What mental health benefits and substance use disorder benefits does Medicare cover?
Medicare covers a range of mental health and substance use disorder services, both inpatient and outpatient, and covers outpatient prescription drugs used to treat these conditions Medicare Advantage plans are required to cover benefits covered under traditional Medicare and most cover Part D prescription drugs as well, but out-of-pocket costs may differ between traditional Medicare and Medicare Advantage plans, and vary from one Medicare Advantage plan to another.
Inpatient Services
• Medicare Part A covers inpatient care for beneficiaries who need mental health treatment in either a general hospital or a psychiatric hospital.
• Medicare Part B covers one depression screening per year, a one-time “welcome to Medicare” visit, which includes a review of risk factors for depression, and an annual “wellness” visit, where beneficiaries can discuss their mental health status. Part B also covers individual and group psychotherapy with doctors (or with certain other licensed professionals, depending on state rules), family counseling (if the main purpose is to help with treatment), psychiatric evaluation, medication management, and partial hospitalization.
• Part B also covers outpatient services related to substance use disorders including opioid use disorder treatment services, which include medication, counseling, drug testing, and individual and group therapy. Medicare covers one alcohol misuse screening per year, and for beneficiaries determined to be misusing alcohol, four counseling sessions per year. Medicare also covers up to 8 tobacco cessation counseling sessions in a 12-month period.
Prescription Drugs
The Medicare Part D program provides an outpatient prescription drug benefit to people on Medicare who enroll in private plans, including stand-alone prescription drug plans (PDPs) or Medicare Advantage prescription drug plans (MA-PDs). Medicare Part D prescription drug plans cover retail prescription drugs related to mental health and are required to cover all or substantially all antidepressants, antipsychotics, and anticonvulsants (such as benzodiazepines), as each is one of the six protected classes of drugs in Part D.
Which health providers can bill Medicare directly for mental health and substance use disorder services, and how much does Medicare pay for these services?
Medicare provides coverage and reimbursement for mental health services provided by psychiatrists or other doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician assistants. Medicare does not provide coverage or reimbursement for mental health services provided by licensed professional counselors and licensed marriage and family therapists.
Medicare fees vary by type of provider, according to the Medicare Physician Fee Schedule:
Medicare Provider Reimbursement for Mental Health and Substance Use Disorder Services
 ✓ Provider Type
✓ Provider Payment Rate
✓ Psychiatrist
Paid at 100% under Medicare Physician Fee Schedule
✓ Clinical Psychologist
Paid at 100% under Medicare Physician Fee Schedule*
✓ Clinical Social Worker
Paid at 75% of the clinical psychologist’s Medicare Physician Fee Schedule*
✓ Clinical Nurse Specialist
Paid at 80% of the lesser of the actual charge or 85% of the amount a physician gets under the Medicare Physician Fee Schedule*
✓ Nurse Practitioner
Paid at 80% of the lesser of the actual charge or 85% of the amount a physician gets under the Medicare Physician Fee Schedule*
✓ Physician Assistant
Paid at 80% of the lesser of the actual charge or 85% of the amount a physician gets under the Medicare Physician Fee Schedule*
NOTE: *Paid only on assignment.
SOURCE: Centers for Medicare & Medicaid Services, Medicare Mental Health, March 2022. PNG
Are psychiatrists accessible to Medicare beneficiaries?
The majority of physicians, both primary care and specialists, report taking new Medicare patients, similar to the share who take new privately insured patients. Psychiatrists, however, are less likely than other specialists to take new Medicare (or private insurance) patients. According to a recent KFF analysis, 60% of psychiatrists are accepting new Medicare patients, which is just over 20 percentage points lower than the share of physicians in general/family practice accepting new patients (81%). However, the survey used to conduct the analysis does not distinguish among physicians seeing new patients covered under traditional Medicare or Medicare Advantage, so it is not clear whether physicians are more inclined to accept new Medicare patients in either Medicare Advantage plans or traditional Medicare.
Further, psychiatrists are more likely than other specialists to “opt out” of Medicare altogether. Providers who opt out of Medicare do not participate in the Medicare program and instead enter into private contracts with their Medicare patients, allowing them to bill their Medicare patients any amount they determine is appropriate. Overall, 1% of all non-pediatric physicians have formally opted-out of the Medicare program, with opt-out rates highest among psychiatrists: 7.5% of psychiatrists opted out in 2022. In fact, psychiatrists account for 42% of the 10,105 physicians opting out of Medicare in 2022.
This is why we offer services like A Free insurance review, exercise classes, and volunteer for programs that call or sit with shut-ins, deliver meals, mail cards, gifts, and more! Contact us today to see how we can help you and/or your family anywhere in the USA!

