First and foremost, yes. Medicare does, in fact, cover mental health services. Considering that mental health concerns can creep up as an issue or come in the form of a full-blown crisis, it’s a relief to know that Medicare beneficiaries do have coverage. That being stated, deductibles, coinsurance, and limitations may apply.
Medicare coverage includes both inpatient and outpatient services in order to help diagnose and treat mental health conditions. Prescription drugs that may be needed are also covered.
What Mental Health Services Does Medicare Cover
As a Medicare beneficiary, you are entitled to benefits for psychotherapy, mental health counseling, psychiatric care, inpatient and outpatient mental health services.
You will want to select providers that accept Medicare assignment to minimize your out of pocket costs.
Keep in mind that deductible, coinsurance and some limitations may apply.
As part of your Medicare Part B coverage, your “welcome to Medicare visit” and your yearly “Wellness Visit” your primary care doctor will ask you some questions to evaluate your physical and mental health.
The “Welcome to Medicare” preventive visit costs you nothing and is a review of potential risk factors.
If your doctor accepts Medicare assignment, you pay nothing for this visit provided it takes place within 12 months of your enrollment into Medicare Part B.
The yearly “Wellness Visit” is also covered by your Medicare Part B coverage. You pay nothing for the wellness visit, again, provided the doctor accepts Medicare assignment.
Your physician will evaluate your well-being each year and discuss any changes in your mental health.
Since your doctor is the one addressing mental health and alcohol or substance misuse, this is an optimal time to discuss any concerns or nagging matters. During the last two decades, the stigma that once surrounded mental health has dwindled.
Understand that in 2004, Psychology Today magazine published that over 59 million people received mental health treatment during a two-year period. Over 80% of those persons found the treatment effective.
Does Medicare Cover Inpatient Mental Health Services
Yes, Medicare covers mental health hospitalization. Part A is the hospital insurance portion of your Original Medicare. Coverage included under Part A consists of the benefits paid when you’re an inpatient in a hospital. Keep in mind your Part A deductibles and coinsurance will apply.
Therefore, if you’re admitted to the hospital your Medicare Part A will help cover those costs. When you’re enrolled in Medicare, your benefits allow you to receive 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.
The same benefits and services are payable as with a general hospital.
However, Part A covers a psychiatric hospital for a lifetime maximum of 190 days.
If you receive mental health services in a general hospital, Part A will measure those hospital services in “benefit periods.”
The day you become admitted as an inpatient is the day your benefit period begins.
This benefit period ends after you haven’t received any inpatient hospital treatment for 60 consecutive days.
If you’re admitted into the hospital after 60 days, it’s considered a new benefit period.
You will incur a new deductible and be responsible for any coinsurance due for that benefit period, but there is no limit to the number of benefit periods you can have for mental health 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 other related services and supplies
Does Medicare Cover Outpatient Mental Health Services
Medicare Part B is medical insurance. It provides coverage for mental health services obtained from a doctor or services rendered outside the hospital. As well as, visits with a doctor, psychiatrist, clinical psychologist or clinical social worker.
Lab tests ordered on an outpatient basis are also covered under Part B. Deductibles and coinsurance may apply.
Furthermore, the doctor or psychiatrist must accept Medicare assignment for their services to be covered. You can check with the office staff when making an appointment for services.
The following must always accept Medicare assignment:
- clinical psychologist
- nurse practitioner
- physician assistants
- clinical social worker
- clinical nurse specialist
Outpatient treatment for inappropriate use of alcohol or drugs is covered under Medicare Part B.
Does Medicare Cover Psychotherapy
Individual and group psychotherapy with doctors or certain other licensed professional may be covered, as permitted by state law.
Covered Professional services: (this is not a full list of services available)
- Psychiatric evaluation
- Diagnostic tests
- Medication management
- Testing to find out if you’re receiving 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 services. In this setting, Medicare beneficiaries would receive acute mental health therapy, more intense than services provided at a therapist’s office.
Medicare does require documentation from the provider stating that partial hospitalization is necessary in lieu of inpatient hospital care.
Does Medicare Cover Mental Health Counseling
Yes, Medicare covers counseling services.
These counseling services include group therapy, psychiatric evaluation and testing, individual therapy, family counseling, and alcohol abuse counseling up to four sessions.
Medicare will not cover marital counseling, nor will it cover counseling with a pastor.
What Mental Health Services are Not Covered by Medicare
Support groups that bring people together to socialize (this is different from group psychotherapy, which is covered)
- Transportation to or from mental health care and services
- 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 medically necessary)
Does Medicare Part D Cover Prescription Drugs for Mental Health
With a few exceptions, Medicare Part D prescription drug plans are required to cover all antipsychotic, antidepressant and anticonvulsant medications.
Each Part D prescription drug plan operates based on a formulary or a pre-set list of medications covered by the plan. Drugs used for mental health are required to be covered and the plan cannot discriminate.
If your doctor thinks you need a prescription not covered under your plan’s formulary, you have the right to request 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 Medicare beneficiaries on a limited income or who may have limited resources. You can apply for extra help, Medicaid or the State Pharmacy Assistance Program, provided 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 also have out of pocket costs that are up to the beneficiary to pay. These costs can add up quickly, leaving you with a financial burden.
To get protection from these out of pocket costs, you would want to enroll in a Medicare Supplement. These supplemental plans cover that 80% Part B doesn’t pay, as well as deductibles, coinsurance and copayments that fall under both Part A & B.
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. Our services are at zero cost to you.
Don’t let Medicare overwhelm you, we want to help. Give us a call, or complete our rate comparison form to see supplement rates in your area today.