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:
- 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.
- Traditional Medicare beneficiaries are required to pay an annual deductible of $240 for some outpatient services, including behavioral health services.
- 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.
- Traditional Medicare beneficiaries do not pay coinsurance for opioid treatment program services, depression screening and smoking cessation counseling.
- 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.
- 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.
- The majority of Medicare Advantage plans require copayments for behavioral-specific services, including group and individual psychiatric services and partial hospitalization programs.
- For Medicare Advantage beneficiaries, the average copay for individual sessions for mental health speciality services and individual psychiatric services was $30.
- The majority of Medicare Advantage plans required prior authorization for partial hospitalization, individual and group therapy and opioid treatment programs.
- 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.