Does Medicare Cover Mental Health?

Medicare mental health coverage is available to beneficiaries. Your benefits can help you cover the care of not only your diagnosis but also treating various mental health conditions you may suffer from. You’ll also enjoy Medicare mental health assistance for preventive care focusing on your mind’s well-being.

The stigmas of mental health continue to be washed away, which is great news for all of us. Getting the right help doesn’t just mean taking care of your physical self but also ensuring your mental needs are met. Thankfully, Original Medicare (Medicare Part A and Part B), along with other forms of Medicare benefits, are here to help.

Beneficiaries qualify for many Medicare mental health benefits, including psychotherapy, counseling, psychiatric care, and other mental health services. Take a closer look at your Medicare coverage for mental health, different scenarios that may arise, and ways to stay better protected, including benefits for your physical health while getting a complete form of healthcare.

Does Medicare Cover Therapy?

Yes, Medicare mental health coverage is available, including going to therapy. However, your Medicare benefits won’t cover every type of therapy out there. There are several important factors that will go into beneficiaries receiving coverage, such as:

• In order for Medicare to approve any service, it must be deemed medically necessary. Therefore, any mental healthcare services you receive must be determined as such by your doctor.
• You’ll also need to receive your mental healthcare from a provider that accepts Medicare assignment. This means some forms of therapy, such as seeking counsel with your spiritual leader, won’t be covered.

Furthermore, it’s important to understand that mental health is far more than seeking therapy. There are preventative care services, tests, prescriptions, etc., available to you. Below, we’ll review more specific forms of mental healthcare, but remember, these methods must be designated by your healthcare provider.

Does Medicare Cover Counseling?

Yes, Medicare will cover different forms of counseling for your mental health needs. While not every form of counseling is covered, here are some common examples of how your Medicare Part B mental health coverage is there for your needs:

• Grief counseling is available and can last as long as you need.
• Alcohol abuse counseling is available, along with screening for those struggling with this form of substance abuse.
• Additionally, you can receive counseling as a part of your opioid use disorder treatment services.
• There are other forms of therapy that are covered by your Medicare mental health coverage, such as family counseling and individual therapy.

Regarding family counseling, it’s important to understand that restrictions exist, with even more applying to marriage counseling. While your Medicare counseling is available, you must fit into the program’s guidelines to qualify for coverage.

Does Medicare Cover Marriage Counseling?

Medicare covers marital counseling along with family counseling, but there are considerations to remember for both forms of healthcare. Your Medicare mental health benefits are there for you, but in order to receive coverage for these forms of counseling, it will need to be deemed necessary by your doctor in connection with a mental illness.

Having Medicare Part B benefits allows for coverage towards family counseling which can include marriage counseling as well. Many different healthcare professionals are covered by these benefits, so long as your provider accepts Medicare assignment. This includes clinical psychologists, clinical social workers, doctors, and many more.

You’ll also need to receive your mental healthcare in an appropriate setting. This can mean in-person at a professional’s office, via the Internet through telehealth, or at a hospital or community center near you.

This does not include your local place of worship or seeking advice from a spiritual leader or influential figure such as your pastor. While all such avenues may be available, if you’re using Medicare benefits, you must adhere to the guidelines above to avoid paying out of your own pockets.

Does Medicare Cover Mental Health Benefits?

Your Medicare mental health coverage is the same thing as your health benefits when you’re enrolled in the Medicare program. These benefits cover a wide range of tests, preventive care, and treatment for your mental health.

Here are some prime examples and which mental health Medicare coverage applies:

Medicare Part A

When receiving mental health services in an inpatient setting, your Medicare Part A benefits will be there for you. This can be in either a general hospital or a psychiatric hospital.

If you are admitted to either or, your benefit period providing 60 days of coverage begins. After 60 days, if you are readmitted, you’ll start a new benefit period after paying your deductible. Here are some of the things covered by Medicare Part A benefits while you are in an inpatient setting:

• Drugs, which include methadone.
• General nursing services
• The cost of your meals.
• Semi-private rooms.
• Various other services and supplies as necessary during your stay.

Keep in mind that if you require hospitalization beyond your 60 days of coverage, you can still receive coverage through your 60 lifetime reserve days, and when admitted into a psychiatric hospital you receive a lifetime total of 190 days.

