Is care from a psychologist or adult daycare covered by Medicare?

Medicare and Mental Health: Page 3

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Psychological care. Psychological counseling is not technically medical care. But under some circumstances, Medicare Part B or Medicare Part C managed care will cover counseling by a clinical psychologist. The person's doctor must prescribe the treatment. The psychologist must be certified by Medicare. And the psychological care must relate to a problem -- such as depression or anxiety -- arising out of a medical condition for which the doctor is treating her. If she's suffering emotionally from the strain of a physical illness, suggest that she discuss the problem with her doctor. If she and the doctor believe she might benefit from psychological counseling, Medicare Part B or her Medicare Advantage managed care plan might cover the care. The office of the psychologist she's referred to can find out in advance from Medicare whether it would cover her treatment there.

Adult daycare. In general, adult daycare provides personal monitoring and attention with structured activity in a secure environment. Medicare usually considers this type of care "custodial" rather than medical and so usually doesn't cover it. Medicare can cover services from an adult daycare center only in very limited circumstances.

Medicare might cover actual mental health treatment, prescribed by a physician, provided at an outpatient mental health clinic. If this clinic is also an adult daycare center, the patient can get the benefit of the center's other care services while receiving treatment there. Medicare will cover this kind of care only if, and for as long as, it involves actual medical treatment -- administration and monitoring of medication, for example, or help with recovery from a medical crisis.

Also, some Part C Medicare Advantage managed care plans offer limited adult daycare coverage as part of their comprehensive home care services. Medicare doesn't require that these plans offer this, so the nature and extent of what they cover depends entirely on the plans themselves.

Finally, Medicare partners with Medicaid to sponsor what's called the Program of All-Inclusive Care for the Elderly (PACE). This provides comprehensive home and community care, including adult daycare, for frail elders who would otherwise require nursing home care. PACE is only available in certain states, however. And in those states, it may be available only to those who are eligible for both Medicare and Medicaid. See Medicare's official website at www.medicare.gov for a list of PACE programs.