What Services Are Included In The Medicare Mental Health Benefits
Medicare mental health coverage is available in an inpatient or outpatient setting, depending onwhich is medically necessary for your treatment. The following services areexamples of whats covered by Medicare for people who need to be treated in aninpatient setting:
- Lab tests
Some of the services available to people inoutpatient care include:
- Lab tests
- Some medications, ifgiven in a medical setting
- Visits with a doctor orsocial worker
Theseare just a few examples of the services that Medicare offers. Medicare alsooffers an annual depression screening, which you can schedule this with yourprimary care physician at your convenience.
Does Medicare Cover Other Types Of Counseling
There are other specific situations in which Medicare may cover specialized counseling services. For example:
- Grief and loss counseling for hospice patients and their families.
- High-intensity behavioral counseling about sexually transmitted infections for at-risk sexually active adults.
- Behavioral counseling to help you lose weight if you meet certain medical requirements.
- Counseling sessions to help you quit smoking.
- Alcohol misuse counseling if its provided in a doctors office or other primary care setting.
These specialized types of counseling are usually limited to a certain number of sessions per year. Ask your health care provider for details if he or she recommends these counseling services.
Medicare Part B: Psychotherapy And More
Medicare Part B covers your outpatient care. Most forms of psychotherapy and group therapy will fall under Part B. Basically, Part B covers care that you receive from a healthcare provider while not admitted as an inpatient, and this includes most testing and therapy you will get done at a doctor’s office, therapist’s office, or mental health center.
Part B will generally cover any necessary outpatient care, including tests, preventative care, and outpatient therapies. Part B will also usually cover partial hospitalization programs. These programs involve treatment plans where you receive intensive care that may take most of the day, but you do not stay the night and are not actually admitted as an inpatient.
The Part B deductible is $233 in 2022. You will also need to pay a 20 percent coinsurance for most services.
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Medicare Coverage Of Preventive Mental Health Services
Medicare Part B covers preventive services that address your mental health, including screenings to identify your risk for depression or substance abuse. You generally need to get these services from a Medicare-assigned health provider in a Medicare-enrolled facility to make sure Part B covers them.
Preventive benefits related to mental health coverage include:
- Depression screening: All Medicare Part B beneficiaries are covered for one depression screening every year at no cost, so long as the doctor accepts Medicare assignment.
- Alcohol misuse screening: All Medicare Part B beneficiaries who arent alcohol-dependent are covered for one alcohol misuse screening every year. If your doctor determines you misuse alcohol, you may qualify for up to four counseling sessions per year.
- Welcome to Medicare visit: This one-time preventive exam includes a review of your overall health and includes an evaluation of your risk for depression. The visit is completely covered if you have the visit within the first year of having Medicare Part B.
- Wellness visit: After the introductory visit, all Medicare Part B enrollees are covered for one preventive visit every year. If you have any questions or concerns about your mental well-being, youll have the chance to speak with your doctor during this exam. Your doctor may discuss treatment options or refer you for additional care.
About The Current State Of Medicaid & Mental Health Services
If you have Medicaid, know that you have access to an array of mental health services you need for yourself and your children. In fact, Medicaid is the largest national single-payer for mental health services in the United States, so rest assured. After all, many others who use Medicaid have found mental health services that are covered, which means you can too its all about knowing where to look.
Theres even more good news: Thanks to the Affordable Care Act, Medicaid is currently expanding its role in the reimbursement of substance use disorder services and behavioral health disorder services to provide more help to more Americans. Congress enacted these laws to improve mental health and substance use disorder services for those with Medicaid, making it easier for you to find a mental healthcare provider without having to pay out of pocket.
The most recent law, the Mental Health Parity and Addiction Equity Act extended coverage for mental health services to millions of Medicaid beneficiaries who participate in Managed Care Organizations, State alternative benefit plans, and Medicaid for children .
Medicaid has greatly expanded its mental health service coverage, which is good news for those seeking therapy, rehabilitation, or other assistance. This coverage has been updated to reflect the current key mental health priority access across the nation for the next several years including:
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Does Medicare Cover Inpatient Mental Health Care
If your condition requires an inpatient stay, Medicare Part A covers general hospital and psychiatric hospital services. Theres a cap on Medicare coverage for inpatient services if you stay at a psychiatric hospital : Medicare Part A will only cover psychiatric hospital care for up to 190 days in your lifetime. Even when youre admitted to a hospital as an inpatient, Medicare Part B covers doctor services you get during your hospital stay.
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 therapists 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.
