General Questions About The Medicare Program
What are the main differences between Original Medicare and Medicare Advantage?
As older adults think about how Medicare will cover their health care needs, their first major decision is whether to enroll in the federally run original Medicare that has been in place since 1966, or select a Medicare Advantage Plan.
Original Medicare
- Original Medicare includes Part A (hospital services) and Part B (physician and other provider services).
- A beneficiary can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
- A beneficiary can use any doctor or hospital that takes Medicare, anywhere in the U.S.
- To help pay out-of-pocket costs in Original Medicare (like your 20% coinsurance), a beneficiary can also buy supplemental coverage, like Medicare Supplement Insurance (Medigap), or have coverage from a former employer or union, or Medicaid.
Medicare Advantage (also known as Part C)
- Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
- In most cases, a beneficiary will need to use doctors who are in the plan’s network.
- Plans may have lower out-of-pocket costs than Original Medicare.
- Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
For more information go to: https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage
What mental health and substance use disorder benefits does Medicare Part B cover for beneficiaries?
Medicare Part B covers one depression screening per year, a one-time “welcome to Medicare” visit, which includes a review of risk factors for depression, and an annual “wellness” visit, where beneficiaries can discuss their mental health status. Part B covers individual and group psychotherapy services provided by several licensed professionals, and depending on state rules, family counseling is covered if the main purpose is to help with treatment, psychiatric evaluation, medication management, and partial hospitalization.
Part B also covers outpatient services related to substance use disorders. These include opioid use disorder treatment services, such as medication, counseling, drug testing, and individual and group therapy. Medicare covers one alcohol misuse screening per year, and for beneficiaries determined to be misusing alcohol, four counseling sessions per year. Medicare also covers some telehealth services, including for mental health and substance use disorder services as well as non-mental health related services, on both a permanent basis and on a temporary basis as part of the COVID-19 public health emergency.