Medicare Coverage for Treatment of PTSD

Post-traumatic stress disorder (PTSD) is a mental condition that can develop after someone directly or indirectly experiences a traumatic event. It doesn’t always occur immediately following the event and may not be caused by an event some would traditionally consider traumatic. This can make identifying or diagnosing PTSD difficult. But, if PTSD isn’t identified and treated, it can be a part of the sufferer’s life for potentially the rest of their life.

Generally, there isn’t a single way that PTSD can be treated, since every person and every case of PTSD is different. Let’s briefly explore a few therapy options and examine what Medicare will cover.

Therapeutic Treatment

Therapy is generally the most common method of treating PTSD. Of course, there are many types of therapies available to explore, ranging from one-on-one to group therapies, among others. Of the different types of therapy, there are two prominent strategies used: cognitive processing therapy and exposure therapy.

The focus of this therapy is teaching how to modify and challenge the negative thoughts and notions as a result of the trauma.

Cognitive processing therapy (CPT) is a cognitive behavioral therapy (CBT) that’s been shown to effectively reduce the symptoms of PTSD. The focus of this therapy is teaching how to modify and challenge the negative thoughts and notions as a result of the trauma. Another example of CBT is called stress inoculation training (SIT), which helps spark a reaction to the emotions in order to manage them.

The other common therapy for PTSD is exposure therapy, specifically prolonged exposure therapy. This therapy has the individual gradually face their trauma or phobia in a safe environment. Over time, integrated strategies to relieve the stress and the development of healthy coping mechanisms can help overcome the anxiety caused by PTSD.

EMDR focuses on how to process or react to the trauma, and changes how the brain stores the memory to reduce its traumatic effects.

Another treatment option important to mention is eye movement desensitization and reprocessing (EMDR) therapy. This option focuses on how to process or react to the trauma, and changes how the brain stores the memory to reduce its traumatic effects.

Medicinal Treatment

Of course, therapy isn’t the only treatment option for PTSD. Prescription drugs may be needed in some cases. In fact, some treatment solutions may incorporate both prescription drugs and one of the therapeutic strategies mentioned above. Generally, the prescriptions used to combat PTSD are used to treat depression or anxiety.

Does Medicare Cover PTSD Treatment?

Under Medicare, there is some coverage for PTSD treatments. Many who are enrolled in Medicare are on a fixed income, either through retirement or disability. So, this makes any coverage Medicare offers all the more important to the treatment that beneficiaries may be able to receive. For your therapy needs, Medicare can cover both inpatient and outpatient mental health services. You’ll most likely be receiving outpatient therapy, so we’ll start with that.

For your therapy needs, Medicare can cover both inpatient and outpatient mental health services.

Outpatient therapy is covered by Medicare Part B, meaning you’ll pay 20 percent of the Medicare-approved amount after meeting your Part B deductible. For 2022, the Part B deductible is $233.

Inpatient therapy is covered by Medicare Part A. For Part A, you’ll have a deductible ($1,556 in 2022) and a daily coinsurance based on how many days you’re in inpatient care. For the first 60 days (days one to 60), there’s no coinsurance. For days 61 to 90, you’ll owe $389 per day in 2022. After 90 days, you’ll use lifetime reserve days, which cost $778 per day in 2022.

Inpatient therapy is covered by Medicare Part A. For Part A, you’ll have a deductible ($1,556 in 2022) and a daily coinsurance based on how many days you’re in inpatient care. For the first 60 days (days one to 60), there’s no coinsurance. For days 61 to 90, you’ll owe $389 per day in 2022. After 90 days, you’ll use lifetime reserve days, which cost $778 per day in 2022.

For this reason, if you’re looking to have coverage for any prescription drugs, you’ll need to look into the specifics of your Part D plan and its formulary.

Any therapeutic drugs that you may be prescribed fall under the coverage of Medicare Part D. Although Part D is approved by the federal government, it’s offered by private companies. This means coverage and costs may vary from plan to plan. For this reason, if you’re looking to have coverage for any prescription drugs, you’ll need to look into the specifics of your Part D plan and its formulary.

● ● ●

PTSD is a difficult condition to live with. It causes a persistant anxious feeling due to a past trauma and rewires the brain to constantly be in flight-or-fight mode. Finding a treatment solution that’s both effective and affordable is important in order to gain back control from the tragic event(s) that caused the PTSD in the first place. The good news is if you have Medicare, there is coverage for PTSD treatment options!