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Limitations To Insurance Coverage For Therapy
In the past, insurance companies routinely placed annual caps on the amount of mental health benefits or severely limited your coverage in other ways. The Mental Health Parity and Addiction Equity Act helped with this. Now, any limits that exist cant be more restrictive than limits placed on your physical health.
However, though ACA-compliant plans, Medicare, and Medicaid provide at least some mental health coverage, non-ACA compliant plans for sale outside the Marketplace arent required to do so. So, check with your insurer to see if any limitations exist. Your policy’s summary plan description is a good starting point for researching limitations.
Medicare Supplement Insurance: Can It Help
Medicare supplement plans, also known as Medigap plans, are plans that help to pay for your out-of-pocket costs associated with Medicare. While Medicare pays for your healthcare costs, they do still leave some of it for you to pay out-of-pocket. As the name implies, Medigap plans fill that gap.
Medigap plans will cover things like your copayment, coinsurance, and excess charges. If your mental healthcare provider doesn’t accept Medicare assignment, Medigap Plan G or Plan F can help cover these fees. It will depend on your specific situation and costs to determine if this is worth it for you. You can find a full comparison of Medigap plans at medicare.gov.
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Does Medicare Cover Mental Health Services
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Medicare pays much of the cost of a wide range of mental health services, whether provided on an outpatient basis or for inpatients in a psychiatric or general hospital. But you need to be aware of limits on these benefits, including substantial copays, coinsurance and a lifetime maximum.
Mental health issues are common among older adults: Thirty-one percent of Original Medicare beneficiaries are living with mental illness, according to a July 2020 report by the Commonwealth Fund, a private foundation focused on health care. And in a July 2020 survey by the Kaiser Family Foundation, 46% of Americans ages 65 and up said that pandemic-related stress and worry were detrimental to their mental health.
What Youll Pay For Outpatient Mental Health Care
For outpatient mental health care, after you meet the Medicare Part B deductible, which is $203 in 2021 , there are typically copayments of 20% for additional services. If you receive additional mental health services in hospital outpatient facilities, you may owe more.
To get information on your out-of-pocket costs, talk to your health care provider. Your bottom line will depend upon providers charges, the facility type, whether your doctor accepts Medicare assignment and any other insurance you may have.
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Does Medicare Cover Counseling If You Have Medicare Advantage
Medicare Advantage is private insurance, which means that your coverage may be different depending on the specific plan you choose. At a minimum, Medicare Advantage must provide the same level of counseling and therapy coverage as Original Medicare.
Your Medicare Advantage plan may charge a flat copayment for counseling and therapy services instead of a percentage-based coinsurance. You may also need to get counseling from providers in the plans approved network of providers.
Also noteworthy, some Medicare Advantage plans require referrals and prior authorization for therapy and counseling services.
If you have a Medicare Advantage plan, check your plan brochure for specific information about mental health coverage. You can also call your plans Member Services department for further help.
Other Parts Of Medicare
Although parts A and B cover most of your mental health needs, you can get additional coverage by enrolling in the following Medicare plans:
- Medicare Part C: automatically covers all Medicare Part A and Part B services, plus prescription drugs and other coverage areas
- Medicare Part D: can help cover some of your mental health medications, including antidepressants, anti-anxiety medications, antipsychotics, mood stabilizers, etc.
- Medigap: can help cover some fees associated with your inpatient or outpatient care such as coinsurance and deductibles
If youre ready to seek mental health treatment, visit the Substance Abuse and Mental Health Services Administrations website to find behavioral health treatment services near you.
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Medicare Coverage Of Counseling And Mental Health Services
Caring for your mental well-being is just as important as taking care of your physical health. As you get older, you might feel sad or frustrated sometimes, especially when you have health problems. However, if youre feeling persistently sad or anxious or having thoughts of suicide, your doctor can be a good resource for helping you get the care you need.
Medicare covers many mental health services to help you stay healthy, such as psychological counseling services, diagnostic evaluations, and preventive screenings.
Which Outpatient Mental Health Care Services Does Medicare Cover
Medicare covers the following outpatient mental health care services:1
- Family counseling, when the goal is to help with treatment
- Psychiatric evaluation and diagnostic tests
- Outpatient treatment programs
- Medication management and certain medications that are not self-administered, like some injections
- For treatment of drug or alcohol abuse
- Partial hospitalization
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What Part Of Medicare Covers Mental Health Care
Medicare Part A covers mental health care in an inpatient setting. Part A mental health care is in a general hospital or a psychiatric hospital only for people with mental health concerns. If you get inpatient care in a psychiatric hospital, Part A will cover up to 190 days in a lifetime. There is no limit to the number of benefit periods you can have for mental health care in a general hospital.
