
MEDICARE MEDICAL INSURANCE
This section tells you about:
     *    Deductible and Coinsurance Amounts 
     *    Covered Doctors' Services 
     *    Second Opinion Before Surgery 
     *    Services of Special Practitioners 
     *    Outpatient Hospital Services 
     *    Other Covered Services and Supplies 
     *    Drugs and Biologicals 
     *    Assignment     
*    Participating Doctors and Suppliers 
     *    Participating Providers 
     *    Explanation of Medicare Benefits Notice 
*Approved or "Reasonable" Charges
     *    Medicare Payments for Outpatient Treatment of 
          Mental Illness 
     
Medicare medical insurance helps pay for (1) doctor's services,
(2) outpatient hospital care, (3) diagnostic tests, (4) durable
medical equipment, (5) ambulance services, and (6) many other
health services and supplies which are not covered by Medicare
hospital insurance.
     The following sections tell you more about these different
kinds of care, the services that are and are not covered by
Medicare medical insurance, and what part of your medical
expenses Medicare will pay.
DEDUCTIBLE AND COINSURANCE AMOUNTS UNDER MEDICARE MEDICAL
INSURANCE
The Annual Deductible
     You must pay the first $75 in approved charges for covered
medical expenses in 1990.  This is called the Medicare medical
insurance annual deductible.  You need to meet this $75
deductible only once during the year, and the deductible can be
met by any combination of covered expenses.  You do not have to
meet a separate deductible for each different kind of covered
service you receive.
The Blood Deductible
     You must pay any nonreplacement fees charged for the first
three pints or units of blood and blood components you use each
year.  This is called the Medicare medical insurance blood
deductible.  After you have replaced or paid for the first three
pints of blood and you have met the $75 annual deductible,
Medicare will pay 80 percent of the approved charges for blood,
starting with the fourth pint.  (If you have already paid for or
replaced blood under Medicare hospital insurance during the
calendar year, you do not have to pay for or replace blood again
under Medicare medical insurance.)
Coinsurance 
     After you pay the annual deductible, you will owe a share of
the Medicare-approved charges for most services and supplies. 
This share is called coinsurance.  Usually, your coinsurance
share is 20 percent.
     Medicare determines the "approved" or "reasonable" charge
for each service you receive.  If your services were provided "on
assignment" (see page xx for an explanation of assignment) you 
pay only the coinsurance.  But if your services were not provided
"on assignment" the charges for your services may be more than
the Medicare-approved amount.  In those cases, you owe the
Medicare coinsurance plus charges above the Medicare-approved
amount, in most cases.  
NOTE: This explanation of your deductible and coinsurance amounts
describes Medicare's payment system for most services covered by
Medicare medical insurance.  In cases where payment for services
is handled in a different way, you will be given an explanation
along with the description of services covered.
COVERED DOCTORS' SERVICES
     Medicare medical insurance helps pay for covered services
you receive from your doctor in his or her office, in a hospital,
in a skilled nursing facility, in your home, or any other
location in the U.S.  Medicare sometimes helps pay for doctors'
services you receive in a Canadian or Mexican hospital.  See page
xx to find out about care in Canadian and Mexican hospitals.
Major doctors' services covered by Medicare
Medicare medical insurance helps pay for these services:
     o    Medical and surgical services, including anesthesia
     o    Diagnostic tests and procedures that are part of your
          treatment
     o    Radiology and pathology services by doctors while you
          are a hospital inpatient or outpatient
     o    Treatment of mental illness (Medicare payments for     
          outpatient treatment are limited.  See page xx)
     o    Other services which are ordinarily furnished in the
          doctor's office and included in his or her bill, such
          as:
          --X-rays
          --Services of your doctor's office nurse
          --Drugs and biologicals that cannot be  
          self-administered
          --Transfusions of blood and blood components
          --Medical supplies
          --Physical/occupational therapy and speech pathology
          services
Some doctors' services not covered by Medicare
Medicare medical insurance does not pay for these services:
     o    Routine physical examinations and tests directly
          related to such examinations (except some pap smears on
          or after July 1, 1990)
     o    Most routine foot care
     o    Examinations for prescribing or fitting eyeglasses or
          hearing aids
     o    Immunizations (except pneumococcal vaccinations or
          immunizations required because of an injury or
          immediate risk of infection, and hepatitis B for
          certain persons at risk)
     o    Cosmetic surgery, unless it is needed because of
          accidental injury or to improve the function of a
          malformed part of the body
Types of Doctors
     Most doctors' services are furnished by a doctor of medicine
(MD) or a doctor of osteopathy (DO).  Other "physicians" that can
furnish some covered services include chiropractors, doctors of
podiatric medicine (podiatrists), doctors of dental surgery or of
dental medicine (dentists), and doctors of optometry
(optometrists).
