Medicare covers care to diagnose and treat mental health conditions. Also, there is coverage for preventive mental health care. As a beneficiary, you qualify for psychotherapy, counseling, psychiatric care, and other mental health services. Below we look at the coverage Medicare provides for mental health.
Does Medicare Cover Inpatient Psychiatric Care?
Inpatient psychiatric mental health care falls under Part A benefits. Further, Part A will cover a portion of the cost for the room, meals, nursing, and other services. You can obtain care in a hospital or psychiatric hospital. But, the lifetime limit of inpatient psychiatric hospital care is 190 days. Also, you may incur costs for Part B while an inpatient in the hospital, this could be from doctor services.
What Happens When I Use all Medicare Mental Health Inpatient Days?
If you’ve exhausted your lifetime days, Medicare may still cover the costs of your care at a general hospital.
Does Medicare Cover Outpatient Health Services?
Part B will cover routine doctor visits for mental health. Coverage allows you to see clinical psychologists, psychiatrists, social workers, counselors, and other health professionals. Like Part A, deductibles and coinsurances will apply. Yet, annual depression and alcohol abuse screenings are free.
You may obtain treatment in a therapist’s office or in a clinic. Further, Medicare will cover activity therapy, such as dance, art, or music therapy. Although, you may need to apply for reimbursement on activity therapy.
What are the Medicare Annual Limits for Mental Health Provider Services?
The law limits Medicare payments for outpatient mental health to 62.5% of expenses in the calendar year. Services include the treatment of mental, psychoneurotic, and personality disorders for people not inpatient in a hospital. These limitations DO NOT apply to diagnosis, but rather, they apply to treatment.
Do Medicare Advantage Plans Cover Mental Health Services?
Medicare Advantage plans must cover the same services as Original Medicare. So yes, they will cover mental health services. How much they cover is up to the carrier you enroll with. They also choose what doctors they have in their network. Medicare Advantage plans include less than 23% of psychiatrists on average. The low number of mental health professionals that accept Advantage plans could indicate that these patients need to change doctors to have coverage.
Do Medicare Supplement Plans Cover Mental Health?
Yes, Medicare Supplements will cover mental health services and treatments. They pick up the cost-sharing left over after Medicare pays their portion.
Does Part D Cover Medications to Treat Mental Health Conditions?
Part D plans must cover all antipsychotic and antidepressant medications. Each plan has a formulary or a list of drugs the policy covers. Drugs for mental health must have coverage, and the insurance company can’t discriminate. These drugs are part of the six protected classes. If you need a drug not available under your plan’s formulary, you have the right to an appeal.