Mental health care (partial hospitalization)

Mental health care (partial hospitalization)

How often is it covered?

 covers 

 in some cases. 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. This treatment is provided during the day and doesn’t require an overnight stay. Medicare helps cover partial hospitalization services when they’re provided through a hospital outpatient department or community mental health center. Along with your partial hospitalization program, Medicare may cover these:

  • Occupational therapy that’s part of your mental health treatment
  • Individual patient training and education about your condition

Medicare only covers partial hospitalization if the doctor and the partial hospitalization program accept 

.

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.
Who's eligible?

For Part B to cover a partial hospitalization program:

  • You must meet certain requirements.
  • Your doctor must certify that you would otherwise need inpatient treatment.
Your costs in Original Medicare

You pay a percentage of the 

 for each service you get from a doctor or certain other qualified mental health professionals if your health care professional accepts 

. You also pay 

 for each day of partial hospitalization services provided in a hospital outpatient setting or community mental health center, and the Part B 

 applies.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • Whether your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

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