Medicare Coverage

No, this isn’t a post about Medicare for All (which is a great goal, but a problematic 2020 campaign platform, in my humble opinion). But this post is about you, if you have Medicare and are seeking psychotherapy, and me, in my quest to be able to provide you with services.

If you have Medicare Part B, I can work with you. If you have a Medicare supplement plan or a secondary plan from a retirement fund or previous employer, that should be OK too. I will need to submit a secondary claim if you have Medicare supplemental coverage; otherwise you will need to pay the coinsurance amount of 20%.

Some Medicare supplement plans “carve out” the supplemental coverage. One example is State of Illinois plans with Aetna supplemental coverage, which is carved out to Magellan Health. This makes the process more complex, but I have successfully worked with that.

Regarding Medicare Advantage all-in-one plans, check your provider list and benefit book. If it’s a PPO and I’m on the network, I should be OK without Medicare Part B billing. If it’s a Medicare Advantage HMO, I may or may not be covered, since you may need a referral from your primary physician and need to stay within their group. Humana Medicare Advantage is an example of that. Even though I am a Humana provider, you may need pre-authorization from your physician. Check with the PCP’s office or Humana.

Medicare billing seems to be geared toward people who have a billing service, and I’m doing it all on my own. But I got some great suggestions and support from other members of the Chicago Therapists listserv.

CC BY-ND 4.0 Medicare Coverage by Fitzgerald Counseling is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.