Chiropractors' services
     Medicare helps pay for only one kind of treatment furnished
by a licensed chiropractor: manual manipulation of the spine to
correct a subluxation that can be demonstrated by X-ray. 
Medicare medical insurance does not pay for any other diagnostic
or therapeutic services, including X-rays, furnished by a
chiropractor.  
Podiatrists' services
     Medicare medical insurance helps pay for any covered
services of a licensed podiatrist to treat injuries and diseases
of the foot.  Examples of common problems include ingrown
toenails, hammer toe deformities, bunion deformities and heel
spurs.
     Medicare generally does not pay for routine foot care such
as cutting or removal of corns and calluses, trimming of nails,
and other hygienic care.  But, Medicare does help pay for routine
foot care if you have a medical condition affecting your legs or
feet (such as diabetes or vascular heart disease) which requires
that such care be performed by a podiatrist or by a doctor of
medicine or osteopathy.
Dentists' services Medicare medical insurance generally does not
pay for care in connection with the treatment, filling, removal,
or replacement of teeth; root canal therapy; surgery for impacted
teeth; and other surgical procedures involving the teeth or
structures directly supporting the teeth.  However, Medicare
helps pay for services of a dentist in certain cases when the
medical problem is more extensive than the teeth or structures
directly supporting them.  (If you need to be hospitalized
because of the severity of a dental procedure, Medicare hospital
insurance will pay for your hospital stay even if the dental care
itself is not covered by Medicare.)
Optometrists' services
     Medicare helps pay for optometrists services if the services
are among those already covered by Medicare and if the
optometrist is legally authorized to perform such services in
your State.  However, Medicare will not pay for routine eye
exams, and it will not pay for eyeglasses or corrective lenses
unless they are prosthetic lenses that replace the natural lens
of the eye. 
SECOND OPINION BEFORE SURGERY
     Sometime your doctor may recommend surgery for the treatment
of a medical problem.  In some cases, surgery is unavoidable. 
But there is increasing evidence that many conditions can be
treated equally well without surgery.  Because even minor surgery
involves some risk, we recommend that you get a second doctor's
opinion to help you decide about surgery.  Medicare will help pay
for a second opinion in the same way it pays for other services
by doctors.  You do not have to pay a deductible or coinsurance
on the second opinion.
     Your own doctor is the best source for referral to another
doctor.  But, if you wish, you can call Medicare's Second Opinion
Referral Center for the names and phone numbers of doctors in
your area who provide second opinions.  The toll-free number is
1-800-638-6833 (in Maryland 1-800-492-6603).
SERVICES OF SPECIAL PRACTITIONERS
     Medicare medical insurance helps pay for covered services
you receive from certain specially qualified practitioners who
are not physicians.  The practitioners must be approved by
Medicare.  Medicare-approved practitioners and services they can
provide are listed below.  These practitioners submit claims to
Medicare for you:
     o    Certified registered nurse anesthetist--can furnish
          covered anesthesia services
     o    Certified nurse midwife--can furnish covered
          obstetrical and gynecological services during pregnancy
     o    Physician assistant--can furnish covered services to
          assist a doctor in a hospital or certain other
          facilities; or as an assistant-at-surgery; or in any
          location that is designated as a rural health manpower
          shortage area
     o    Clinical psychologist--can furnish covered services
          through a community mental health center or a rural
          health clinic
OUTPATIENT HOSPITAL SERVICES
     Medicare medical insurance helps pay for covered services
you receive as an outpatient from a participating hospital for
diagnosis or treatment of an illness or injury.  Under certain
conditions, Medicare helps pay for emergency outpatient care you
receive from a non-participating hospital.
     When you go to a hospital for outpatient services, you are
often asked how much of your Part B deductible you have met.  One
easy way to answer that question is to show the people there your
most recent Explanation of Medicare Benefits notice.  From this
form, they usually can tell how much of the $75 annual deductible
you have met.