Medicare Part B

Mental health counseling is covered by your Part B coverage, along with many additional outpatient mental health services. There are several things covered by Medicare Part B, including a free yearly depression screening, which must be conducted in a professional healthcare provider’s office. Other examples include:

• A preventive visit to evaluate depression risk factors when joining Medicare.
• Yearly visits to discuss your wellness and changes in your mental health.
• Evaluations and testings.
• Psychotherapy on both individual and group levels.
• Medication management and other prescriptions that are provided at the time of your visit.
• Family counseling sessions when they are essential to your mental illness.

Mental health coverage for Medicare Part B allows you to receive services from various health professionals in various settings, such as community mental health centers or doctors’ offices. The focus here is on mental health services that are provided through an outpatient setting.

While some mental healthcare services are free with your benefits, such as your yearly preventive care services to evaluate depression and your wellness, you’ll need to cover your yearly deductible and 20% of your healthcare costs afterward. For those with a Medicare Supplement plan, the remaining balance is mostly, if not completely, covered for the same healthcare services.

Medicare Part C (Medicare Advantage)

Medicare Advantage plans provide benefits from private insurance carriers that cover your healthcare. All Medicare Advantage plans are required to cover the same healthcare services as Original Medicare, but there are several restrictions to remember:

• You’re going to have to work within your network when using Medicare Advantage plans or pay a higher rate.
• While the same healthcare services must be provided, because of the network restrictions, you may have to change doctors to keep your costs low.

Your Medicare Advantage benefits can come with extra perks associated with your coverage but often severely limits healthcare options for mental health resources. Everyone has their own healthcare needs, so a Medicare Advantage plan may be right for you, but it’s important to explore all options before enrolling.

Speaking with a licensed Medicare agent can help you weigh the pros and cons of each coverage, an important part of ensuring your mental health services are covered. While both Medicare Supplement and Medicare Advantage plans can help you cover vital mental health services, you are only allowed to be enrolled in one or the other.

Medicare Part D

Medicare and mental health coverage can extend beyond simply receiving healthcare at a facility. Mental health needs can require some enrollees to take prescribed medication for several reasons. Fortunately, Medicare Part D prescription drug plans are available from private carriers to help cover the costs of your medication.

But be aware that not all plans are the same. You’re going to need to check your plan’s formulary to ensure that the medicine you require is a part of that plan’s coverage. Shopping around can help you find the right plan at the lowest price, as availability can change from Zip Code to Zip Code.

Note: antidepressants and antipsychotics are protected classes of drugs by Medicare and must be offered by carriers. This does not mean, however, that every mental health drug is provided on your plan. For more information, check out the section centering around Medicare Part D and mental health below.

Medicare Supplement (Medigap)

If you have a Medicare Supplement plan, you’ll be able to supplement the cost of your healthcare services that are covered by Original Medicare. Remember, when you use Medicare Part B, you’ll only have to pay 20% out of pocket once your deductible for the year is met. But if you have a Medigap plan, you’ll be covered for most or all of these costs.

Often, Medicare Supplement coverage from private insurance carriers is thought of in terms of physical health, but Medigap mental health coverage also exists. Healthcare for both your body and mind may be necessary to help address your concerns. If your doctor deems mental health services as needed for your health, Medicare Supplement plans are available to help you cut costs.

Does Medicare Cover Counseling for Anxiety?

Yes, Medicare mental health coverage is available for counseling for beneficiaries suffering from anxiety. This service will be provided to you through your Medicare Part B benefits and must meet the guidelines of other Medicare-approved counseling, including being medically necessary and administered by a professional that accepts Medicare assignment.

What Is the Medicare Approved Amount for Mental Health Services?

Medicare-approved amounts are the agreed-upon price that healthcare providers agree to with the Medicare program for healthcare services. Below, you can explore what these amounts are for both inpatient and outpatient healthcare services.

Inpatient Mental Health Services:

Medicare Part A has a $1,632 deductible in 2024 (up from $1,600 in 2023) when receiving inpatient healthcare services, and there are also coinsurance expenses to consider. The price of your coinsurance will vary depending on the length of your stay in the hospital:

• You’ll pay $0 for your coinsurance for days 1 through 60.
• In 2024, a $408 coinsurance cost (up from $400 in 2023) for hospital days is required for days 61 through 90 of your stay.
• If you require a stay lasting 91 days or more, you’ll have $816 coinsurance per day ($800 in 2023) within your lifetime reserve days, which equates to 60 total lifetime days.
• Once your lifetime reserve days are maximized, if you require a stay after your initial 90-day hospitalization, you’ll incur all costs on your own.

