How Medicare Covers Outpatient and Inpatient Treatment for Bipolar Disorder
Key Takeaways
- People with bipolar disorder may experience depressive, manic, hypomanic, or mixed episodes that require a range of treatments.
- Medicare coverage for mental health can help people who are over 65 or who receive disability benefits manage their bipolar disorder symptoms.
- Medicare Part A covers hospitalization, while Medicare Part B covers therapy, intensive outpatient programs, and other medical services.
- To get coverage for prescription medications, people on Medicare must enroll in either a Medicare Part D or a Medicare Advantage Prescription Drug plan from a private insurance carrier.
Treating bipolar disorder, a mental health condition associated with radical shifts in mood and energy, is a complex, lifelong challenge for millions of people in the U.S. In a 2023 report from the scientific research institute RTI International and the federal Substance Abuse and Mental Health Services Administration (SAMHSA), 1.5% of the adults surveyed reported experiencing bipolar I disorder in the previous year. Managing their symptoms may involve medication, hospital stays, outpatient programs, and talk therapy.
Most U.S. adults who are over 65 and many who receive disability benefits rely on either Original Medicare, a federally administered insurance program, or a Medicare Advantage plan from a private insurance carrier to cover healthcare costs. By learning about how Medicare helps to pay for both outpatient and inpatient treatment for bipolar disorder, you or a loved one with this condition can plan to manage the symptoms in the years ahead.
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Understanding Bipolar Disorder
While we don’t know precisely what causes bipolar disorder, research suggests that genetics are a factor. People with a close relative who has the condition, such as a parent or a sibling, are more likely to develop symptoms themselves. There also seem to be biological differences in the structure and functioning of brains that’s associated with the disorder.
Bipolar disorder was once known as manic depression because of the extreme swings the condition can cause in emotional states and activity levels. People with bipolar I disorder go through both the emotional lows of depressive episodes and the highs of manic episodes.
During a depressive episode, a person may:
- Feel sad and hopeless
- Lack energy or motivation
- Lose pleasure in activities
- Sleep too much or too little
- Eat too much or too little
- Think about suicide
Someone experiencing a manic episode may:
- Feel highly energetic with thoughts racing
- Talk more and faster than usual
- Become highly motivated and overconfident
- Make risky or ill-advised decisions
- Struggle to concentrate
- Be short-tempered and easily irritated
It’s also possible to have mixed episodes that include both depressive and manic symptoms. During various types of episodes, people with bipolar I may experience psychosis, meaning they lose the ability to discern what is real and can have delusions or hallucinations.
Bipolar Type 1 vs. Type 2
People with bipolar II disorder don’t have full manic episodes. Instead, they experience episodes of heightened moods called hypomania that don’t lead to psychosis. Hypomania is still associated with high energy, racing thoughts, increased confidence, and irritability, but not to the same degree as full-blown mania.
That doesn’t mean bipolar II is necessarily a milder condition than bipolar I. People with bipolar II often have depressive episodes more frequently.
Bipolar Disorder Medicare Coverage
Original Medicare consists of Medicare Part A and Part B. Part A, which is hospital insurance, covers inpatient treatment, such as hospital stays. Part B is medical insurance and covers outpatient treatment.
How Medicare Covers Inpatient Treatment for Bipolar Disorder
People with bipolar disorder may need emergency inpatient treatment during episodes of either mania or depression. They might be hospitalized because they’re engaging in dangerous behaviors or having thoughts of harming either themselves or others.
Medicare Part A covers inpatient treatment for bipolar disorder, such as stays in either a general or a psychiatric hospital. For every benefit period (which begins after admission) inpatients are responsible for the Part A deductible for the first 60 days and additional costs for longer stays. Patients pay 20% of the Medicare-approved amount for any mental health services received during their stay.
Part A covers up to 190 lifetime days of services in a psychiatric hospital. However, there’s no limit on total benefit periods, and it’s possible to receive more care in a general hospital.
Outpatient Coverage for Bipolar Disorder Treatment on Medicare
Medicare Part B covers a variety of mental health services: Depression screenings, psychiatric evaluation, diagnostic tests, and an annual wellness visit could all reveal signs of bipolar disorder or rule out other causes of symptoms.
If medically necessary, Part B covers treatments like:
- Individual or group psychotherapy: Talk therapy is typically a major part of treatment for bipolar disorder. If you’re on Medicare, you can see care providers like a psychiatrist, clinical psychologist, clinical social worker, clinical nurse specialist, or mental health counselor, as long as they accept your coverage.
- Intensive outpatient programs or partial hospitalization: A bipolar disorder treatment program that offers several hours a day of both individual and group counseling is often necessary to adjust to life with this condition.
- Family counseling as part of mental health treatment: Family members play an important part in managing bipolar disorder. Counseling sessions help them learn to support treatment adherence and identify signs of an episode.
Medicare Coverage and Medications for Bipolar Disorder
For people with bipolar disorder, it’s vital to take medications as directed. Psychiatrists often prescribe:
- Mood stabilizers: Drugs like lithium can manage the symptoms of mania and may prevent the recurrence of episodes.
- Antipsychotics: These medications, such as olanzapine and risperidone, can also stabilize moods and reduce symptoms of mania.
- Antidepressants: SSRIs or other antidepressants may be used for depressive episodes, but they can carry the danger of triggering mania. For that reason, psychiatrists usually prescribe them alongside an antipsychotic or mood stabilizer.
- Antianxiety drugs: Benzodiazepines can help with anxiety, problems sleeping, and severe manic episodes. Because of a high risk for dependency, they’re typically only recommended for short-term use.
Original Medicare covers medically necessary drugs administered in clinical settings like the hospital or a doctor’s office. For medications taken at home, however, people on Medicare need a Medicare Part D prescription drug plan from a private insurance carrier. Coverage details vary by plan, so it’s important to check the costs of medications to treat bipolar disorder.
Medicare Advantage Prescription Drug plans are also available from private insurance carriers. These plans substitute for Original Medicare, include Part D coverage, and may feature other benefits. Plan availability depends on where you live, and people on Medicare Advantage generally need to see healthcare providers in their plan’s network to make full use of their coverage.
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Putting It All Together
Bipolar disorder is a complex and challenging condition with no cure. However, a strategy that includes therapy, medication, support, and, when necessary, hospitalization or an intensive outpatient program can help to manage symptoms. If you or a loved one are living with bipolar disorder, it’s important to understand how Original Medicare and Medicare Advantage plans cover treatment so you can make the best choices for your needs.
Sources
- Bipolar Disorder. NIH.
- Mental and Substance Use Disorders Prevalence Study. RTI International.
- Mental health care (inpatient). Medicare.gov.