                Best Things to Do In Knoxville with Grandchildren

Is it your week to spend much-needed quality time with your grandchildren? There are so many wonderful things to do with them in the fantastic city of Knoxville, Tennessee. Founded in 1791, Knoxville is the third-largest city in Tennessee and is home to exciting museums, beautiful parks, and endless entertainment opportunities. If you're ready to have some fun, here is our list of the best things to do with grandchildren in Knoxville!

​1. Zoo Knoxville in East Knoxville
What better way to get outside than to see and learn about animals? Zoo Knoxville is open from 9:00 a.m. to 5:00 p.m. daily and closes only on Thanksgiving, Christmas Eve, and Christmas Day. Parking is only 5 dollars. The zoo is the birthplace of the first African elephant born in the Western Hemisphere - adorable Little Diamond. An Aldabra Giant Tortoise named Big Al also lives at the zoo. He weighs an impressive 525 pounds and is estimated to be about 150 years​old! 
Other fun animals at Zoo Knoxville include: 

• Elephants
• Giraffes
• Gorillas
• Critically-endangered Malayan Tigers

Birds and Reptiles The zoo is a great way to build fun memories with your grandkids while staying active in your golden years.

2. South Knoxville's Ijams Nature Center
​For kids five and up, try the exciting and adventure-packed Ijams Nature Center located on 315 acres of protected land in south Knoxville. This nonprofit environmental education center is full of so many exciting things to do! You can explore the outdoors and enjoy their playground, including stone, wood, and boulder fields. Each section provides a different way to exercise, and you can even download workouts in their green workout space or take the Primal Playground Challenge! You can climb, hike, bike, paddleboard, and swim at the Ijams Nature Center. The canoes, kayaks, and paddleboards rent for $14 per hour. Here, the adventures are endless for your little ones!

3. Downtown Knoxville's Market Square
After enjoying some quality time with your grandkids in nature, head to the city and check out the vibrant and bustling Market Square in Downtown Knoxville. First used in the mid-1800s, this famous square was originally for regional farmers. It is a unique and fun-filled area with plenty of shopping, dining, and entertainment options - exciting for all ages! You can take the kids to see a movie, outdoor concert, or even Shakespeare on the Square. When you're done, you can head over to play in the water fountains near Krutch Park or visit Knoxville’s Urban Wildnerness, a nearby 1,000 acre stretch of land which features over 50 miles of trails.

4. Knoxville Museum of Art
Are your grandkids budding artists? Inspire them with a trip to the Knoxville Museum of Art! It's appropriate for ages three and up, and admission is free. You can enjoy a stroll through their beautiful galleries and elegant exhibitions or have a picnic in their beautiful outdoor space.  The museum is open daily Tuesday through Saturday from 10 a.m. to 5 p.m. and Sunday from 1 p.m. to 5 p.m. Be sure to check their calendar before going for exciting events, informational workshops, and educational lectures. 

5. World's Fair Park
One of the go-to experiences when visiting Knoxville is the World's Fair Park, located in the heart of the city. This vast cultural space features a beautiful riverfront park and kid-friendly splash pads and fountains. The grandkids can play in the fountains from mid-April to early October. There are two remaining structures left from the 1982 World’s Fair - an amphitheater and the newly renovated Sunsphere. The Sunsphere is a tower with an observation deck that offers 360-degree views of the original 1982 World’s Fair site. The fee is $5, and you need a reservation. 

6. Seven Islands State Birding Park
Another must-see is the wildlife refuge, Seven Islands State Birding Park. What better way for the grandkids to spread their wings than birdwatching! This extensive 425-acre haven in East Knoxville features lush, beautiful meadows and gardens, including a captivating sunflower garden. Seven Islands boasts over eight miles of natural trails and includes impressive views of the Smoky Mountains. The park is home to over 190 species of birds, including songbirds, waterfowl, and hawks. There are even some old barns that house Barn Owls!

​7. Muse Knoxville
Are the grandchildren toddlers? The Muse in East Knoxville is an excellent place for young ones. This creative museum offers fascinating exhibits, exciting facilities, and a variety of activities for kids. There's a book nook, planetarium, illumination station, and outdoor spaces. The kids will love racing air rockets and interacting with the STEAM stations. Kids 8 and up can enjoy hands-on physical science stations in the museum's exhibit space. This museum brings science to life for young kids, showing them how it connects to their everyday world and environment. Admission is $10 per person, and seniors 65+ only pay $5. Parking is free. 
Article written by Amara Home Care in Chattanooga Tennessee

Join Citizens Insurance and the Tellico Village community in Loudon as our guests to raise money for Our Place! 
​Our Place's Mission is to improve quality of life by providing a day program of care, social interaction, and therapeutic activities in a safe and nurturing environment to senior adults living with Alzheimer's or other dementia-related diseases. Our PLACE works to support caregivers and care partners through respite, support, education, and resources. 
​​Tickets are $35 and are tax-deductible. Citizens Insurance Solutions is a proud supporter of local community resources, veterans, senior programs, and more!

