Can I Still Get Treatment for My Eating Disorder With Medicare?

If you have Medicare, many eating disorder treatment options are available. Medicare typically covers inpatient treatment, which is traditionally done in a hospital setting for medical stabilization.

Inpatient eating disorder treatment is provided for a short period and followed by residential care.

How to Use Your Medicare Benefits 

More than 63 million people are enrolled in Medicare. [1] This government program can be complicated and hard to understand, but if you want to use your benefits and have questions, you can get the answers you need below.

Do You Have Original Medicare?

Original Medicare is a benefit you’re entitled to regardless of your connection to a private insurance company. Some people have Medicare coverage alone, with no tagalong benefit from private insurance.

If this describes your situation, you can contact Medicare via phone at 1-800-Medicare. Be prepared to provide your name and enrollment number.

Do You Have Supplemental Medicare Insurance?

Some people work with private insurance companies and get expanded benefits through Medigap or Medicare Advantage Plans. Contact the company via the phone number on your membership card, and be prepared to give your ID number.

What Happens Next?

Explain that you’d like to use your benefits for eating disorder treatment, and ask the representative what facilities are available.

When using your insurance coverage, your team may need to outline your:

• Eating disorder diagnosis
• Other psychiatric disorders
• Physiological complications of the eating disorder
• Level of care recommended (outpatient, inpatient, partial hospitalization, or intensive outpatient)
• Anticipated duration of recommended treatment

If you’ve already chosen a provider, personnel at the facility can do an assessment and contact your insurance to obtain benefits.

Medicare Coverage & Benefits Explained

Like other health insurance companies, Medicare typically requires that you obtain outpatient treatment before using a higher level of care.

Medicare agents authorize reasonable and necessary treatments for each person’s condition. Covered services often include the following:

• Medication therapy
• Psychotherapy
• Patient education

Inpatient Care Benefits

Insurance will typically cover the duration of inpatient care if a physician can demonstrate that inpatient treatment is medically necessary for therapy. Most often, an increased risk of relapse without constant care and supervision does not constitute a medical necessity. Co-occurring mental health disorders, however, may fall into this category as it increases the risk of complications.

Outpatient Care Benefits 

Medicare does cover outpatient treatment services for ongoing therapy after inpatient care. However, similar to inpatient coverage, a medical doctor must recommend outpatient care and any psychotherapy or drug maintenance on a case-by-case basis for coverage.

Partial Hospitalization

Medicare Part B covers partial hospitalization (PHP) in some cases. PHP provides a structured program of outpatient services as an alternative to inpatient care.

Medicare will help cover PHP services when provided through a hospital outpatient department or community mental health center. Medicare will also cover occupational therapy that may be a part of your mental health treatment or individual patient training and education about the eating disorder. [3]

Medicare only covers PHP if your medical physician and the PHP program accept your request and care needs. Typically, Medicare does not cover meals, transportation, support groups, or mental health testing.

What You’ll Pay for Eating Disorder Treatment With Medicare

While Medicare can help you cover the cost of treatment, paying attention to the process is essential, as you could still have some bills to cover.

Preauthorization

Seeking authorization for coverage before the start of treatment is important. Medicare can refuse to cover all or part of the services requested, and a person (or family) is responsible for paying the portion insurance does not cover. This is critical information to know before initializing treatment.

Coinsurance 

When using Medicare, you are responsible for a percentage of the payment for each Medicare-approved service you receive. Go over what this looks like with your case manager before starting treatment, so you know your out-of-pocket costs.

What if Treatment Isn’t Covered?

If you need to begin treatment and the program is not covered by Medicare or the process takes a long time to work out coverage details, there are other options for treatment.

These include:

• Supplemental insurance, such as health savings accounts
• Savings from a retirement fund or college fund
• Borrowing money from family and friends
• Financing treatment with payment plans

Get the Help You Need 

Medicare can cover part or all of the services requested when seeking treatment for your eating disorder.

It is important to remember to call and ask for a case manager who can be your advocate before, during, and following treatment. Ask questions regarding coverage for treatment, the location of services, out-of-pocket costs, and the duration of treatment options.

Treatment Programs Accepting Medicare/Medicaid

• The Johns Hopkins Hospital
  600 North Wolfe Street
  Baltimore, MD 21287
  410-955-3863
• Rogers Memorial (If outside Wisconsin, the patient’s case manager through Medicaid/Medicare must authorize a single case agreement.)
  34700 Valley Road
  Oconomowoc, WI 53066
  800-767-4411
  Medicare accepted for IP only
• River Oaks Hospital
  1525 River Oaks Road
  West New Orleans, LA 70123
  504-734-1740
  800-366-1740
• White Horse Ranch
  1601 Wilkie Road
  Mooreland, OK 73852
  580-994-5649
  [email protected]
• UNC Center of Excellence for Eating Disorders
  101 Manning Drive, CB #7160
  Chapel Hill, NC 27599
  984-974-3834
• Eating Disorder Institute (takes all Medicare, takes Medicaid from ND, MT, SD, and MN)
  Route 331
  1720 S. University Drive
  Fargo, ND
  701-461-5300
• UCLA (only takes CA Medicaid for patients under the age of 25)
  Los Angeles, CA
  310-206-3954
• University of Iowa UI Eating Disorders Services
  University of Iowa Hospitals and Clinics
  200 Hawkins Drive
  Iowa City, IA 52242-1009
  319-356-2263
• Brookhaven Specialty Hospital
  201 S Garnett Road
  Tulsa, OK 74128
  877-764-8580
• Walden Behavioral Care (Accepts Medicare for IP Only)
  9 Hope Avenue, Suite 500
  Waltham, MA
  781-647-6727
• Denver Children’s Hospital-Eating Disorder
  Unit 13123 East 16th Avenue
  Aurora, CO 80045
  Admissions Clinician: Vicky Sullivan
  720-777-6452

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References

1. Tarazi W, Welch P, Nguyen N, Bosworth A, Sheingold S, De Lew N, Sommers BD. (2022). Medicare Beneficiary Enrollment Trends and Demographic Characteristics. U.S. Department of Health and Human Services. 
2. Get Your Medicare Questions Answered. (2016). U.S. Department of Health and Human Services.
3. Mental Health Care. (2022). Medicare.gov. Accessed September 2022.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on January 11, 2023 and reviewed by Jacquelyn Ekern, MS, LPC
Published on EatingDisorderHope.com