Networks change. We verify your specific Medicare Advantage Plans plan before your first visit; call with your member ID and we will confirm benefits, copay and any referral or authorization requirements.
Also appears on cards as: Medicare Part C, Medicare Advantage HMO, Medicare Advantage PPO, MA plans.
Medicare Advantage, also called Part C, is Medicare coverage delivered through a private insurer such as Humana, UnitedHealthcare, Aetna, Florida Blue, WellCare, Devoted Health, Simply Healthcare or Cigna. More than half of Medicare beneficiaries in Florida and a growing share in South Carolina are enrolled in these plans. They must cover everything Original Medicare covers, including outpatient psychiatry, but they replace the 20 percent coinsurance with their own copays, usually a flat specialist copay for mental health visits, and they use provider networks. HMO plans require in-network providers and sometimes a primary care referral, though most waive referrals for behavioral health. PPO plans allow out-of-network care at a higher cost. Telehealth mental health visits are covered by nearly all Medicare Advantage plans at the same copay as office visits.
For Deep TMS and Spravato, Medicare Advantage plans must cover what Original Medicare covers but may require prior authorization, and nearly all of them do. Criteria mirror Medicare's local coverage determinations: major depressive disorder with failure of at least two antidepressants and a psychotherapy trial for TMS, and treatment-resistant depression with a concurrent oral antidepressant for Spravato. Copays for TMS sessions and for Spravato drug and monitoring vary widely by plan, so our staff verify your specific benefits before treatment begins.
What we check before your visit
- Whether your plan is in network at the office you chose and for telehealth
- Your copay or coinsurance for an evaluation and for follow-ups
- Whether a primary-care referral is required (common with HMO plans)
- Prior-authorization criteria for Deep TMS and Spravato, if those are being considered
Frequently asked questions
Which Medicare Advantage plans does Stedfast Psychiatry accept?
Stedfast Psychiatry accepts many Medicare Advantage plans from Humana, UnitedHealthcare, Aetna, Florida Blue, WellCare, Devoted Health, Simply Healthcare and others, but plan networks vary by county and by product. Call the number on your card to confirm that our office is in network for your plan, or ask our front desk to verify.
Do I need a referral to see a psychiatrist on a Medicare Advantage HMO?
Most Medicare Advantage HMO plans do not require a primary care referral for outpatient mental health visits, but a few do. Check your evidence of coverage or call your plan. If a referral is required, your primary care office can usually send one electronically the same day, and we can help coordinate.
How much is a psychiatry visit copay on Medicare Advantage?
Copays for outpatient mental health visits on Medicare Advantage plans typically range from $0 to $50 per visit, with no deductible, depending on the plan. Telehealth visits usually carry the same copay. Your plan's summary of benefits lists the mental health outpatient amount, and our staff can confirm it before you come in.
Does Medicare Advantage cover Deep TMS?
Medicare Advantage plans cover TMS for major depressive disorder under Medicare's criteria, which require failure of at least two antidepressants and a psychotherapy trial. Unlike Original Medicare, nearly all Advantage plans require prior authorization. Our TMS team submits the request and confirms your per-session copay before scheduling the course at Palm Beach Gardens.
Is Spravato covered on Medicare Advantage plans?
Yes, with prior authorization. Plans cover Spravato for treatment-resistant depression when you are taking an oral antidepressant and receive treatment at a certified site. Your cost share may be a copay or a percentage of the drug cost, and it differs by plan, so we verify it in advance. Treatment is offered at our Boynton Beach, Palm Beach Gardens and Royal Palm Beach offices.