With regard to mental health care, Medicare covers a variety of resources such as family counseling, psychotherapy, diagnostic tests, and depression screenings. If you have Medicare Part D, prescription drugs will also be covered; however, you’ll want to keep in mind that Medicare won’t cover everything.
Medicare and Outpatient Mental Health Care
If you have Medicare Part B, it can cover a variety of outpatient mental health services, medical supplies, and preventative care. These services include:
One depression screening per year
This needs to be performed in a primary care doctor’s office or clinic so that follow-up treatment and referrals can be administered.
Individual and group psychotherapy
This can be performed by a doctor or a licensed professional; however, your state has to permit it.
This is covered by Medicare, but only if it’s part of a larger treatment plan.
Necessary testing to help determine which services you need and if your current treatment is working
Drugs that aren’t typically “self-administered,” such as injections
One “Welcome to Medicare” preventive visit
This includes a review of possible risk factors for depression.
One yearly “Wellness” visit
Outpatient mental health services for substance abuse treatment
Which Costs Remain?
If your doctor or provider accepts the assignment, you don’t pay anything; however, after you meet the Medicare Part B deductible, you’re responsible for 20 percent of the Medicare-approved amount for doctor visits or other providers who diagnose or treat your conditions.
For services in a hospital outpatient clinic or department, you’re required to pay an additional copayment or coinsurance to the hospital.
Does Medicare Cover Therapy, Counseling, and Psychologists?
Medicare Part B covers mental health services from professionals like psychiatrists, doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician assistants.
Family counseling will be covered, but only if its main function is to help with your treatment. Individual and group therapy are also covered; however, it needs to be performed by a licensed doctor/professional in the state you reside in.
Original Medicare will only cover said visits if you receive them from a healthcare provider who accepts the assignment. Not all healthcare professionals will accept Medicare assignments.
Does Medicare Cover Inpatient Mental Health Care?
Medicare Part A covers inpatient mental health care. These services can be given in a general or psychiatric hospital, and there’s no limit to the number of benefit periods you can have. If you’re in a psychiatric hospital, Part A only covers up to 190 days of inpatient psychiatric hospital services during your lifetime.
During inpatient mental health care, Medicare doesn’t cover private duty nursing, in-room phone/TV, personal items, or a private room (unless medically necessary).
Medicare and Prescription Drugs for Mental Health
Medicare Part D covers prescription medications for mental health. While they aren’t required for all prescription drugs, they are mandatory for antidepressant, anticonvulsant, and antipsychotic medications.
If your prescriber thinks you need a drug that your Medicare plan doesn’t cover, you can ask for coverage determination.
If you believe you need mental health services, always check to see which services your Medicare plan covers. While Part A covers many inpatient services and Part B covers many outpatient services, there are some restrictions. If you require a prescription drug that needs to be covered, enroll in a Part D plan.
Nonetheless, if you or someone you know is in a crisis, call (800) 273-TALK (800-273-8255) to speak with a counselor 24 hours a day, seven days a week.
To learn more about Medicare, be sure to read our updated guides.
Amie has been writing about senior care products and services for the last decade. She is particularly passionate about new technologies that help improve the quality of life for seniors and their families. Seeing her parents and grandparents age made Amie ask herself, “Would this be good enough for my loved ones?” In her spare time, Amie enjoys outdoor adventures and spontaneous road trips. Learn more about Amie here