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Does Medicare Cover ADHD Testing & Treatment?

Does Medicare Cover ADHD Testing & Treatment?

Does Medicare Cover ADHD Testing & Treatment?

Yes, Medicare insurance may be able to cover ADHD testing and treatments in Tennessee, depending on your insurance plan.1 Medicare part B, specifically, helps cover the costs of outpatient services.

To qualify for Medicare ADHD treatment coverage, you must meet the following criteria:

  • United States citizen
  • 65 or older
  • Or younger, with disabilities or End Stage Renal Disease

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How to Verify Medicare ADHD Coverage

Athena Care is in-network with most major insurance plans. The best way to verify the specifics of your Medicare ADHD testing and treatment is by filling out our free, no-obligation online insurance verification form.

Let our highly experienced, expert care coordinators handle the difficulties of contacting your insurance carrier for more information about Medicare ADHD testing and treatment. A care coordinator will review your policy and thoroughly explain your options after you’ve completed the form. Rest assured, all submitted or discussed information will remain confidential.

What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common pediatric neurodevelopmental disorders diagnosed in childhood and lasting well into adulthood.

Children with ADHD may struggle to pay attention, manage impulsive behaviors (acting without considering the consequences), or be extremely active.2

Signs & Symptoms of ADHD

It’s common for kids to have trouble paying attention or issues acting appropriately. However, these behaviors do not just disappear in children with ADHD.

The following symptoms of ADHD linger and can be severe, causing issues at school, home, and other social situations.

  • Frequent daydreaming
  • Forgetfulness
  • Difficulty paying attention
  • Easily loses things
  • Squirming or fidgeting
  • Talking too much
  • Taking unnecessary risks
  • Making careless decisions
  • Hard time resisting temptation
  • Trouble with taking turns
  • Difficulty getting along with others

Is ADHD Testing Covered by Medicare?

Medicare ADHD testing may be covered depending on your specific insurance plan’s benefits.

Several different specialists can diagnose and treat ADHD. Just a few examples include family doctors, pediatricians, psychiatrists, and neurologists. Additionally, psychotherapy with family members or individually may be used to treat ADHD. Furthermore, a clinical diagnosis is the only way to determine whether someone has ADHD.

Medicare ADHD doctors use a mix of exams, testing, and other information to diagnose attention deficit hyperactivity disorder. The doctor will consult the American Psychiatric Association’s (APA) guidelines while considering the following when making the diagnosis:

  • An interview with the child.
  • Medical background – A doctor will discuss your child’s social, emotional, educational, and behavioral history.
  • A physical examination.
  • ADHD behavior rating scales3 or checklists – Parents and teachers use these to assess their children’s symptoms.

Verbal and written tests may also be used to rule out other health conditions with similar symptoms to ADHD.4 When a patient displays some or all of the symptoms consistently for more than six months in different settings, experts will diagnose ADHD.5

Does Medicare Cover ADHD Treatments & Medications?

Yes. Medicare ADHD medication coverage is available through the optional Part D for those with Original Medicare.6 Medication management services are also available.7 Sometimes, generic prescription drugs are covered rather than the brand name.

Specific medications can manage ADHD symptoms. Children with ADHD should be treated with medication and/or behavioral treatment, according to the American Academy of Pediatrics (AAP).

Patients should consistently be monitored after receiving medication, taking their prescription regularly and as directed. The physician can then verify that the patient is receiving the appropriate dosage. The side effects typically disappear after a few weeks of using the medicine. As an alternative, decreasing the dosage can help to minimize side effects.

Medicines used to treat ADHD include:

  • Stimulants8
    • Stimulant medications, like Adderall or Ritalin, are commonly used to treat ADHD. These medications work for people of all ages to alleviate symptoms. Behavioral changes are usually rapid and significant.
  • Non-Stimulants9
    • If stimulant medications cause unpleasant side effects or are ineffective, a doctor may prescribe a non-stimulant medication, like Strattera. These can be taken on their own or in combination with stimulants.
  • Complementary or Alternative Medicines10
    • Some therapists and other health professionals employ complementary or alternative medicines. These treatments have not proven effective in managing ADHD. However, acupuncture, for example, can assist in relieving stress and muscle tension while also improving your overall health and quality of life.

How To Find Medicare ADHD Testing & Treatment Clinics Near Me?

With Athena Care, gaining access to ADHD testing clinics in Tennessee has never been easier. Athena Care health clinics are open Monday through Friday, 7:00 a.m. to 6:00 p.m. A care coordinator can assist you with any questions or concerns regarding Medicare ADHD testing at one of our multiple locations throughout Tennessee.