     If the hospital cannot tell how much of the $75 deductible
you have met and the charge for the services you received is less
than $75, the hospital may ask you to pay the entire bill.  The
amount you pay the hospital can be credited toward any part of 
the deductible you have not met.  If you pay the hospital for
deductible amounts you do not owe, the hospital or the Medicare
intermediary will refund the amount you overpaid.

Major outpatient hospital services covered by medical insurance
Medicare medical insurance helps pay for these services:
     o    Services in an emergency room or outpatient clinic,
          including ambulatory surgical procedures
     o    Laboratory tests billed by the hospital
     o    Mental health care in a partial hospitalization
          psychiatric program, if a physician certifies that
          inpatient treatment would be required without it
     o    X-rays and other radiology services billed by the
          hospital
     o    Medical supplies such as splints and casts
     o    Drugs and biologicals that cannot be self-administered
     o    Blood transfusions furnished to you as an outpatient
Some outpatient hospital services not covered by medical
insurance
Medicare medical insurance does not pay for these services:
     o    Routine physical examinations and tests directly
          related to such examinations (except some pap smears on
          or after July 1, 1990)
     o    Eye or ear examinations to prescribe or fit eyeglasses
          or hearing aids
     o    Immunizations (except pneumococcal and Hepatitis B
          vaccinations, or immunizations required because of an
          injury or immediate risk of infection)
     o    Most routine foot care
OTHER COVERED SERVICES AND SUPPLIES
Ambulatory surgical services
     An ambulatory surgical center is a facility that provides
surgical services that do not require a hospital stay.  Medicare
medical insurance (Part B) will pay for the use of an ambulatory
surgical center for certain approved surgical procedures. 
However, by law Medicare can only pay centers that have an
agreement with Medicare to participate in the Medicare program. 
The center can be affiliated with a hospital or it can be
independently operated.  In addition to helping pay for the use
of the ambulatory surgical center, Medicare also helps pay for
physicians' and anesthesia services that are provided in
connection with the procedure.
Home Health Services
     If you have both Medicare hospital insurance (Part A) and
medical insurance (Part B), your hospital insurance pays for home
health services.  But Part B will pay for home health services if
you do not have Part A.  Medicare home health services are
described on page xx.
Outpatient physical and occupational therapy and speech pathology
services
     Medicare medical insurance helps pay for medically necessary
outpatient physical and occupational therapy or speech pathology
services, if all the following three conditions are met:
     (1)  your doctor prescribes the service,
     (2)  your doctor or therapist sets up the plan of treatment,
          and
     (3)  your doctor periodically reviews that plan.
     You may receive physical therapy, occupational therapy or
speech pathology services as an outpatient of a participating
hospital or skilled nursing facility, or from a participating
home health agency, rehabilitation agency, or public health
agency.  The provider of services always submits the claim to
Medicare and may only charge you for any part of the $75 annual
deductible you have not met, 20 percent of the remaining approved
amount, and any noncovered services.
     Also, you may receive services directly from an
independently practicing, Medicare-approved physical or
occupational therapist in his or her office or in your home if
such treatment is prescribed by a doctor.  But, the maximum
amount Medicare pays for each of these services provided by an
independently practicing physical or occupational therapist in
1990 is $600 a year.*  The Medicare payment would be less than
$600 if charges for these services are used to meet part or all
of your $75 annual deductible.  Either you or the therapist can
submit the claim to Medicare as described on page xx.
----
*This is 80 percent of the maximum approved amount of up to $750.
---
Comprehensive outpatient rehabilitation facility services
     Under certain circumstances, Medicare helps pay for
outpatient services you receive from a Medicare-participating
comprehensive outpatient rehabilitation facility (CORF).  Covered
services include physicians' services; physical, speech,
occupational and respiratory therapies; counseling; and other
related services.  You must be referred by a physician who
certifies that you need skilled rehabilitation services.  The
CORF submits the claim to Medicare for you.  For most CORF
services, you are responsible only for the annual deductible and
20 percent of the Medicare approved charges.  Medicare helps pay
for mental health treatment in a CORF; the Medicare payment limit
for mental health treatment in a CORF is discussed on page xx.
Rural Health Clinic Services
     Medicare medical insurance helps pay for services of
physicians, nurse practitioners, physician assistants, nurse
midwives, visiting nurses (under certain conditions), clinical 
psychologists, and clinical social workers furnished by a rural
health clinic.  The clinic submits the claim to Medicare for you. 