Part A covers your room , meals, nursing care , therapy and treatment, lab tests, medications, and other services and supplies you need. Part A does not cover personal items or a phone or TV in your room.
Medicare Part B covers mental health care on an outpatient basis in these types of settings:
- A doctors or other health care providers office
- A hospital outpatient department
- A community mental health center
And from these types of providers :
- Psychiatrist or another doctor
- Clinical psychologist, social worker, or nurse specialist
- Nurse practitioner
- Physician assistant
Part B helps pay for these outpatient mental health services:
Part D helps cover self-administered prescribed drugs.
Medicare Advantage plans cover all services offered through Original Medicare Part A, Part B, and usually Part D. Copays and coinsurance amounts vary, depending on your plan. Providers and services must be in-network and typically require referrals and prior authorizations before you can receive services.
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.
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How To Find Care
The Medicare online Physician Compare tool is the easiest way to find a Medicare psychiatrist near you.
Enter your city or zip code and type psychiatry into the keyword box.
Hit Search, and a list of psychiatrists who accept Medicare will appear. You can click a doctors name for contact information, driving directions and other details.
If you are covered under a Medicare Advantage plan, you may need to check your plans website or call your provider to find psychiatrists who accept your specific Medicare Advantage insurance.
Medicare Advantage plans are an all-in-one alternative to Original Medicare.
These plans must cover the same services as Original Medicare, but often restrict beneficiaries to specific networks of doctors and providers.
In some cases, you may need a referral to see a specialist.
If you have trouble accessing the Physician Compare website, you can call 1-800-633-4227 and speak with a Medicare representative. This representative can also send you a printed version of the psychiatrist search results.
Does Medicare Pay For Therapy Services
As part of mental health care benefits that Medicare offers, therapy, or counseling, is typically covered under Part B as an outpatient service with Original Medicare. MA plans provide the same benefits as Part B does. Therapy generally can be for an individual or a group. Family therapy is covered if it is to support the Medicare beneficiarys mental health treatment goals.
Like all mental health services, therapy must be received from a provider that accepts assignment for Original Medicare or is in-network for MA plans. The provider must be licensed in your state. Copay or coinsurance and deductibles apply.
In 2021, for instance, for outpatient mental health care through a UnitedHealthcare MA HMO plan, you pay $25 copay for each Medicare-covered individual therapy session and $15 copay for group therapy. For a similar type of plan with Humana, you pay a $20 copay for mental health services received from a specialist, an outpatient hospital, or intensive therapy that is part of the day program in a hospital. For a similar plan with BCBS/Anthem, you pay $40 for each Medicare-covered visit, group, or individual.
Your copays vary depending on your MA plan. To find out what your out-of-pocket costs will be and precisely what your plan will cover based on Medicare rules, talk with your plans administrator, review your EOC, and talk with your healthcare provider. Allow for the time it takes to get a referral and prior authorization.
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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.
Stay In The Comfort Of Your Home
For those struggling with depression, anxiety, or a variety of other disorders, it can be a struggle to get out of the home. Unfortunately, such ailments can make individuals neglect their own care, as attending in-person appointments can be too stressful. With online counseling, it removes the obstacle of transportation, making therapy more accessible for those in need. Debilitating mental and physical health issues can now be treated from the comfort of your home with online counseling.
Online therapy and counseling operate very similarly to traditional appointments. When you video chat or voice call your specialist, they will generally be located in their office. As long as you are in a secure location, you will receive the same level of privacy you would expect from an in-person appointment.
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Medicare Coverage Of Therapy And Mental Health Benefits
Contributing expert: Kelly Blackwell, Certified Senior Advisor®Medicare beneficiaries can access mental health care benefits through Original Medicare Part A for inpatient care and Part B for outpatient services or through a Medicare Advantage plan. Mental health coverage through Medicare supports optimal emotional, psychological, and social well-being.Updated: December 07, 2021
Kelly Blackwell
Kelly Blackwell is a Certified Senior Advisor ®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.
What Original Medicare Doesnt Cover
Your health care provider may recommend you receive services more frequently than Medicare covers, or services that Medicare doesnt cover, and you may end up paying some or all of these costs. Ask your provider why they are recommending such services and whether Medicare will cover them.
You will have to pay for private duty nursing or a private room, unless its medically necessary. Other limits may apply.
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