Medicare

Medicare is a form of public health insurance for individuals who have certain disabilities. It also covers individuals with permanent kidney failure requiring either a transplant or dialysis, and those with Amyotrophic Lateral Sclerosis (ALS).

Original Medicare provides Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). You can also purchase a Medicare Part D plan which provides prescription drug coverage.

Private insurance companies may also offer Medicare in the form of “Medicare Health Plans.” The most notable are Medicare Advantage Plans that provide hospital and medical insurance and usually prescription drug insurance.

If a Medicare Health Plan does not cover something that is covered by Original Medicare, you can still receive coverage under Original Medicare. Some Medicare Health Plans may provide additional benefits not included in Original Medicare.

Where NAMI Stands

NAMI believes that Medicare Part D should fully cover all medications prescribed for the treatment of serious mental illness. Medicare should also cover psychiatric rehabilitation, case management, assertive community treatment and other evidence-based mental health services.

To be eligible for Medicare solely based on disability, you must have received Social Security Disability Income (SSDI) for at least the past 24 months. NAMI believes that if someone finds employment and no longer qualifies for SSDI, and therefore loses Medicare eligibility, they should automatically be reenrolled in Medicare if their disability returns.

Since mental health is as important as physical health, NAMI believes that copayment rates for outpatient mental health care and services should be the same as other copayment rates under Medicare. Also, that coverage for both inpatient and outpatient mental health care should be the same as coverage for other types of health care. Furthermore, there should be no lifetime limit on coverage for inpatient psychiatric hospitalization, as many conditions can be permanent.

What NAMI is Doing

In 2014, NAMI lobbied to prevent changes to Medicare Part D proposed by the U.S. Department of Health & Human Services (HHS) that would have restricted access to antidepressant and antipsychotic medications. The effort was successful, and the HHS backed away from the proposals.

NAMI is now supporting a bipartisan bill, the Medicare Formulary Improvement Act, which would safeguard the “protected class” status of mental health medications covered in Medicare part D, ensuring future coverage.

NAMI also joined almost 60 organizations in drafting a letter to Congress asking it to reject a proposal to increase Medicare co-pays for brand name medications. The increase would have applied to low-income subsidy individuals who fall below a certain income limit.

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