Medicare: 190 Day Limit

The Issue:  Medicare 190-day Lifetime Limit

Where We Stand:

NAMI believes that people with mental illness deserve access to mental health care services without arbitrary limits on treatment. NAMI opposes Medicare’s 190-day lifetime limit on inpatient psychiatric hospital care and supports eliminating this harmful provision.

Why We Care:

Access to needed health care services is essential for people with mental illness to successfully manage their condition. Medicare is a lifeline for much of that care, providing health insurance for over 60 million Americans, including millions of people with mental health conditions. Unlike other health coverage programs, however, Medicare is not subject to mental health parity requirements and imposes additional limitations on mental health benefits. Specifically, Medicare restricts people to just 190 days in their lifetime for care in inpatient psychiatric hospitals—facilities that specialize in treating mental health conditions. These limits don’t apply to psychiatric units within general hospitals, and they also don’t apply to any other Medicare specialty inpatient hospital service. Instead, they create additional barriers and disruptions to care before a person may fully stabilize and be able to maintain wellness.

How We Talk About It:

  • It is important to end discrimination – in all its forms – against people with mental illness. 
  • Medicare covers many people of all ages who live with disabilities, including mental illness, even though it is often thought of as a program for older adults.
  • Even though Medicare provides health insurance to more than 60 million Americans, including millions with a mental health condition, Medicare puts up barriers to care for people with mental illness.
  • Medicare limits people to just 190 days of inpatient psychiatric hospital care in their lifetime. This is discrimination plain and simple.
  • Medicare’s 190-day limit does not apply to inpatient hospital care for any other health care condition.
  • People with serious mental illness may easily go over Medicare’s 190-day limit during their lifetime, especially if they gain Medicare coverage at a younger age.
  • People who receive Medicare benefits in inpatient psychiatric facilities often have a diagnosis of schizophrenia, bipolar disorder, or major depressive disorder—conditions that typically require ongoing treatment over the course of a lifetime.
  • The 190-day lifetime limit hurts people by ending coverage and stopping needed care before a person is fully stable. 
  • When people with mental illness cannot receive care in the right setting, they can end up in hospital emergency rooms, in jail, or on the streets. This leads to worse long-term outcomes for the individual, more pain and suffering, and a greater cost to the federal and state government. 
  • While federal parity laws have helped put a stop to discrimination against mental illness for private insurance, these protections do not apply to Medicare. 
  • The Medicare 190-day limit must be eliminated to bring greater mental health parity to the Medicare program while providing people with better health care access. 

What We’ve Done:

  • NAMI blog on mental health reform legislation
  • NAMI blog on the 2016 federal budget