You are responsible only for the annual Part B deductible plus 20
percent of the Medicare approved charge for the clinic.
Independent clinical laboratory services
     Medicare medical insurance pays the full approved fee for
covered clinical diagnostic tests provided by independent
laboratories that are approved to perform them.  The laboratory
must accept assignment for these tests.  It may not bill you for
the tests.
     Not all laboratories are approved by Medicare and some
laboratories are approved only for certain kinds of tests.  If a
doctor prescribes tests which the laboratory is not approved to
perform, Medicare does not pay for the tests, and you can be
required to pay for them.  Your doctor can usually tell you which
laboratories are approved and whether the tests he or she is
prescribing from an approved laboratory are covered by Medicare. 
Your doctor must accept assignment for covered clinical
diagnostic laboratory tests which he or she furnishes.  He or she
may not bill you for them.
Portable diagnostic x-ray services
     Medicare medical insurance helps pay for portable diagnostic
X-ray services you receive in your home if they are ordered by a
doctor and if they are provided by a Medicare-approved supplier.
Other Diagnostic Tests
     Medicare medical insurance also helps pay for other
diagnostic tests, including X-rays, that your doctor orders to
evaluate your medical problems.
Radiation Therapy
     Medicare medical insurance helps pay for radiation therapy
furnished under the supervision of your doctor.
Kidney Dialysis and Transplants
     For detailed information on kidney transplants and renal
dialysis, you can get a copy of Medicare Coverage of Kidney
Dialysis and Kidney Transplant Services, available from Social
Security or the Consumer Information Center (see inside back
cover).
Ambulance transportation
     Medicare medical insurance helps pay for medically necessary
ambulance transportation but only if (1) the ambulance, equipment
and personnel meet Medicare requirements, and (2) transportation
in any other vehicle could endanger your health.
     Under these conditions, Medicare helps pay for ambulance
transportation but only to a hospital or skilled nursing
facility, or from a hospital or skilled nursing facility to your
home.  Also, if you are an inpatient in a hospital or Medicare-
participating skilled nursing facility which cannot provide a
medically necessary service, Medicare helps pay for round trip
ambulance transportation to the nearest appropriate facility.
     Medicare does not pay for ambulance use from your home to a
doctor's office.
     Medicare usually helps pay only if the ambulance
transportation is in your local area.  But, if there are no local
facilities equipped to provide the care you need, Medicare helps
pay for necessary ambulance transportation to the closest
facility outside your local area that can provide the necessary
care.  If you choose to go to another institution that is farther
away, Medicare payment is based on the reasonable charge for
transportation to the closest facility that can provide the
necessary care.
     Necessary ambulance services in connection with a covered
inpatient stay in a Canadian or Mexican hospital (see page XX)
are also covered by Medicare.
Durable Medical Equipment
     Medicare medical insurance helps pay for durable medical
equipment such as oxygen equipment, wheelchairs, and other
medically necessary equipment that your doctor prescribes for use
in your home.  (A hospital or facility that mainly provides
skilled nursing or rehabilitation services cannot be considered
your home.) 
     To be considered durable medical equipment, the equipment
must be able to be used over again by other patients, must
primarily serve a medical purpose, must not be useful to people
who are not sick or injured, and must be appropriate for use in
your home.  Not all types of equipment that you might find useful
can meet all four of these requirements.  
NOTE: The durable medical equipment supplier must have your
doctor's prescription before delivering any of the following
items:  seat lift chairs, power-operated vehicles, equipment for
care of pressure sores, or transcutaneous electrical nerve
stimulators.
     Generally, Medicare pays for durable medical equipment on a
rental basis.  However, Medicare pays for the purchase of some
types of equipment.  Your Medicare carrier will be able to
provide more specific guidance on these rules.  (Carriers are
listed on pages xx to xx)
Prosthetic devices
     Medicare medical insurance helps pay for prosthetic devices
needed to substitute for an internal body organ.  These include
Medicare-approved corrective lenses needed after a cataract
operation, colostomy or ileostomy bags and certain related
supplies, and breast prostheses (including a surgical brassiere)
after a mastectomy.  Medicare also helps pay for artificial limbs
and eyes, and for arm, leg, back, and neck braces.  Medicare does
not pay for orthopedic shoes unless they are an integral part of
leg braces and the cost is included in the charge for the braces. 
Medicare does not pay for dental plates or other dental devices.
