Does Medicare Cover Mental Health Services?
Yes, Medicare covers mental health services, including outpatient services like counseling, therapy, and an annual depression screening. Medicare also covers inpatient care provided at both general and psychiatric hospitals. Approximately 25% of older adults suffer from a mental disorder such as dementia, depression, or anxiety, making Medicare’s mental health coverage crucial for overall health and wellbeing.
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Make Mental Health a Priority With Medicare Coverage
Mental health problems are fairly common among older adults, with approximately 22% reporting that they have feelings of loneliness and isolation. This is commonly triggered by the loss of loved ones, lack of friends, living alone, or a lack of transportation. Chronic illness and mental health conditions can also fuel these feelings.
Unfortunately, fewer than 50% of older adults actually receive the mental health treatment they need. These statistics highlight the importance of using Medicare coverage to proactively address mental health challenges among older adults.
What Mental Health Services Does Medicare Cover?
|Annual depression screening||Part B covers 100% of the Medicare-approved amount|
|Annual wellness visit||Part B covers 100% of the Medicare-approved amount|
|Psychiatric evaluation||Part B covers 80% of the Medicare-approved amount|
|Follow-up evaluations for treatment and/or drug effects||Part B covers 80% of the Medicare-approved amount|
|Individual and group therapy||Part B covers 80% of the Medicare-approved amount|
|Family counseling||Part B covers 80%|
|Partial hospitalization||Part B covers 80% of the Medicare-approved amount|
|Hospital stay, psychiatric or general||Part A covers 80% of the Medicare-approved amount; additional coinsurance may be needed from beneficiary|
|Medication; professionally administered||Part B covers 80% of the Medicare-approved amount|
|Medication; self administered||Part D coverage varies; Medicare Advantage may also offer coverage|
Both Medicare Part A and Part B offer coverage for a wide range of mental health services. Some services have annual and benefit period limits, while others may have lifetime limits.
Screenings and Evaluations
Evaluations and screenings are critical for the early detection and treatment of mental health challenges.
- Depression screening: Medicare covers one depression screening per year to evaluate whether you are at risk of depression. This must occur at the office of your primary care physician, or at a primary care clinic that can provide referrals and follow-up treatment. You do not need to show signs of depression to be eligible for this screening.
- Annual wellness visit: After the first 12 months of coverage, Medicare beneficiaries are eligible to receive an annual wellness visit. This visit may include a cognitive assessment and screening for anxiety, depression, delirium, and dementia.
- Psychiatric evaluation: Medicare covers psychiatric evaluations as long as they are provided by a physician, psychiatrist, or another licensed healthcare provider. If the evaluation is provided in a hospital outpatient department or a clinic, an additional coinsurance or copayment may be due to the hospital.
- Follow-up evaluations for treatments and/or drugs: Periodic evaluations are necessary to track the effectiveness of any prescribed treatments and medications. Medications are not covered by Original Medicare, though some Medicare Advantage plans may include drug coverage. Beneficiaries interested in prescription drug coverage may purchase a stand-alone Medicare Part D plan.
Counseling and Therapy
Therapy and counseling can be effective in addressing mental health challenges.
- Individual and/or group therapy: Individual and group psychotherapy, also called “talk therapy,” is covered when it is provided by psychologists, psychiatrists, and certain licensed and trained mental healthcare professionals.
- Family counseling: Medicare covers family counseling if the primary goal is to help with the covered individual’s mental health treatment. In some cases, grief and loss counseling may also be covered for eligible hospice patients and their families. However, marriage and other types of relationship counseling are not covered.
In some cases, mental health conditions require inpatient hospitalization, whether in a psychiatric hospital or a general medical hospital.
- Partial hospitalization: Partial hospitalization is an outpatient program in which a patient receives structured psychiatric care as an alternative to inpatient care. Medicare Part B covers partial hospitalization if your doctor certifies that you would otherwise need inpatient hospital treatment.
- Hospital stay, psychiatric or general: A psychiatric hospital is a facility that exclusively provides services for individuals with mental health disorders. Medicare Part A limits treatment in a psychiatric hospital to 190 total days during a patient’s lifetime. After that, additional treatment may be covered if it is provided in a general medical hospital.
Certain types of medication may help treat mental health disorders. Depending on how the medication is administered, the cost of your mental health drugs may be covered under Medicare Part B or Medicare part D.
- Medication administered by a healthcare professional: When a prescribed medication cannot be self-administered, it may be covered by Medicare Part B. These are medications you receive in a doctor’s office or a hospital outpatient setting, like intravenous drugs.
