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Dear Marci: What home health services does Medicare cover?

Home health care includes a wide range of health and social services delivered in your home to treat illness or injury. If you qualify for the home health benefit, Medicare covers the following: • Skilled nursing services, such as injections, tube feedings, catheter changes, observation and assessment of your condition, and wound care o Provided up to seven days per week for generally no more than eight hours per day and 28 hours per week. In some circumstances, Medicare can cover up to 35 hours per week. • Skilled therapy services, such as physical therapy, speech language pathology, and occupational therapy o Note: You cannot qualify for Medicare home health coverage if you only need occupational therapy. However, if you qualify for home health care on another basis, you can also get occupational therapy. When your other home health needs end, you can continue receiving Medicare-covered occupational therapy under the home health benefit if you need it. • Home health aide, who provides personal care services like bathing, toileting, and dressing o Note: Medicare pays in full for an aide if you required skilled care. Medicare will not pay for an aide if you only require personal care and do not need skilled care. • Medical social services, such as counseling or help finding resources in your community o Medical social services are ordered by your doctor to help with social and emotional concerns you have related to your illness. • Medical supplies, such as wound dressings and catheters • Durable medical equipment (DME), such as wheelchairs and walkers There are certain requirements one must meet to be eligible for the home health benefit. For example, an individual must be considered homebound and have a plan of care approved by their doctor. Do note, however, that during the current coronavirus public health emergency, some of these requirements have been changed to allow for greater access to home health care. It is also important to know that your home health care is covered by Medicare even if your condition is chronic or if you are not showing signs of improvement. Speak with your doctor to begin home health care. If you have Original Medicare, call 1-800-MEDICARE or visit www.medicare.gov/care-compare to find a list of Medicare-certified home health agencies (HHAs). If you have a Medicare Advantage Plan, you should contact the plan directly for a list of HHAs in your plan’s network. -Marci Dear Marci is a free e-newsletter from the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. For more free answers to your Medicare questions, visit Medicare Interactive (MI) at www.medicareinteractive.org. Subscribe to Dear Marci by registering for your free account on Medicare Interactive. For more postings by Medicare Interactive, click Here Receive a 20% discount on Medicare Interactive courses with code: "WCC20" Website: https://www.medicareinteractive.org/wcc WealthCare Connect may receive a referral fee from Medicare Interactive for purchases make through these links.

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Medicare Interactive

March 1, 2021

Dear Marci: Will Medicare cover therapy appointments with a psychologist?

Medicare does cover outpatient mental health care services, like individual therapy sessions. There are some important considerations to take when choosing your provider, if you would like to ensure your care is covered and to save money. Let’s discuss Medicare coverage and outpatient mental health care services more. Medicare Part B covers outpatient mental health care, including the following services: • Individual and group therapy • Substance use disorder treatment • Tests to make sure you are getting the right care • Occupational therapy • Activity therapies, such as art, dance, or music therapy • Training and education (such as training on how to inject a needed medication or education about your condition) • Family counseling to help with your treatment • Laboratory tests • Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you • An annual depression screening (speak to your primary care provider for more information) Original Medicare covers the outpatient mental health services listed above at 80% of the Medicare-approved amount. This means that as long as you receive services from a participating provider, you will pay a 20% coinsurance after you meet your Part B deductible. If you are enrolled in a Medicare Advantage Plan, contact your plan for cost and coverage information. Your plan’s deductibles and copayments/coinsurance may differ. Medicare covers mental health care you receive through an outpatient hospital program, at a doctor’s or therapist’s office, or at a clinic. You may receive services from the following types of providers: • General practitioners • Nurse practitioners • Physicians’ assistants • Psychiatrists • Clinical psychologists • Clinical social workers • Clinical nurse specialists If you see a non-medical doctor (such as a clinical psychologist or clinical social worker), make sure that your provider is Medicare-certified and takes assignment. Medicare will only pay for the services of non-medical doctors if they take assignment. It is also important to note that psychiatrists are more likely than any other type of provider to opt out of Medicare. Be sure to ask any provider if they take your Medicare insurance before you begin receiving services. Remember, if you see an opt-out provider, they must have you sign a private contract. The contract states that your doctor does not take Medicare and you must pay the full cost of the service yourself. Medicare will not reimburse you if you see an opt-out provider. If your provider does not have you sign a contract, you are not responsible for the cost of care. If you have Original Medicare and need help finding a participating provider, you can use Medicare’s Physician Compare tool online or call 1-800-MEDICARE. If you have a Medicare Advantage Plan, call your plan directly for a list of mental health care providers in your plan’s network. For additional assistance accessing behavioral health care providers and other local resources, call the Substance Abuse and Mental Health Services Administration (SAMHSA) at 800-662-4357. -Marci Dear Marci is a free e-newsletter from the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. For more free answers to your Medicare questions, visit Medicare Interactive (MI) at www.medicareinteractive.org. Subscribe to Dear Marci by registering for your free account on Medicare Interactive. For more postings by Medicare Interactive, click Here Receive a 20% discount on Medicare Interactive courses with code: "WCC20" Website: https://www.medicareinteractive.org/wcc WealthCare Connect may receive a referral fee from Medicare Interactive for purchases make through these links.