Medical supplies
     Medicare medical insurance helps pay for surgical dressings,
splints, and casts ordered by a doctor in connection with your
medical treatment.  This does not include adhesive tape,
antiseptics, or other common first-aid supplies.
DRUGS AND BIOLOGICALS
Pneumococcal vaccine
     Medicare medical insurance pays the full approved charges
for pneumococcal vaccine and its administration.  Neither the $75
annual deductible nor the 20 percent coinsurance apply to this
service. 
Hepatitis B vaccine
     Medicare medical insurance helps pay for hepatitis B vaccine
administered to beneficiaries considered to be at high or
intermediate risk of contracting the disease.
Hemophilia Clotting Factors
     Medicare medical insurance helps pay for blood clotting
factors and items related to their administration for hemophilia
patients who are able to use them to control bleeding without
medical or other supervision.  The amount of clotting factors
necessary to have on hand for a specific period is determined for
each patient individually.
Blood
     Medicare medical insurance helps pay for blood and blood
components you receive as a hospital outpatient or as part of
other covered services, except for any nonreplacement fees
charged for the first 3 pints or units received in each calendar
year.  After you have met the $75 annual deductible, medical
insurance pays 80 percent of the approved charges for blood,
starting with the fourth pint in a calendar year.  If you have
paid for or replaced blood under Medicare hospital insurance
(Part A), you do not need to pay for or replace that blood again
under Medicare medical insurance (Part B).
Antigens
     Medicare medical insurance helps pay for antigens prepared
by your doctor.
Immunosuppressive Drugs
     Medicare medical insurance helps pay for drugs used in
immunosuppressive therapy for one year beginning with the date of
discharge from the inpatient hospital stay during which a
Medicare-covered organ transplant was performed.
THE ASSIGNMENT PAYMENT METHOD
     Under the assignment method, your doctor or supplier agrees
to accept as total payment for services the charge approved by
the Medicare carrier: the doctor or supplier agrees to "take
assignment." 
     The assignment method can save you time and money.  The
doctor or supplier fills out your claim form and sends it to
Medicare.  Medicare pays your doctor or supplier 80 percent of
the Medicare-approved charge, after subtracting any part of the
$75 annual deductible you have not met.  The doctor or supplier
can charge you only for the part of the $75 annual deductible you
have not met and for the coinsurance, which is the remaining 20
percent of the approved charge.  Of course, your doctor or
supplier also can charge you for services that Medicare does not
cover. 
     If your doctor or supplier does not accept assignment, you
may have to send in your claim form yourself.  Medicare pays you
80 percent of the approved charge, after subtracting any part of
the $75 annual deductible you have not met. Many doctors that do
not take assignment will fill out claim forms for patients.  Ask
your doctor if he or she provides this service.  
     For all Medicare medical insurance-covered services you get
on or after September 1, 1990, a new rule will apply.  All
doctors and suppliers must fill out claim forms for you and send
them to Medicare--whether or not they take assignment.
     On or after April 1, 1990, doctors must take assignment on
all claims for physician services furnished to Medicare
beneficiaries who are eligible for medical assistance through
their State Medicaid program, including qualified Medicare
beneficiaries.  (The qualified Medicare beneficiary program is
discussed on page xx.)

PARTICIPATING DOCTORS AND SUPPLIERS
     Doctors and suppliers may sign agreements to become
Medicare-participating doctors or suppliers.  This means that
they have agreed in advance to accept assignment on all Medicare
claims.  Doctors and suppliers are given the opportunity to sign
participation agreements each year.  Medicare-participating
doctors and suppliers can display emblems or certificates which
show that they accept assignment on all Medicare claims.
     The names and addresses of Medicare-participating doctors
and suppliers are listed by geographic area in the
"Medicare-Participating Physician/Supplier Directory."  You can
get the directory for your area free of charge from your Medicare
carrier (see page XX); or you can call your carrier and ask for
names of some participating doctors in your area.  Also, this
directory is available for review in Social Security offices,
State and area offices of the Administration on Aging, and in
most hospitals.  
     Many doctors and suppliers that do not take assignment on
all claims, do take assignment on a case-by-case basis.  They
take assignment on some or most claims.  Ask your doctor or
supplier whether he or she will take assignment on your claims.
     Below are examples of the two payment methods (in both
examples, the $75 deductible has already been met).
                         START-OF-TABLE

[In the following table, the column headings are: Medicare you
are; Actual charge; Approved charge; Responsible for; Medicare
pays.]  
