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In recent years, there has been a greater focus on mental health and access to mental health services for patients of all ages. Seniors on Medicare may wonder what mental health services Medicare covers.
What Mental Health Services does Medicare Cover?
Medicare covers both inpatient mental health services under Part A and outpatient mental health services under Part B, including evaluation and visits with a mental health provider. In general, Medicare covers mental health services and visits provided by psychiatrists, clinical psychologists, clinical nurse specialists, clinical social workers, and other doctors, nurse practitioners, and physician assistants who provide mental health services and accept Medicare assignment. If you’re enrolled in Original Medicare, it’s important to check that a mental health provider accepts Medicare assignment before scheduling an appointment. If you have a Medicare Advantage plan, you will want to ensure that the provider is “in-network.”
Each provider must consent to the amount Medicare approves as payment in full, called accepting assignment. A 2022 Kaiser Family Foundation analysis found that 60 percent of psychiatrists are accepting new Medicare patients so it’s important to choose a provider on that list.
Inpatient mental health services – Medicare Part A
Medicare Part A covers mental health services for people admitted as a hospital inpatient, at a general or a psychiatric hospital. The coverage and cost sharing typically line up with other inpatient hospital stays, with one key exception: Medicare will cover only 190 days total over your lifetime in a psychiatric hospital that specializes in mental health conditions (days spent in a general hospital do not count toward this limit).
For each benefit period*, after the Part A deductible is met, this is what a patient owes for inpatient stays:
Days 1-60: $0
Days 61-90: $400 copayment each day
Days 91-150: $800 copayment each day while using your 60 lifetime reserve days
After day 150: You pay all costs.
*A benefit period begins the day you’re admitted to a hospital as an inpatient or become a patient in a skilled nursing facility. It ends when you’ve been out of the hospital or skilled nursing facility for 60 consecutive days.
If you’re an inpatient at a general or psychiatric hospital, you can also expect to pay 20% of the Medicare-approved amount for mental health services you get from providers during your stay.
Outpatient mental health services – Medicare Part B
Medicare Part B covers mental health services received outside of a hospital setting, such as in a therapist’s office or community health center.
Depression screening:
Medicare beneficiaries are entitled to one depression screening each year as a Part B preventive service that is 100% covered and not subject to the deductible or coinsurance. The only rule is that you must seek this screening in a primary care setting from a primary care provider who accepts the Medicare-approved amount and can provide follow-up treatment or referrals. (Follow-up treatments and referrals are subject to the deductible and coinsurance).
Therapy:
Medicare covers both group and individual therapy with doctors or other licensed professionals. Until 2008, Medicare charged beneficiaries more for outpatient psychiatric treatment than other physicians’ services but congress passed a law that gradually reduced the out-of-pocket expense for those services from 50% to 20% of the Medicare-approved cost. Now, once you have met your standard Part B deductible, you will pay 20% coinsurance for mental health appointments, which is in line with other Part B medical services.
Partial hospitalization:
Medicare Part B will cover partial hospitalization for more intensive treatment than a doctor or therapist can provide in an office setting if you meet certain requirements, including having your doctor certify that you would otherwise need inpatient treatment. In many cases, this treatment is provided in a hospital outpatient department or mental health center where patients do not stay overnight. For partial hospitalization services, Medicare covers 80% of each service received from a doctor or other qualified mental health professional who accepts Medicare assignment.
Medicare Part B also covers a variety of other mental health services, such as:
Diagnostic tests
Family counseling (if the purpose is to help with your mental health treatment)
Medication management
Psychiatric evaluation
Does Medicare cover prescription drugs for mental health?
Yes, separate Medicare Part D policies or Advantage plans with drug coverage do cover prescription drugs for mental health. These plans are required to cover all anticonvulsant, antidepressant, and antipsychotic medications with limited exceptions. During the Annual Enrollment Period, check a plan’s formulary to ensure it covers your preferred mental health drugs. Keep in mind that prescription drugs come with copays.
How can Medigap/Medicare Supplement insurance help cover mental health services?
Medigap or Medicare Supplement plans help pay for Medicare deductibles and copayments or coinsurance for all services covered by Medicare, including mental health services.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. We are the only insurance agency in Hawaii contracted with EVERY Medicare Advantage plan, which means we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.
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