Does Medicare Cover ECT? 

Although electroconvulsive therapy (ECT) often gets a bad reputation due to its depiction in movies and television shows, ECT is actually still used today as an effective treatment for a range of mental health ailments. ECT is sometimes administered in cases of severe mood and psychiatric disorders. Severe depression is just one example of a mental condition that may benefit from ECT. Seniors who suffer from mania or catatonic state disorders may also benefit from ECT.

How does ECT work?

In virtually all cases, ECT is administered under general anesthesia. While movies often show ECT being administered while someone is fully awake, this practice can be very uncomfortable. Modern ECT administration is not carried out while someone is conscious. Some seniors and their doctors find ECT a suitable alternative to prescription medications when such medications are not well-tolerated.

ECT usually involves affixing electrodes to the head, generally around the temple and forehead areas. An administering physician may also use handheld electrodes to direct electrical energy. The treatment itself is brief, and ECT triggers a mild seizure within the brain. This action is believed to reset electrical signals that have gotten out of balance, similar to how cardioversion shocks a heart back into rhythm when it has suffered an arrhythmia.

Does Medicare cover ECT?

Medicare coverage is available for ECT through various parts of the program. Medicare Part B is most commonly used to provide benefits for treatment using ECT in an outpatient setting. Under Medicare Part B, Medicare covers 80% of the cost of treatment. Medicare recipients are responsible for the remaining 20% of costs, but you should note that Part B premium payments must be current to utilize benefits. Additionally, Medicare Part B requires that plan recipients meet a deductible before benefits apply to outpatient services. In 2023, the standard Medicare Part B deductible is $226, but this amount is usually evaluated and adjusted once per year.

ECT coverage in an inpatient facility

ECT may also be administered in a hospital or skilled nursing facility. In these instances, Medicare Part A provides coverage. Although most seniors do not have to pay a monthly premium to carry Medicare Part A inpatient insurance, all Medicare Part A plans include a deductible that once again must be met before benefits apply toward treatment. For 2023, the standard Medicare Part A deductible is $1,600.

Additionally, Medicare benefits for inpatient care services, including ECT, can only be used at Medicare-participating hospitals and skilled nursing facilities. If services are provided by medical professionals who need to be brought in from outside of the facility’s staff, Medicare Part B supplies coverage for these services. This also means that Medicare recipients may receive separate bills after receiving ECT in an inpatient setting.

Medicare Advantage plan coverage of ECT

Although Original Medicare benefits cover ECT, some seniors opt for a Medicare Advantage plan instead. These are plans offered by private health insurance companies that contract with the Centers for Medicare & Medicaid Services (CMS), the agency that regulates Medicare on the federal level.

Medicare Advantage plans include all of the same benefits found in Original Medicare, but Medicare Advantage plan providers have more flexibility to include additional benefits. Medicare Advantage plans will cover ECT in much the same way as Original Medicare, but recipients of Medicare Advantage plans may have to visit providers and clinics within your plan’s network. 

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