      
Doctor Accepts     $500      $400      $320 (80% of   $80 (20%
Assignment                                                       
            
*Doctor Does       $500      $400      $320 (80% of   $180 (diff-
Not Accept                             approved       erence bet-
Assignment                             charge)        when
actual
                                                      charge and
                                                      Medicare
                                                      payment)

-----
*Medicare law requires doctors who do not take assignment for
elective surgery to give you a written estimate of your
out-of-pocket costs if the total charge is $500 or more.  If the
doctor does not give you a written estimate, you are entitled to
a refund of any amount you paid him or her over the Medicare
approved amount.  There are also certain limits to charges of
doctors who do not accept assignment.
                          END-OF-TABLE
----- 
PARTICIPATING PROVIDERS
     Hospitals, skilled nursing facilities, home health agencies,
comprehensive outpatient rehabilitation facilities, and providers
of outpatient physical and occupational therapy and speech
pathology services are all participating providers under Medicare
medical insurance.  They submit their claims directly to
Medicare--you cannot submit claims for their services.  Medicare
subtracts any deductible you have not met and the coinsurance
amount and pays the provider.  The provider then bills you for
only those deductible and coinsurance amounts.
EXPLANATION OF MEDICARE BENEFITS NOTICE
     After you, the doctor, your provider, or your supplier sends
in a medical insurance claim, Medicare will send you a notice
called Explanation of Medicare Benefits to tell you the decision
on the claim.  
     For services of a physician, this notice shows what services
were covered, what charges were approved, how much was credited
toward your $75 annual deductible, and the amount Medicare paid. 
For other medical insurance services the notice shows similar
information.  Please examine the notice carefully.  If you
believe payment was made for a service or supply you didn't
receive, or the payment is otherwise questionable, call or write
the carrier that handled your claim.  
     The address and toll-free number you can use to contact your
carrier is printed on the Explanation of Medicare Benefits form
and on pages XX to XX of this handbook.
     Many carriers have installed an automated telephone
answering system to help make their response to you faster and
more accurate.  If your carrier has a system of this type, when
you call you will be connected to a special automated voice
system.  If you have a touch-tone telephone, follow the
instructions you receive over the phone to get information about
the status of your claims.
     If you need other information or want to talk about a claim,
you can ask the system to connect you with a customer service
representative at any time.  If you do not have a touch-tone
telephone, stay on the line after you dial and you will be
connected to a customer service representative.
     If you are enrolled in a prepaid health care organization,
such as an HMO or CMP, you will seldom need to submit a claim. 
Medicare pays the HMO or CMP a set amount and the HMO or CMP
provides your medical care.  In most cases you are required to
receive all non-emergency care through your HMO or CMP or through
arrangements they make before you receive care.  However, if you
have a claim for an out-of-plan service, you should submit the
claim directly to your HMO or CMP. 
APPROVED OR "REASONABLE" CHARGES
     Medicare medical insurance payments are based for the most
part on what the law defines as "reasonable charges" or the
amounts approved by the Medicare carrier.  Because of the way the
approved amounts are determined and because of high rates of
inflation in medical care prices, the charges approved are often
less than the actual charges billed by doctors and suppliers. 
Medical insurance usually pays only 80 percent of the approved
charge even if it is less than the actual charge.
     When you submit a medical insurance claim that is payable on
a reasonable charge basis, the carrier compares the actual charge
shown on the claim with the customary and prevailing charges for
that service.  The charge approved by the carrier will be the
lowest of: 1) the customary charge (the charge most frequently
made by the doctor or supplier for each item or service); or 2)
the prevailing charge (based on all the customary charges in the
locality for each type of service); or 3) the actual charge. 

MEDICARE PAYMENTS FOR OUTPATIENT TREATMENT OF MENTAL ILLNESS
     Medicare helps pay for services you receive for outpatient
treatment of a mental illness.  You may get the services from
doctors, comprehensive outpatient rehabilitation facilities
(CORFs), physician assistants and psychologists.  
     These services for outpatient treatment of a mental illness
are subject to a special payment rule.  In effect, Medicare pays
only 50 percent (rather than 80 percent) of approved charges for
these services, and beneficiaries are required to pay the
remaining 50 percent.  
     Hospital outpatient treatment (including partial
hospitalization psychiatric programs) of mental illness is not
subject to this limit.
