Mental Health Coverage with Medicare
Key Takeaways
- Mental health is crucial to your overall health, and Medicare covers some mental health services.
- Part B of Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). covers annual screenings and treatment for mental health conditions.
- Part A covers hospital costs if you receive inpatient mental health services.
- Get additional coverage with either a MedigapMedicare Supplement Insurance (Medigap) is designed to provide coverage that Original Medicare (Parts A and B) does not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you’ll need to pay. plan or a Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plan.
Medicare offers some coverage of mental health services, including visits with Medicare-approved clinicians to treat conditions such as depression and anxiety and preventive visits to assess whether further treatment is needed.
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Is Mental Health Covered by Medicare?
Mental health is vital to overall well-being, and Medicare Part B will cover many of your mental health services.
For starters, Medicare Part B — which provides medical insurance — fully covers several preventive services that can assess the state of your mental health to see if you have a condition that qualifies for coverage.
- Part B allows you to get one depression screening per year. The screening is provided at no cost to you if it’s performed in a primary care setting (such as a doctor’s office) by a Medicare-approved clinician who can either provide further treatment if needed or refer you to someone else for further treatment.
- Part B also fully covers the cost of an annual wellness visit that can assess your mental health.
Note: As with all preventive treatment offered by Medicare, if a covered visit goes beyond assessment and includes treatment, that portion of the visit may be labeled as “diagnostic.” You could then be responsible for related costs.
What Mental Health Services Does Medicare Cover?
Preventive services provided by Medicare Part B can help identify issues with mental health, but that’s only one part of the equation. As of January, 2024, Part B covers a lengthy list of outpatient mental health services when administered by Medicare-approved professionals:
- Visits with:
- Psychiatrists or other doctors
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
- Nurse practitioners
- Physician assistants
- Marriage and family therapists
- Mental health counselors
- One depression screening per year.
- Individual and group psychotherapy.
- Psychiatric evaluation.
- Testing to determine whether you’re receiving the services you need and your current treatment is helping you.
- Family counseling, when mainly intended to help with mental health treatment.
- Medication management.
- Certain prescription drugs that aren’t usually self-administered, like some injections.
- Diagnostic tests.
- Treatment for alcohol and drug use.
- Partial hospitalization for covered services.
- Intensive outpatient program services.
- A “Welcome to Medicare” preventive visit to a Medicare-approved doctor during the first year you have Part B, followed by annual wellness visits.
Still have questions? GoHealth has the answers you need.
How Much Will Medicare Pay for Mental Health Services?
Medicare pays 80% of the approved cost for most covered mental health services after you meet the Part B annual deductible. You pay 20% of the cost. You pay nothing for the annual depression screening if your healthcare provider accepts the Medicare-approved amount as full payment.
Some Medicare mental health coverage may fall under Part A of Original Medicare.
Part A is hospital insurance and covers Medicare-approved mental health services that require inpatient hospitalization. Medicare Part A will cover 100% of hospital-specific costs for the first 60 days of a stay — after you pay the deductible for that benefit period. You must pay coinsurance for Days 61-90, and your daily coinsurance rate increases if you stay beyond Day 90 and begin using your 60 lifetime reserve days.
For expenses during the hospital stay that fall under Part B — among them, the doctors’ services — Part B pays 80% after your annual deductible.
How Many Days Will Medicare Pay for Mental Health Services?
While Part A will cover unlimited benefit periods for mental health in a hospital setting, lifetime days in a psychiatric hospital are limited to 190.
Inpatient stays in a psychiatric hospital follow the same coverage rules as any other hospital stay (you pay the benefit period deductible; Part A pays for Days 1-60; you pay coinsurance for additional days). But for your lifetime, Medicare Part A limits you to a total of 190 days in a psychiatric hospital. After Day 190, Part A doesn’t help with any psychiatric hospital costs.
What Is Partial Hospitalization for Mental Health?
Part B of Original Medicare may cover partial hospitalization, which Medicare defines as a structured outpatient care that is more intensive than you’d get in a doctor’s or therapist’s office, but provided during the day without overnight stays.
Part B may also cover occupational therapy and individual education about your qualifying condition as part of the covered treatment at a hospital’s outpatient department or community mental health center. It won’t cover related transportation or meals.
How Can Original Medicare Beneficiaries Get More Financial Assistance for Mental Health?
If you’re enrolled in Medicare Parts A and B, you have the option to add a Medicare Supplement plan, also called Medigap, provided by a private insurance company.
Medigap plans fill in some of the gaps in Original Medicare coverage. Among the 10 Medigap plan types that provide standardized supplemental coverage, all pay at least 50% of Part B coinsurance and copays (eight pay 100%).
Do Medicare Advantage Plans Cover Mental Health?
Having Part A and Part B of Original Medicare qualifies you to switch to a Medicare Advantage plan. Provided by private insurance companies with guidance from the federal Medicare program, Medicare Advantage plans substitute for Original Medicare. These plans are required to match the coverage from Parts A and B, but they may also feature additional benefits in areas like mental health and preventive services.
Medicare Advantage plans come in many shapes and sizes. All plans set an out-of-pocket maximum that limits how much you’ll spend on covered services in a plan year (Original Medicare doesn’t have an out-of-pocket maximum).
A GoHealth licensed insurance agent can help you identify a Medicare Advantage plan that fits your needs.
Find the Medicare Advantage plan that meets your needs.
Sources
- Depression screening. Medicare.gov.
- Mental health care (outpatient). Medicare.gov.
- Medicare Costs. Medicare.gov.
- Mental health care (inpatient). Medicare.gov.
- Mental health care (partial hospitalization). Medicare.gov.
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