Mental health care (partial hospitalization)
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Medicare Part B (Medical Insurance)
may cover a partial hospitalization program if you meet certain requirements and your doctor certifies that you would otherwise need inpatient treatment.
Your costs in Original Medicare
- You pay a percentage of the
Medicare-Approved Amount
for each service you get from a doctor or certain other qualified mental health professionals 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.
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
- If your doctor accepts assignment
- The type of facility
- Where you get your test, item, or service
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 if, or how much, Medicare will pay for them.
What it is
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. You get this treatment during the day, and you don't have to stay overnight. Medicare helps cover partial hospitalization services you get through a hospital outpatient department or community mental health center.
Things to know
As part of 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 program accept
assignment
.
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
Is my test, item, or service covered?
