment during the day, and you don't have to stay overnight.
Coverage details
Medicare only covers partial hospitalization if the doctor (or other qualified mental health professional) and the partial hospitalization program accept assignment .
As part of your partial hospitalization program, Medicare may cover:
- Occupational therapy that’s part of your mental health treatment
- Individual patient training and education about your condition
- Caregiver training services
- Principal illness navigation services
Medicare doesn't cover:
- Meals
- Transportation to or from mental health care services
- Support groups that bring people together to talk and socialize (this is different from group psychotherapy, which is covered.)
- Testing or training for job skills that isn't part of your mental health treatment
Costs
- You pay a percentage of the Medicare-approved amount for each service you get from a qualified mental health professional if they accept assignment .
- After you meet the Part B deductible you also pay coinsurance for each day of partial hospitalization services you get in a hospital outpatient setting or community mental health center.
Facility
Hospital outpatient department or community mental health center.
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
Other insurance you may have
How much your doctor charges
If your doctor accepts assignment
The type of facility
Where you get your test, item, or service