There are two types of Medicare. The most common is the national Fee-for-Service Medicare plan that is typically reserved for eligible only individuals - those over 65 or those who have a documented disability. This is the plan that is managed by the federal government and is always primary if there is a supplementary plan. The government plan pays 80% of the contracted rate and the client is then responsible for a 20% coinsurance, unless they have a supplemental or secondary plan through another insurer, in which that plan would then effectively pay the remaining 20% balance.
The other kind of Medicare plan is a private or commercial insurance Medicare plan through one of the major insurance companies (e.g., AARP, United, Humana, etc.). These may be a primary plan and/or a secondary or supplemental plan. If there is only one commercial Medicare plan, each plan will have its own specific set of benefits. There may be a deductible, copay, or coinsurance, just like any other commercial insurance plan. Clients should find out what their financial responsibility is for mental health benefits before setting an appointment. They should also make sure that their provider is in-network with their specific commercial Medicare plan.
Please note that only Licensed Psychologists (LP) and Licensed Clinical Social Workers (LCSW) can accept any Medicare plan - either national or commercial. If a Licensed Professional Counselor (LPC) or Licensed Marriage and Family Therapist (LMFT) is contracted to take a private commercial non-Medicare plan (e.g., United Healthcare), they are still not able to take the Medicare plan offered by that commercial insurance company. Please make sure you are scheduling with an LCSW or LP who can take your specific Medicare plan.
Please always confirm the service address with the provider, our Office Manager, or on this website, as address updates are not always accurate or updated in a timely fashion with insurance companies including Medicare plans.
Please note it is the client's responsibility to make sure the provider they choose is in-network and that they know their benefits and their financial obligations before setting the first appointment.