Does Medicare cover mental health services?
What types of mental health services, like therapy or counseling, does Medicare cover?
Medicare provides coverage for a wide range of mental health services, including therapy, counseling, and psychiatric care. These services are covered under both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), depending on whether the care is provided in an inpatient or outpatient setting. Here’s an overview of the mental health services that Medicare covers:
1. Medicare Part A (Hospital Insurance) – Inpatient Mental Health Care:
Medicare Part A covers mental health care when you’re admitted as an inpatient to a hospital or psychiatric facility for treatment. This includes:
Inpatient psychiatric hospital stays: Part A covers up to 190 days of inpatient psychiatric hospital care during your lifetime. If you need additional inpatient mental health care beyond 190 days, it must be provided in a general hospital, not a psychiatric hospital.
Inpatient care in a general hospital: There is no limit to the number of days Medicare will cover for mental health care provided in a general hospital, but you will be subject to deductibles and coinsurance for hospital stays.
Room and meals: Medicare Part A covers your room, meals, and nursing care during your stay.
Doctor’s services: Psychiatric and medical care provided by doctors during your stay is also covered.
Cost-sharing for inpatient mental health services:
Part A deductible: $1,632 per benefit period in 2024.
Coinsurance: You’ll pay $0 for the first 60 days of inpatient care, $408 per day for days 61-90, and $816 per day for lifetime reserve days (beyond day 90, with a 60-day lifetime limit).
2. Medicare Part B (Medical Insurance) – Outpatient Mental Health Care:
Medicare Part B covers a variety of outpatient mental health services, including therapy and counseling. Covered services include:
Individual therapy: Medicare covers one-on-one sessions with a licensed psychiatrist, psychologist, clinical social worker, or other mental health professional who accepts Medicare.
Group therapy: Group counseling sessions led by a Medicare-approved mental health professional.
Family counseling: Family therapy sessions, as long as they are related to the treatment of your mental health condition.
Diagnostic tests: Medicare covers psychological testing and diagnostic evaluations to determine your mental health condition.
Psychiatric evaluations: Medicare covers visits with a psychiatrist to diagnose and develop a treatment plan for mental health issues.
Medication management: Medicare covers outpatient visits to manage mental health medications prescribed by a psychiatrist or other medical provider.
Substance abuse treatment: Outpatient care for alcohol or drug misuse, including counseling and therapy.
Cost-sharing for outpatient mental health services:
Part B deductible: You’ll pay the Part B deductible ($240 in 2024).
Coinsurance: After meeting the deductible, Medicare typically covers 80% of the Medicare-approved amount for outpatient mental health services. You are responsible for 20% of the cost unless you have additional coverage like a Medigap plan to help with coinsurance.
3. Preventive Mental Health Screenings:
Medicare also covers certain preventive services to help detect mental health conditions early, including:
Annual depression screening: Medicare covers one depression screening per year, conducted by your primary care doctor or a qualified provider. This screening must take place in a primary care setting that can offer follow-up treatment or referrals.
Alcohol misuse screening and counseling: Medicare covers an annual alcohol misuse screening for individuals who don’t have alcohol dependence but may engage in risky drinking behaviors. If you screen positive, Medicare covers up to four counseling sessions per year.
Welcome to Medicare visit: During your initial “Welcome to Medicare” visit, Medicare covers an evaluation of your risk factors for depression and other mental health concerns.
4. Telehealth for Mental Health Services:
Medicare covers telehealth services for mental health care, allowing you to receive counseling and therapy remotely via phone or video calls with a licensed mental health provider. Telehealth is particularly helpful for individuals who have difficulty accessing in-person care due to geographic or mobility issues.
5. Partial Hospitalization Programs (PHPs):
Partial hospitalization programs (PHPs) are covered by Medicare Part B as an alternative to full inpatient hospitalization. PHPs are structured day programs that provide intensive mental health treatment for individuals with serious mental health conditions. These programs typically include:
Therapy sessions.
Group counseling.
Medication management.
Other therapeutic activities.
PHPs are designed for individuals who need more intensive care than outpatient therapy but don’t require full-time hospitalization. Medicare covers these programs if they are provided by a Medicare-certified facility.
6. Medicare Part D (Prescription Drug Coverage) for Mental Health Medications:
Medicare Part D covers prescription medications needed to manage mental health conditions, such as:
Antidepressants.
Antipsychotics.
Mood stabilizers.
Anti-anxiety medications.
Part D plans are offered by private insurers, so it’s important to choose a plan that covers the specific medications you need. Check the plan’s formulary (list of covered drugs) to ensure your prescriptions are included.
7. Medigap and Medicare Advantage for Mental Health Services:
Medigap: If you have Original Medicare and a Medigap plan, your Medigap plan can help cover the out-of-pocket costs (deductibles, copayments, and coinsurance) for mental health services.
Medicare Advantage (Part C): Medicare Advantage plans are required to provide the same coverage as Original Medicare for mental health services, but they may offer additional benefits such as lower copayments or access to additional mental health resources. Always check your plan’s network to ensure you can access the mental health providers you need.
Key Takeaways:
Medicare Part A covers inpatient mental health care, while Part B covers outpatient services such as therapy, counseling, and psychiatric evaluations.
Preventive services like depression screenings and alcohol misuse counseling are covered at no cost to you.
Telehealth for mental health care is covered, providing access to therapy via phone or video.
Medicare Part D helps cover the cost of prescription medications for mental health conditions.
For personalized guidance on accessing mental health services through Medicare or finding a plan that covers your specific needs, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
