Medicare covers mental health services. Considering that mental health concerns can creep up as an issue or be a full-blown crisis, it’s a relief to know recipients have coverage. Although deductibles, coinsurance, and limitations may apply.
Medicare coverage includes services to help diagnose and treat mental health conditions. With a Part D plan, drugs, your doctor orders will likely have coverage.
What Mental Health Services Does Medicare Cover
As a beneficiary, you qualify for psychotherapy, mental health counseling, psychiatric care, inpatient, and outpatient mental health services.
Although, you need to select doctors that accept Medicare assignment to minimize out of pocket costs.
As part of Part B, at your “welcome to Medicare visit” and “Wellness Visit,” your doctor will evaluate your physical and mental health.
Also, the “Welcome to Medicare” preventive visit costs you nothing and is a review of possible risk factors.
If your doctor accepts assignment, you pay nothing for this visit if it takes place within 12 months of your Part B.
Also, the yearly “Wellness Visit” has coverage by your Part B. You pay nothing for this visit.
Your doctor will assess your well-being each year and discuss any changes in your mental health.
Since your doctor is the one discussing mental health and alcohol or substance misuse, this is an optimal time to review any concerns.
In 2004, Psychology Today magazine published that over 59 million people receive mental health treatment for two years. Additionally, over 80% of those persons found the therapy useful.
Does Medicare Cover Inpatient Mental Health Services
Yes, Medicare covers mental health hospitalization. Part A is the hospital portion of your Medicare.
Coverage under Part A consists of the benefits paid when you’re an inpatient in a hospital.
Therefore, if you become an inpatient the hospital, your Part A helps cover those costs. When you have Medicare, your benefits allow you to get inpatient mental health services at both a psychiatric hospital or general hospital.
Does Medicare Cover Psychiatric Care
A psychiatric hospital cares only for patients with mental health conditions; however, the same benefits and services are available at a general hospital.
Part A covers a psychiatric hospital for a lifetime maximum of 190 days. Although, If you get mental health services in a general hospital, Part A marks those hospital services in “benefit periods.”
The day you become an inpatient is a day, your benefit period begins. However, this benefit period ends after you don’t have any inpatient hospital treatment for 60 consecutive days.
If you become an inpatient after 60 days, it’s a new benefit period.
You’ll incur a new deductible and be responsible for any coinsurance due for that benefit period. Still, there is no limit to the number of benefit periods you can have in a general hospital.
Included in Part A for mental health coverage:
- Room and meals
- Lab tests
- Nursing care
- Therapy or treatment for your condition
- Medications and supplies
Does Medicare Cover Outpatient Mental Health Services
Part B is medical insurance. It provides coverage for mental health services you get from a doctor or services done outside the hospital.
Part B coverage is suitable for a doctor, psychiatrist, clinical psychologist, or clinical social worker. Lab tests have coverage under Part B.
The following must always accept assignment:
- clinical psychologist
- nurse practitioner
- doctor assistants
- clinical social worker
- clinical nurse specialist
Outpatient treatment for inappropriate use of alcohol or drugs has coverage under Part B.
Does Medicare Cover Psychotherapy
Individual and group psychotherapy with doctors may have coverage.
Professional services include but are not limited to:
- Psychiatric evaluation
- Diagnostic tests
- Medication management
- Testing to find out if you’re getting the treatment you need and if the current treatment is helping
- Substance abuse treatment
- Occupational therapy
Partial Hospitalization is an alternative to inpatient care for mental health. In this setting, Medicare beneficiaries get acute mental health therapy, more intense than services at a therapist’s office.
Medicare does need documentation from the doctor stating that partial hospitalization is necessary for lieu of inpatient hospital care.
Does Medicare Cover Mental Health Counseling
Yes, Medicare covers counseling help. These services include group therapy, psychiatric evaluation, individual therapy, family counseling, and alcohol abuse counseling up to four sessions.
Medicare won’t cover marital counseling, nor will it include counseling with a pastor.
Mental Health Services Not Covered by Medicare
- Support groups bring people together
- Transportation to or from mental health care
- Training for job skills that are not part of your mental health treatment
- Television or phone in your room
- Personal items, such as a toothbrush or socks
- Private duty nursing
- Private room (unless necessary)
Does Medicare Part D Cover Prescription Drugs for Mental Health
Part D plans must cover all antipsychotic, antidepressant, and anticonvulsant medications. Each Part D plan operates on a formulary or a pre-set list of drugs the policy covers.
Drugs for mental health must have coverage, and the insurance company can’t discriminate.
If your doctor thinks you need a drug not available under your plan’s formulary, you have the right to a “coverage determination.” In other words, file an appeal with the drug plan.
If you have limited income and resources
There are many programs available to help beneficiaries with a low income. You can apply for extra help, Medicaid, or the State Pharmacy Assistance Program; one is available in your state.
If you or someone you know is in a crisis, call the National Suicide Prevention Lifeline. They have counselors available 24/7. You can reach them at 1-800-273-TALK. (1-800-273-8255)
Get More Help Paying for Mental Health Services Under Medicare
Part B only covers 80% of your mental health services. Part A & B have out of pocket costs you pay. These costs can add up quickly, leaving you with a financial strain.
To get protection from these out of pocket costs, you would want to enroll in a Supplement. These plans cover the 80% Part B doesn’t pay, as well as deductibles, coinsurance, and copayments.
When you enroll in a supplement plan through us, you’ll always have a support team there for you. Our Client Care Team will assist you in any claims, appeals, and much more.
Don’t let Medicare confuse you; we want to help. Give us a call or complete our rate comparison form to see rates in your area today.