Medicare mental health coverage is available, but you’ll still need to pay 20% of the inpatient costs as they apply unless you have a Medigap plan or a Medicare Advantage plan that covers such costs.

Outpatient Mental Health Services:

When it comes to the costs of your outpatient services, such as therapy, counseling, or evaluations, Medicare Part B benefits come into play. There are annual depression, wellness, and substance abuse screenings that are free, but other services are priced based on the agreed-upon amount between Medicare and each provider.

In many states, this also includes the possibility of excess charges. Medicare Part B excess charges are a 15% upcharge that healthcare providers who are a part of Medicare but don’t accept Medicare assignment can charge for approved services.

If you’ve covered your deductible then you’ll need to pay 20% of the cost agreed upon by healthcare providers and Medicare. Alternatively, Medicare Supplement plans are available to cover most, if not all, of the remaining costs instead. Medicare Advantage can also help cover outpatient costs.

Medicare Mental Health Providers

Creating a comprehensive Medicare mental health providers list is a daunting task, but thankfully, it’s a bit easier than you think to locate providers near you. The Medicare mental health provider search tool doesn’t just connect you with facilities and doctors in your area but also provides valuable information for both your mental and physical health.

However, if you are in need of immediate assistance and you or someone you know is experiencing a mental health crisis, national help is also available. The Substance Abuse and Mental Health Services Administration (SAMHSA)’s national hotline is available 24/7/365, ready to help. This includes the following services in both English and Spanish:

• Calling SAMHSA’s hotline directly at 1-800-662-HELP (4357) or TTY at 1-800-487-4889.
• Sending your Zip Code to 435748 (HELP4U) to find professional help near you or reviewing mental health options online.
• For direct help with mental health crises and suicide, you should dial 988.

Does Medicare Cover Counseling for Depression?

Yes, Medicare Part B covers counseling for depression when deemed medically necessary by your healthcare provider. It works the same way mental health and Medicare work for counseling, as listed above. Your counseling must be medically necessary and come from an acceptable healthcare professional that accepts Medicare assignment.

Does Medicare Cover Mental Health Hospitalization?

Yes, Medicare Part A benefits cover mental health hospitalization whether you are being admitted into a general hospital or a psychiatric hospital. It’s important to remember that you can receive a variety of mental healthcare services, including medication, while admitted.

Your benefit period begins when you are admitted, and you are provided 60 days of coverage. You begin a new benefit period if you are readmitted after another 60 days and pay your deductible.

Furthermore, if you require more days during your hospitalization, you can also use your coverage which provides 60 lifetime reserve days. For those seeking care in a psychiatric hospital, you have a lifetime total of 190 days of coverage.

If you’ve exhausted your lifetime days, Medicare may still cover the costs of your care at a general hospital. 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. However, these limitations do not apply to diagnosis. Rather, they apply to treatment.

Does Medicare Cover Mental Health Inpatient Services?

Yes, inpatient mental health facilities that accept Medicare are covered by your Medicare Part A benefits. Your benefits work the same as they do when you are hospitalized because in order to receive inpatient mental healthcare services, you’ll need to be admitted into a hospital.

An exception to this would be beneficiaries that are receiving care at nursing homes and living facilities. Inpatient services can still be conducted at these locations, but you’ll need to pay for these services outside of your Medicare benefits. This may mean covering the costs out of your own pockets, through other forms of insurance, or Medicaid.

Does Medicare Cover Mental Health Outpatient Services?

Yes, Medicare Part B covers outpatient services, which include mental health services, such as routine doctor visits, counseling, psychotherapy, and even medications that are provided during your visit.

Your coverage allows you to see clinical psychologists, psychiatrists, social workers, counselors, and other health professionals that accept Medicare assignment, and like Medicare Part A, deductibles and coinsurances will apply to your Part B coverage. Yet, annual depression and alcohol abuse screenings are free.

