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 you’re 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.

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 aren’t 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, you’ll have the chance to speak with your doctor during this exam. Your doctor may discuss treatment options or refer you for additional care.

Medicare outpatient mental health services

Medicare Part B covers outpatient mental health services, such as care you’d get in a health clinic or doctor’s office. You’ll generally pay 20% of the Medicare-approved cost for outpatient care delivered by providers that accept Medicare assignment.

Medicare covers the following types of psychotherapy (also called counseling):

  • Psychiatric assessment
  • Individual counseling
  • Group counseling
  • Family counseling, when the primary goal is to treat your condition
  • Alcohol misuse counseling, up to four sessions

You may need to meet other criteria to be eligible for therapy coverage, and the doctor, psychologist, or other health-care professional must accept Medicare assignment. Medicare doesn’t cover certain types of therapy, such as pastoral counseling or marriage counseling.

If you need more structured or frequent treatment, Medicare Part B also covers partial hospitalization programs, which are outpatient mental health programs where treatment is provided throughout the day and doesn’t require an overnight, inpatient stay. The programs are usually run through a community mental health center or a hospital’s outpatient department. Services may include therapy with a mental health professional, diagnostic services, and occupational therapy (if it’s part of your treatment). These programs don’t cover meals or transportation to the facility.

Partial hospitalization programs can be another treatment option for those who need more intensive care, but don’t want to be fully hospitalized or are transitioning from an inpatient hospital stay. To be eligible, your doctor must certify that you’d need inpatient hospitalization without the program.

Medicare inpatient mental health services

If you do need inpatient care as part of your treatment, Medicare Part A covers services during an inpatient hospital or psychiatric hospital stay. There’s a limit to Medicare coverage if you stay at a psychiatric hospital that’s dedicated to treating mental health patients, as opposed to a general hospital. Medicare Part A pays for up to 190 days of psychiatric hospital care in your lifetime.

Even during inpatient stays, Medicare Part B still covers certain mental health benefits, such as physician services.

Medicare Part D coverage

Your doctor may prescribe medications as part of your treatment. Keep in mind that Original Medicare, Part A and Part B, includes only limited prescription drug coverage, although Part B covers certain prescription drugs you get in an outpatient setting, such as medications you can’t give yourself. For most other prescription needs, you’ll need to enroll in a stand-alone Medicare Part D Prescription Drug Plan if you have Original Medicare.

Another option is to sign up for a Medicare Advantage Prescription Drug plan, which includes both health and drug benefits. These plans must provide at least the same level of coverage as Medicare Part A and Part B, but may include additional coverage, including drug benefits, routine vision and dental, and more. You need to continue paying your Medicare Part B premium along with any plan premium. There are only certain times when you can enroll in a Medicare Advantage plan.

Antipsychotics, anticonvulsants, and antidepressants are under protected drug classes under Medicare Part D, meaning all Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans must cover nearly all of the medications in these categories (with some exceptions). You can find out if a specific Medicare Part D Prescription Drug Plan covers your medications by checking the plan’s formulary, which is a list of covered prescription drugs. If a drug plan doesn’t cover a medication you need, you or your doctor may be able to file an exception to have the drug covered. The formulary may change at any time. You will receive notice from your plan when necessary.

Keep in mind that prescription costs may vary by plan, even for the same medications. One way to minimize your costs is to compare plans and find a Medicare Part D Prescription Drug Plan that covers your prescriptions with low cost-sharing. Remember, costs to consider include not only premiums and copayments or coinsurance, but also deductibles and out-of-pocket maximum limits.

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To learn about Medicare plans you may be eligible for, you can:

  • Contact the Medicare plan directly.
  • Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
  • Contact a licensed insurance agency such as Medicare Consumer Guide’s parent company, eHealth.
    • Call eHealth's licensed insurance agents at 888-391-2659, TTY users 711. We are available Mon - Fri, 8am - 8pm ET. You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.
    • Or enter your zip code where requested on this page to see quote.

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