No two individuals are the same. People are different and deal with different things.

For example, maybe your loved one has mental health-related issues. What kind of coverage do you encourage them to get?

Medicare Part A and Part B does cover partial hospitalization for mental health treatment; therefore if your loved one were to visit the hospital because of mental health-related problems, then Medicare would be a good choice for them.

Partial hospitalization programs offer outpatient care in hospitals part-time. These times can be only during the day, only at night, or only on the weekends. These programs offer care that is more intensive than some forms of outpatient care.

In these programs, there are various types of resources so that the patient can have access to services tailored to their needs. These resources can include, individual/group therapy, occupational therapy, activity therapies (art, dance, or music therapy), prescription drugs that cannot be administered by oneself, and services needed to diagnose the condition and evaluate the care.

Partial hospitalization programs can be offered by hospitalization outpatient departments or even local mental health centers. Medicare will cover the patient’s partial hospitalization if a doctor verifies that they would otherwise need inpatient treatment or if they have recently finished inpatient treatment and requires partial hospitalization to avoid a relapse of their condition. Medicare will also cover partial hospitalization if a doctor certifies that less intensive treatments would not be enough to help the condition or avoid hospitalization. Medicare will also pay if the patient receives care from a Medicare-certified program.

Once the Medicare Part B deductible is met, the patient will be responsible for paying a percentage of the Medicare-approved amount for each service they have received from a mental health professional or doctor. The patient will also be responsible for coinsurance on each day they receive treatment in a hospital outpatient setting.

For help or other questions, call Medicare Pathways at 866-466-9118, and we would be glad to assist you!