In this guide 5 sections
The key question is whether the residential program will admit your sister as a hospital inpatient. Original Medicare covers inpatient mental health care in a general hospital or psychiatric hospital.
When does Original Medicare cover the stay?
Part A covers mental health services when she is admitted as a hospital inpatient. Part B covers services from doctors and other health care providers while she is in the hospital. In a freestanding psychiatric hospital, Part A has a 190 day lifetime limit for inpatient psychiatric hospital services.
What could inpatient care cost in 2026?
For each benefit period in 2026, the Part A deductible is $1,736. After that, the daily cost is $0 for days 1 through 60, $434 for days 61 through 90, and $868 while using lifetime reserve days 91 through 150. After day 150, the patient pays all costs. Part B generally requires 20% of the Medicare approved amount for provider services received during the inpatient stay. These amounts are for 2026 and can change each January.
How do you find and check a facility?
- 1.Use the Medicare provider search linked from Medicare’s inpatient mental health coverage page. Enter the ZIP code where treatment is needed.
- 2.Call each facility. Ask whether it participates in Original Medicare and whether the proposed program is an inpatient hospital admission.
- 3.Ask how the facility will bill Medicare.
- 4.Call Medicare at 1-800-633-4227 with billing, claim, medical record, and expense questions.
- 5.If your sister is an older adult, contact the Eldercare Locator at 1-800-677-1116. It can connect the family with the local Area Agency on Aging and community services.
Can Medicare discuss her case with a family member?
Medicare may need an Authorization to Disclose Personal Health Information before sharing her personal claim or expense information with someone else.
What if she is in crisis now?
Call or text 988 for a mental health crisis. Call 911 for an immediate medical crisis.
Questions families ask
Does Original Medicare cover every residential mental health program?
Medicare’s inpatient mental health benefit applies when the person is admitted as a hospital inpatient. Ask the program whether the specific admission will be classified and billed as inpatient hospital care.
Where can I search for a participating facility?
Use the provider search linked from Medicare’s inpatient mental health coverage page and enter a ZIP code. Call Medicare at 1-800-633-4227 with billing, claim, medical record, and expense questions.
Does the psychiatric hospital limit apply to general hospitals?
The 190 day lifetime Part A limit applies to inpatient psychiatric hospital services in a freestanding psychiatric hospital, rather than a general hospital.
Can I speak with Medicare for my sister?
Medicare may require an Authorization to Disclose Personal Health Information before it gives you her personal information.
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