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Medicare Interactive

February 8, 2021

Dear Marci: Will Medicare cover therapy appointments with a psychologist?

Medicare does cover outpatient mental health care services, like individual therapy sessions. There are some important considerations to take when choosing your provider, if you would like to ensure your care is covered and to save money. Let’s discuss Medicare coverage and outpatient mental health care services more. Medicare Part B covers outpatient mental health care, including the following services: • Individual and group therapy • Substance use disorder treatment • Tests to make sure you are getting the right care • Occupational therapy • Activity therapies, such as art, dance, or music therapy • Training and education (such as training on how to inject a needed medication or education about your condition) • Family counseling to help with your treatment • Laboratory tests • Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you • An annual depression screening (speak to your primary care provider for more information) Original Medicare covers the outpatient mental health services listed above at 80% of the Medicare-approved amount. This means that as long as you receive services from a participating provider, you will pay a 20% coinsurance after you meet your Part B deductible. If you are enrolled in a Medicare Advantage Plan, contact your plan for cost and coverage information. Your plan’s deductibles and copayments/coinsurance may differ. Medicare covers mental health care you receive through an outpatient hospital program, at a doctor’s or therapist’s office, or at a clinic. You may receive services from the following types of providers: • General practitioners • Nurse practitioners • Physicians’ assistants • Psychiatrists • Clinical psychologists • Clinical social workers • Clinical nurse specialists If you see a non-medical doctor (such as a clinical psychologist or clinical social worker), make sure that your provider is Medicare-certified and takes assignment. Medicare will only pay for the services of non-medical doctors if they take assignment. It is also important to note that psychiatrists are more likely than any other type of provider to opt out of Medicare. Be sure to ask any provider if they take your Medicare insurance before you begin receiving services. Remember, if you see an opt-out provider, they must have you sign a private contract. The contract states that your doctor does not take Medicare and you must pay the full cost of the service yourself. Medicare will not reimburse you if you see an opt-out provider. If your provider does not have you sign a contract, you are not responsible for the cost of care. If you have Original Medicare and need help finding a participating provider, you can use Medicare’s Physician Compare tool online or call 1-800-MEDICARE. If you have a Medicare Advantage Plan, call your plan directly for a list of mental health care providers in your plan’s network. For additional assistance accessing behavioral health care providers and other local resources, call the Substance Abuse and Mental Health Services Administration (SAMHSA) at 800-662-4357. -Marci Dear Marci is a free e-newsletter from the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. For more free answers to your Medicare questions, visit Medicare Interactive (MI) at www.medicareinteractive.org. Subscribe to Dear Marci by registering for your free account on Medicare Interactive. For more postings by Medicare Interactive, click Here Receive a 20% discount on Medicare Interactive courses with code: "WCC20" Website: https://www.medicareinteractive.org/wcc WealthCare Connect may receive a referral fee from Medicare Interactive for purchases make through these links.

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Medicare Interactive

February 1, 2021

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