My wife has Original Medicare, and is currently a hospital inpatient receiving treatment for a mental health condition. Her doctor there has indicated that she might benefit partial hospitalization when she is discharged. Is this something that Medicare covers?
-Terry (Rapid City, SD)
Dear Terry,
Medicare Part B does cover partial hospitalization for mental health treatment. Partial hospitalization programs offer outpatient care in a hospital setting on a part-time basis, which can mean only during the day, only at night, or only during weekends. Partial hospitalization programs provide care that is more intensive than other forms of outpatient care, but less intensive than inpatient care.
In such a program, your wife will follow a plan of care tailored to her needs. Services may include the following:
Individual or group therapy
Occupational therapy
Activity therapies such as art, dance, or music therapy, when they are used to help your wife meet the goals of her plan of care
Prescription drugs that your wife cannot administer herself
Training and education closely related to your wife’s plan of care
Family counseling that primarily supports your wife’s treatment (not if it primarily promotes the wellbeing of the family)
Services needed to diagnose your wife’s condition and evaluate her care
Partial hospitalization programs may be offered by hospital outpatient departments and by community mental health centers. Medicare will cover your wife’s partial hospitalization if both of the following apply:
A doctor certifies that:
She would otherwise need inpatient treatment, or has recently been discharged from inpatient care and needs partial hospitalization to avoid a relapse in her condition.
And, less intensive treatment options (such as outpatient therapy) would not be enough to help her avoid hospitalization.
She receives care from a Medicare-certified program.
After meeting the Part B deductible, your wife will be responsible for paying a percentage of the Medicare-approved amount for each service she gets from a doctor or other qualified mental health professional if the providers accept assignment. She will also be responsible for a coinsurance for each day of partial hospitalization services provided in a hospital outpatient setting or community mental health center.
If you and your wife need assistance finding a Medicare-certified partial hospitalization program, you can call 1-800-MEDICARE or visit www.medicare.gov.