- Medication taken at home: Prescription drugs that can be self-administered fall under Medicare Part D coverage. Antidepressants, antipsychotics, and anticonvulsants are three of the six protected classes of drugs that Medicare Part D plans must cover.
What Does Medicare Not Cover?
Medicare’s mental health coverage typically does not extend to the following:
- Inpatient psychiatric hospital care beyond 190 days
- Marriage and/or relationship counseling
- Counseling provided by social workers, pastors, or other non-licensed professionals
- Private duty nursing
- Private hospital rooms, unless medically necessary
- Personal items while in the hospital (ex. socks, razors, toothpaste)
- Extra costs for having a phone or television in your hospital room
- Support groups (not group psychotherapy) designed to bring people together to talk and socialize
- Transportation to and from mental health services
- Meals during partial hospitalization
- Training or testing for job skills that aren’t part of an individual’s mental health treatment
The Cost of Mental Health Care With Medicare
When assessing the potential cost of mental health evaluations, diagnosis, and treatment, it’s important to factor in the following:
A deductible is the amount you must pay before your Medicare benefits kick in. In 2023, the Medicare Part A deductible is $1,600 for each benefit period. The Part B deductible is $226 per year.
Flat Coinsurance Rate For Hospitalization
Medicare Part A also has a flat daily coinsurance rate for hospitalization, which is a fixed fee that depends on the number of days you’re in the hospital. It acts like a copayment, and breaks down into the following:
- First 60 days are 100% covered
- Days 61-90 have a $400 flat coinsurance rate per day
- Days 91-150 have a $800 flat coinsurance rate per day, and also counts as using your 60 lifetime reserve days
- Beyond 150 days, you cover 100% of all costs
Both Medicare Parts A and B pay 80% of Medicare-approved costs for covered services. This means after you’ve met your deductibles, you would be responsible for covering the remaining 20% of costs.
How Do Other Medicare Options Cover Mental Health Services?
Beyond Original Medicare, you may choose a Medicare Advantage plan or a Medicare Supplement (Medigap) plan for additional coverage. Medicare Part D (prescription drug) coverage may also help cover the cost of mental health medications.
Medicare Advantage plan is another way to get your Medicare Part A and Part B coverage, as these plans must cover at least the same mental health services as Original Medicare. In addition, they feature an annual out-of-pocket cost maximum, which may help limit the amount you have to pay for your mental health services each year.
Medicare Advantage plans typically bundle Part D coverage as well as additional benefits like vision and hearing. Some Medicare Advantage plans also offer further mental health benefits, like coverage for more counseling types. Review your policy details to see if your plan has extended mental health benefits, or speak with a trusted Medicare agent to help you find a plan with these coverages included.
Medicare Supplement, or Medigap
Medicare Supplement plans, also called Medigap, work in tandem with Original Medicare to help offset some out-of-pocket costs like deductibles, copays, and coinsurance. After your Original Medicare coverage pays its share of your healthcare costs, your Medigap policy contributes towards the remaining costs that are your responsibility to pay. This can help offset the cost of your mental healthcare.
Medicare Part D, or Prescription Drug Coverage
Medicare Part D is prescription drug coverage that can offset the cost of self-administered mental health drugs. This includes antidepressants, antipsychotics, and anticonvulsants.
How to Get Mental Health Care With Medicare
If you’re struggling with mental health challenges, it’s important to seek professional help. Medicare recipients can do this by following these steps:
- Find a Medicare-certified provider: When a healthcare provider or licensed mental health professional is Medicare-certified, this means that they offer services that are at an approved level of quality. It’s important to confirm this, as Medicare does not pay for services rendered by a non-certified provider.
- Create a care plan with your physician: Once you’ve found a Medicare-certified healthcare provider, you can work together to create a care plan. This typically starts with an evaluation and diagnosis. The provider then identifies the type of care you need and creates a written plan that includes the recommendation and the outcomes you are trying to achieve. The care plan may include psychotherapy, counseling, and/or medication.
- Follow physician recommendations and prescriptions: It’s important to carefully follow your provider’s recommendations and keep appointments and take medications as prescribed. If you feel like the treatment is not working, or you’re uncomfortable with the side effects, or you have any other issues, speak to your provider before making any changes.
Putting It All Together
It’s common for older Americans to suffer from mental health issues, including depression, anxiety, and dementia. Taking advantage of no-cost annual screenings and evaluations can help you proactively address challenges to your mental health. Medicare also covers a wide range of mental health services, making them accessible and relatively affordable. If you’re suffering from mental health challenges, consider seeking help from a Medicare-certified mental health professional.