Even if you do not want to drink, dance, eat, and bid on silent auction items, you can still make a donation or purchase a tax-deductible ticket and/or invite your friends!

​

As we trudge through the workday, laden with responsibilities, never-ending to-do lists, overbooked schedules, and countless commitments, we can’t help but let our minds drift to the blissful days of retirement. We all have a vision of what life will look like once this day arrives. Dreams of endless free time, relaxation, carefree travel, and a week full of Saturdays are just a few of the things that come to mind. But in reality, retirement isn’t always the cakewalk we envisioned it to be! As we settle into a routine, we can easily become complacent with the day-to-day monotony. If we aren’t intentional with our time and decisions, we can inadvertently lead ourselves down the road of poor physical and mental health.   ​
​We must strive to be engaged mentally, physically, socially, spiritually, and even romantically for our Golden Years to truly sparkle and shine! Though this alone may sound like a full-time job (been there… done that), it can be quite simple. If we deliberate with our actions and choices, we can ensure that our years beyond retirement are thoroughly enjoyed and embraced. 
​
MENTALLY It all begins with our attitude– after all, “they” say your attitude determines your altitude, and it’s no different when it comes to your retirement years. Taking control of your mental health and approaching the day with a “glass half full” perspective is proven to affect your overall health positively. A positive outlook allows you to better cope with negative situations; it’s the driving force behind our decisions that helps steer us in the right direction. An optimistic mindset leads to an overall healthier lifestyle, improved physical health, and increased happiness, self-confidence, and success.

PHYSICALLY The two main components of physical health include a balanced diet and regular exercise. Maintaining a healthy weight is crucial for optimal health and sets the stage for our overall wellbeing. When you’re overweight, you’re at a greater risk for heart disease, elevated blood pressure, diabetes, high cholesterol, stroke, and other severe health conditions. You can achieve and maintain a healthy weight by consuming a balanced diet filled with lean proteins, fruits and vegetables, and complex carbohydrates. Additionally, it’s best to eat 4-5 small meals per day to help maintain blood sugar levels, allowing you to feel more energetic. Incorporating daily activity into your schedule is equally as important as your nutrition. Organized exercise classes such as water aerobics, yoga, Jazzercise, and circuit training are great opportunities to be active regularly. If you have access to a gym that offers these. 
This was written by our guest writer at the Senior Directory! A reputable community resource and nationwide publication.

Our very own owner, Heather Majka - has written an article to compare and contrast the two in a well known and trusted senior publication and resource, the Senior Directory.

Join Heather Majka, Tennessee's only Social Security Claiming strategist for basic rules and filing strategies when filing for Social Security retirement. In just 30 minutes learn:​- How to decide when to collect your benefits. 
- How to coordinate benefits with your spouse. 
- The Social Security options available to divorcees.
- How the death of a spouse affects your Social Security benefits. 
- How work affects your benefits.
- How your benefits are taxed and what you can do about it. ​​

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​Cobra is temporary insurance that allows people to remain on their group health plan after leaving employment for up to 18 months.  It is the same health insurance as before except you pay 102% of the premium (including what the employer was contributing).  This can be the best option coverage-wise and even pricewise for some if under 65.
If you are 65 or older and you or your spouse is offered COBRA, YOU MUST GET Medicare to avoid any penalties. Medicare DOES NOT consider COBRA coverage as good or better than Medicare (“not creditable”).  What’s worse if you do NOT enroll in Medicare not only will you be penalized but COBRA will not pay your bills because they are secondary. 
When an insurance company is secondary that means that their contract and applicable laws dictate that they reduce their payment by the amount the first (primary) company would pay their share and that the second company pays only AFTER the first company. The Medicare Secondary Payer rules are complex. Much of the bill-shuffling takes place behind the scenes.
If you are 65 and over, you can apply for Medicare at ANY time (while covered by employer health insurance/group health insurance).  You also have up to 8 months to sign up for Medicare when your group coverage ends. The problem with signing up after coverage ends is that YOU WILL have a lapse in health insurance UNLESS you take Cobra.
Most HR personnel and the average person do not realize that COBRA is not as good as Medicare and that YOU should sign up for Medicare before you (or your spouse) leave your employer. Here is the bottom line: RETIREMENT AFTER 65 = SIGN UP for Medicare (whether you are taking COBRA, Medicare Supplement, Medicare Advantage, Tricare, VA, or your employer’s retirement plan).