Medicare Complexity

Medicare beneficiaries have a complicated matrix of out-of-pocket expenses if they need behavioral health treatment. Take a typical psychiatric inpatient hospital stay. In the traditional Medicare fee-for-service plan, beneficiaries paid a deductible of $1,632 for days 1 to 60. For hospitalizations over 60 days, there is a coinsurance amount of $816 per day.

There is additional complexity when determining what a beneficiary would owe for an acute behavioral health episode. There are limits on how many days of hospitalization are covered per benefit period. And any days over 91 are “lifetime reserve days”. For inpatient . . .