Taking care of your mental health is something that cannot be overlooked. It affects your work, your personal relationships and even your physical health. Today, the CDC estimates that one in five Americans are living with a mental illness. But you can get the help you need, and Medicare can help cover the cost.
Original Medicare is divided into two parts – with each part covering different types of mental healthcare:
- Medicare Part A (hospital insurance) pays for the mental healthcare services you get when you're admitted to a hospital.
- Medicare Part B (medical insurance) covers the outpatient mental health services you get from a doctor or other healthcare provider.
It’s important to know how this all works. So, let’s take a closer look at everything you need to know about how Medicare can help you manage your mental health needs.
Inpatient Mental Health Coverage
Inpatient mental health is defined as treatment you receive in a general hospital or a psychiatric hospital. Medicare coverage for these services falls under Part A. There’s no limit to the number of benefit periods you can have – no matter which facility is providing your mental healthcare. However, if you're in a psychiatric hospital (instead of a general hospital), Part A will only pay for up to 190 days of inpatient psychiatric hospital services during your lifetime.
Despite its coverage, there are some things Part A won’t pay for, including:
- Private duty nursing.
- Any phone or television in your room.
- Personal items, like toothpaste, socks or razors.
- A private room (unless it’s considered medically necessary).
Your costs for each benefit period will vary depending on the length of your stay. After paying your $1,632 deductible, you’ll be responsible for the following costs:
- $0 per day for days 1-60.
- $408 copayment per day for days 61-90.
- $816 copayment per each “lifetime reserve day” for day 91 and beyond (up to a maximum of 60 reserve days over your lifetime).
- All costs for each day after the lifetime reserve days.
- 20% of the Medicare-approved amount for mental health services you get from a doctor and other healthcare providers as an inpatient.
Outpatient Mental Health Coverage
Where Part A covers inpatient services, Medicare Part B pays for outpatient mental health treatment. The list of outpatient services that Medicare covers is wide-ranging. It includes:
- One depression screening every year in your doctor’s office or primary care clinic.
- Individual and group psychotherapy with a doctor or licensed professional.
- Family counseling (if the main purpose is to help with your treatment).
- Testing to see if you’re getting the services you need and that treatment is helping.
- A psychiatric evaluation.
- Medication management.
- Prescription drugs that require professional assistance, like some injections.
- Any doctor-recommended diagnostic tests.
- Partial hospitalization for specific situations.
- Intensive outpatient program services.
- A one-time “Welcome to Medicare” visit to review possible risk factors for depression.
- A yearly wellness visit to talk about changes in your mental health.
Part B will also pay for outpatient mental health services that are a part of substance abuse treatment.
Because there are many different types of health professionals that treat mental health, it’s good to know Medicare covers most, including:
- Psychiatrists or other doctors.
- Clinical psychologists.
- Clinical social workers.
- Clinical nurse specialists.
- Nurse practitioners.
- Physician assistants.
- Marriage and family therapists.
- Mental health counselors.
When it comes to your costs, you will not need to pay for your yearly depression screening. However, a doctor or healthcare provider must first accept you as their patient. Once you meet your Part B deductible, you pay 20% of the Medicare-approved amount for visits to your doctor or other healthcare provider to treat your condition.
If you get your services in a hospital outpatient clinic or a hospital outpatient department, you may have to pay an additional copayment or coinsurance amount to the hospital.
Additional Coverage Options
Even though Medicare covers mental healthcare, not all mental health providers accept it. This is where Medicare Advantage can help. Also known as Part C, these plans are offered by private insurance companies and include bundled benefits for things not covered in Original Medicare. So, if you’re having a hard time finding a therapist or psychiatrist, Medicare Advantage may help you expand your options and offset the cost of your mental healthcare. Contact us to learn more.
Medicaid is another mental healthcare option for people who qualify based on income. Additionally, if you’re a veteran, you may qualify for mental health benefits through the VA healthcare system. To see if you qualify, contact your local Veterans Affairs office.
Your mental health matters. Taking care of it not only helps improve your life, but the lives of people around you. And if you or someone you love needs help now, call or text 988 or chat 988lifeline.org.
Medicare Mental Health Coverage Questions
Does Medicare cover therapy?
Yes, Original Medicare covers therapy to help with your mental health. Most therapy is done on an outpatient basis and is covered by Medicare Part B (medical insurance). If you need to be admitted to a hospital or psychiatric facility, Part A will pay the costs.
Does Medicare cover psychiatrists?
Yes, Medicare covers treatment received from a psychiatrist. If treatment is provided outpatient, Medicare Part B coverage applies. But if you are admitted to a hospital or psychiatric facility, you are covered under your Part A benefits.
Does Medicare cover inpatient mental healthcare?
Inpatient services for mental healthcare falls under Medicare Part A. You can receive this treatment either in a general hospital or a psychiatric hospital.
Does Medicare cover outpatient mental healthcare?
Yes, Medicare Part B covers outpatient mental health services you get from a doctor or other healthcare provider.
Which Medicare Advantage Plan is right for you?
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Centers for Disease Control & Prevention - About Mental Health
Medicare.gov - Medicare Costs
Medicare.gov - Outpatient Mental Health Care
Medicare.gov - Medicare and Your Mental Health Benefits
Medicare.gov - Inpatient Mental Health Care