What Medicare beneficiaries spend on behavioral care: 10 numbers to know

Traditional Medicare and Medicare Advantage beneficiaries typically paid out-of-pocket for inpatient and outpatient behavioral services, according to a report from the Government Accountability Office. 

Congress instructed the GAO to review behavioral health benefits provided by Medicare. Previous government reports have raised concerns about a lack of providers participating in Medicare. 

Here are 10 numbers to know about cost-sharing for traditional Medicare and Medicare Advantage services: 

  1. For inpatient behavioral hospitalizations, traditional Medicare beneficiaries paid a deductible of $1,632 for days 1-60 of hospitalization. After 60 days, coinsurance is $408 per day. After 91 days, coinsurance increases to $816 per day. 

  2. Traditional Medicare beneficiaries are required to pay an annual deductible of $240 for some outpatient services, including behavioral health services. 

  3. In addition to the deductible, traditional Medicare beneficiaries pay 20% coinsurance for most outpatient behavioral health services. For a $150, 60-minute therapy session, traditional Medicare members would pay $30 in coinsurance. 

  4. Traditional Medicare beneficiaries do not pay coinsurance for opioid treatment program services, depression screening and smoking cessation counseling. 

  5. Most Medicare Advantage plans do not require coinsurance for inpatient psychiatric hospitalizations, the GAO found. The majority of plans did implement co-pays for inpatient psychiatric hospitalizations. 

  6. The median copayment for a 3-day hospitalization in an acute-care facility was $900. For a 60-day hospitalization, the median copay was $1,650. 

  7. The majority of Medicare Advantage plans require copayments for behavioral-specific services, including group and individual psychiatric services and partial hospitalization programs. 

  8. For Medicare Advantage beneficiaries, the average copay for individual sessions for mental health speciality services and individual psychiatric services was $30. 

  9. The majority of Medicare Advantage plans required prior authorization for partial hospitalization, individual and group therapy and opioid treatment programs. 

  10. Around 1 in 4 Medicare Advantage plans offered additional sessions for smoking and tobacco cessation counseling than traditional Medicare. A smaller number of plans offered additional coverage for residential treatment and counseling services. 

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