When choosing a care provider for your ADHD assessments, it’s important to ask many questions and keep the following in mind:

  • Education, training, license, and years of experience
  • Specialties and services offered
  • Treatment methods and philosophies
  • Insurance companies they work with
  • Office hours
  • Pricing
  • Session length

Here, you’ll find a list of practitioners organized by city and information about their backgrounds and specialties.

How Much Does ADHD Testing & Treatment Cost Without Insurance?

The following are average costs for therapy, though they may vary by location and other factors. Therefore, they may not reflect the actual cost of treatment or what you may pay in Tennessee.

Medication costs can range from $8 to $288 per month. For example, a month’s supply of widely prescribed generic stimulants costs around $187.97.11 Doctor’s appointments alone can cost anywhere from a few hundred dollars to over $2,700. In the United States, the typical cost of psychotherapy ranges from $100 to $20012 a session, dependent upon the state, the provider’s qualifications, and the length of the session.

For example, Cognitive Behavioral Therapy (CBT) sessions can cost between $100 and $200 a session, while Dialectical Behavioral Therapy (DBT) usually consists of a weekly individual therapy session, a weekly group therapy session, and weekly phone conversations. Therefore, the cost for this evidence-based practice varies depending on the services rendered.

Telehealth treatment for ADHD patients, especially those in rural communities with limited access to treatment facilities, is also a beneficial option. According to the Rural Health Information Hub, more than 66 million Americans live in non-metropolitan counties with a lack of mental health professionals.13 Telehealth treatment for ADHD can range from a fixed monthly cost to $275 a session.

Sources

  1. “Is Your Test, Item, or Service Covered? | Medicare.” Medicare.Gov, U.S. Centers for Medicare and Medicaid Services, www.medicare.gov/coverage/is-your-test-item-or-service-covered. Accessed 17 June 2022.
  2. “What is ADHD?” Centers for Disease Control and Prevention, 2021, https://www.cdc.gov/ncbddd/adhd/facts.html
  3. “Behavior Rating Scales for ADHD.” BlueCross BlueShield of Tennessee, Inc., 2022, https://www.healthwise.net/bcbst/Content/StdDocument.aspx?DOCHWID=hw160505#hw160505-sec
  4. “Attention Deficit Hyperactivity Disorder (ADHD).” BlueCross BlueShield of Tennessee, Inc., 2022, https://www.healthwise.net/bcbst/Content/StdDocument.aspx?DOCHWID=hw166083#hw166085
  5. “Diagnosing ADHD in Children and Adults.” WebMD, WebMD LLC, 1 July 2004, www.webmd.com/add-adhd/childhood-adhd/diagnosing-adhd.
  6. Pietro, MaryAnn Crt de. “Does Medicare Cover Adderall?” Medical News Today, Healthline Media, 29 Jan. 2021, www.medicalnewstoday.com/articles/does-medicare-cover-adderall#part-d-and-adderall.
  7. “Medication Therapy Management Programs for Complex Health Needs | Medicare.” Medicare.Gov, U.S. Centers for Medicare and Medicaid Services, www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans-cover/medication-therapy-management-programs-for-complex-health-needs. Accessed 17 June 2022.
  8. “Medicines for ADHD (Attention Deficit Hyperactivity Disorder).” BlueCross BlueShield of Tennessee, Inc., 2022, https://www.healthwise.net/bcbst/Content/StdDocument.aspx?DOCHWID=pl1029#pl1030
  9. “Attention Deficit Hyperactivity Disorder (ADHD).” BlueCross BlueShield of Tennessee, Inc., 2022, https://www.healthwise.net/bcbst/Content/StdDocument.aspx?DOCHWID=hw166083#hw166085
  10. “Complementary Medicine.” BlueCross BlueShield of Tennessee, Inc., 2022, https://www.healthwise.net/bcbst/Content/StdDocument.aspx?DOCHWID=aa63785#ut1164
  11. “The Costs of Childhood ADHD.” WebMD LLC, 2022, https://www.webmd.com/add-adhd/costs-childhood-adhd
  12. Lauretta, Ashley. “How Much Does Therapy Cost?” edited by Alena Hall, Forbes Health, 2021, https://www.forbes.com/health/mind/how-much-does-therapy-cost/ [1] “Rural Mental Health.” Rural Health Information Hub, 2022, https://www.ruralhealthinfo.org/topics/mental-health#workforce-challenges

If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.

One of our friendly associates will help you get the help you need. Take this first step to feel better and take control. 

(615) 320-1155