Medicare 190-Day Lifetime Limit

Where We Stand

NAMI believes that health insurance should provide comprehensive mental health and substance use disorder coverage without arbitrary limits on treatment. NAMI supports repeal of Medicare’s discriminatory 190-day lifetime limit on inpatient psychiatric hospital care.

Why We Care

Access to 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 U.S. adults, 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.

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 and multiple hospitalizations over the course of a lifetime. Limiting inpatient psychiatric care to 190-days in a lifetime is a discriminatory policy that creates barriers and disruptions to care and should be repealed.

How We Talk About It

• It is important to end discrimination — in all its forms — against people with mental illness. This includes ending Medicare’s 190-day lifetime limit.
• Even though Medicare provides health insurance to more than 60 million Americans, including millions with a mental health condition, Medicare imposes detrimental barriers to care for people with mental illness.
• Medicare limits people to just 190 days of inpatient psychiatric hospital care over 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.
• The 190-day lifetime limit hurts people by arbitrarily 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 reduce discrimination by private insurance against people with mental illness, these protections do not apply to Medicare.
• We call for the elimination of the Medicare 190-day limit to bring greater mental health parity to the Medicare program.

What We’ve Done

• NAMI letter supporting the Medicare Mental Health Inpatient Equity Act
• NAMI blog on legislation to eliminate the 190-day limit
• NAMI blog on a budget proposal to eliminate the 190-day limit