Medicare is a federal health care program that provides coverage for individuals with disabilities who receive federal Social Security Disability Insurance benefits, as well as people age 65 and over. Serious mental illnesses are especially prevalent among those under 65 who receive Medicare benefits due to a disability. Approximately 37 percent of Medicare beneficiaries with a disability have a serious mental illness.
Medicare covers hospital, nursing home and limited home health care (Part A), outpatient services (Part B) and prescription medications (Part D). Part C of Medicare authorizes alternative plans (such as managed care plans) in place of the standard Medicare fee-for-service plan.
Under Part D, the costs of psychiatric medication are covered as are the costs of medication for other conditions. Medicare requires the drug plans operating under Part D to cover nearly or all drugs in certain classes, including antidepressants and antipsychotics.
Despite the rates of serious mental illness among Medicare beneficiaries, the program does not offer the full array of mental health benefits that are effective in helping people recover from mental illnesses. Therapy, medication management and partial hospitalization are covered, but other intensive services, such as psychiatric rehabilitation and case management, are not. A limited mental health benefit package deprives beneficiaries of the mental health services that are most needed to improve their functional health. Medicare coverage should be expanded so that it more appropriately meets the needs of beneficiaries with serious mental illnesses.
A recent and important Medicare reform was enacted in 2008. By 2014 it will end a discriminatory requirement that makes Medicare beneficiaries pay a greater share of the costs of covered mental health services than for other medical care. While this is a step toward parity, it should be noted that this applies only to the limited range of mental health services covered under Part B—i.e., therapy and medication management.