You may obtain treatment in a therapist’s office or in a clinic as well as through qualifying telehealth options. Medicare and your mental health benefits cover medically necessary services, including activity therapy, such as dance, art, or music therapy. Although you may need to apply for reimbursement on activity therapy, the option is available if determined to be medically necessary by your healthcare provider.

Does Medicare Cover Out of Network Mental Health?

In order to have Medicare cover your mental health services, you’re going to have to use a healthcare provider that accepts Medicare assignment. However, it’s also important to note that network restrictions may still exist for some beneficiaries. Let’s break things down:

• Original Medicare doesn’t have a network, and in order to use these benefits, you’re going to have to receive your mental health services at a facility that accepts Medicare assignment.
• The same is true when using Medicare Supplement plans. If a healthcare provider accepts Original Medicare then they also accept Medigap coverage.
• But Medicare Advantage plans are different. These plans do have networks, and while your Medicare benefits may cover an out-of-network mental health service, be prepared to pay a lot more for doing so.

If you suffer from mental health issues and require care but travel often, Medicare Supplement plans can be a great consideration, whereas Medicare Advantage may actually put you at a disadvantage.

Medicare and Mental Health Parity

Originally, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) only applied to group coverage, but since then, MHPAEA was amended by the collectively named Affordable Care Act to also apply to individual healthcare plans.

The Mental Health Parity Act of 1996 (MHPA) is a protection that disallows annual and lifetime dollar limits on large-group healthcare coverage for mental health benefits less acceptable than limits in place for medical and surgical benefits.

MHPAEA upholds the protections in place by MHPA while adding larger parity requirements for substance use disorders for beneficiaries. The Affordable Care Act also adds additional protection for beneficiaries by requiring mental healthcare services, including substance abuse services, as an essential health benefit (EHB) category in non-grandfathered individual healthcare plans.

How Many Mental Health Therapy Sessions Does Medicare Cover?

There isn’t a limit on mental health therapy sessions covered by your Medicare benefits each year. The limitations you may face come from whether or not your healthcare provider deems the therapy sessions as necessary for your healthcare and whether or not a healthcare provider accepts Medicare assignment.

Here are key considerations to remember:

• Your Medicare Part B benefits will cover the cost of therapy sessions that are considered medically necessary after you cover your yearly deductible.
• Once your deductible is met, you’ll still be responsible for 20% of the cost of receiving therapy for the rest of the year unless you have supplemental coverage, such as Medigap.

Therefore, if you’re receiving therapy and are medically cleared but still wish to take more sessions, you’ll need to pay for it out of pocket. If you still require therapy but are beginning a new year, you’re still covered but will have to pay your yearly deductible again before Medicare Part B covers 80% of the costs.

Medicare Advantage Mental Health Coverage

Medicare Advantage plans must cover the same services as Original Medicare, meaning they cover mental health services. But how much they cover is up to the carrier you enroll with.

A Medicare Advantage plan will also choose what doctors they have in their network, which can limit availability, considering Advantage plans only have 23% of psychiatrists on average.

The low number of mental health professionals that accept Medicare Advantage plans and network restrictions can make it difficult to receive mental health services, especially when traveling. Furthermore, because of the limited amount of mental health providers, you may have to switch providers and have difficulty when doing so as an enrollee of Medicare Advantage.

If you want more freedom, no network restrictions, and still maintain lower costs for your Medicare mental health coverage, a Medigap plan may be the right fit for your needs instead. Healthcare looks different for everyone, and taking the time to assess your needs with a licensed Medicare agent can help you discover the best coverage for you.

Best Plan for Mental Health Medicare Part D

Medicare Part D plans must cover all antipsychotic and antidepressant medications, but each plan will come with a formulary listing the drugs your specific policy covers. Because drugs for mental health must be covered, carriers can’t discriminate against providing antidepressants and antipsychotics.

But the best Medicare plan for mental health prescriptions will be the one that offers the medication you need. Yes, antidepressant and antipsychotic drugs are part of the six protected classes, but other mental health medications may be necessary for your healthcare.

If you need a drug not available under your plan’s formulary, you have the right to an appeal, but you should still check Medicare Part D plans with a licensed Medicare agent before enrolling to best understand your options and your coverage.

Medicare Telehealth Mental Health Coverage

Telehealth coverage is available for access to community mental health centers. Medicare covers evaluation and management visits provided through telehealth meetings, as well as psychotherapy, standard office visits, and consultation. These mental health services are available via telehealth, often at the same price as they would be in person.

Your coverage works the same way as it would in person. Medicare Part B benefits will cover you, and after you meet your yearly deductible, you’ll need to cover just 20% of the costs associated with your visit. Of course, the exceptions here are if your state allows excess charges or if you have Medicare Supplement benefits, which cover most, if not all, of these lingering costs.

It’s important to note that while things are always subject to change, the use of telehealth services may not always be available. After December 31, 2024, more restrictions are coming involving telehealth services at home unless you are eligible due to specific healthcare reasons. Otherwise, even rural beneficiaries will need to seek telehealth services at a medical facility or office.

Does Medicare Cover Inpatient Psychiatric Care?

Yes, if you require inpatient psychiatric care, you are covered by your Medicare Part A benefits. This includes coverage for a portion of the cost of your room, meals, nursing, and other necessary healthcare services. You can obtain care in a hospital or psychiatric hospital.

But it’s important to note that there is a lifetime limit of inpatient psychiatric hospital care when using Medicare. Unlike a hospital that provides 90 days per benefit period and as many as 60 lifetime reserve days, you’ll have a total of 190 days when in a psychiatric hospital.

Medicare Part A does the heavy lifting when it comes to covering the costs of your healthcare as an inpatient, but additional costs related to certain services may persist.

There is a possibility that you may incur costs for Medicare Part B while an inpatient in the hospital due to these doctor services. You may also face costs for amenities or healthcare services that are not deemed medically necessary, such as a private nurse or room. If you require further coverage, either a Medigap or Advantage plan may be able to help.

Do Medigap Plans Cover Mental Health?

Yes, Medicare Supplement plans will cover mental health services and treatments. Medigap mental health coverage works by picking up the cost-sharing left over after Original Medicare pays its portion for your services.

In the end, beneficiaries with Medicare Supplement plans are often left with little to no costs when receiving mental healthcare. Additionally, there are many other impressive features that come along with your coverage:

• Unlike Medicare Advantage, Medigap plans don’t have a network. Therefore, you don’t have to worry about where you go to receive your healthcare, so long as they accept Medicare assignment.
• There are 12 lettered plans offering ranging levels of benefits for enrollees. Medigap Plan F mental health benefits are a beloved option, but if you weren’t eligible for Medicare before 1/1/2020, you are not eligible. Fortunately, there are similar options, less comprehensive options that save on costs, and other impressive options available.
• As you can see above, there are many different mental health and Medicare scenarios that can arise. Fortunately, because Medicare Supplement is supplemental insurance, if Original Medicare benefits cover your healthcare service, your Medigap benefits also cover them.

Everyone has different healthcare needs, but for many, the benefits found within Medicare Supplement plans can be extremely helpful in cutting costs. This is especially true for those who often travel, as your Medigap outpatient mental health benefits are there for you regardless of network.

By comparison, Medicare Advantage’s limited access to mental health professionals and network restrictions can make it even more difficult to receive the healthcare you deserve. Speaking with a licensed Medicare agent is the best way to ensure your mental health needs are being met while saving costs on the services necessary for your health.

How To Find Help With Medicare Mental Health Coverage

It’s easy to see that there are plenty of different needs when it comes to your mental health, and the good news is that Medicare benefits are available to help. Whether you are needing inpatient, outpatient, or prescription drugs, there are benefits available to help you cut the cost of your healthcare.

But just as there are many different healthcare needs, there are also many solutions. For some, a Medicare Advantage plan may be the right option, but even still, it’s important to choose the right coverage and carrier.

If you decide to choose a Medicare Supplement plan, you can likely cover the majority or all of your inpatient mental health costs. However, with 12 lettered plans to choose from, there are a lot of options available.

There are even Medicare Part D prescription drug plans to also consider, so overall, these options can be a lot. At the end of the day, your healthcare coverage should be there for you and your needs both when receiving care and in regard to your bank account. This is where we can help.

At MedicareFAQ, our team of experts consists of licensed Medicare agents that can match your healthcare needs with the best coverage options to suit you. Then, we compare your coverages and deliver the most affordable benefits that keep you covered when receiving healthcare.

Give our agents a call at the number above to learn more about your Medicare mental health coverage options. If you can’t call now, fill out our online rate comparison form to compare your rates today!

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