In today’s world, many more people understand the benefits of mental health services and seek them out. Specifically, Medicare patients may be wondering if mental health services are covered by their Medicare insurance plan. The answer is yes — in many cases, Medicare will cover some of the costs associated with mental health services.
Mental health programs help individuals diagnose and treat various mental health conditions, such as depression and anxiety. These services may include individual or group counseling with a licensed mental health professional or psychiatric evaluation and medication management with an authorized psychiatrist.
However, you should still understand the specifics of your Medicare plan and what it covers. For example, some plans do not cover certain services, or they may only cover a portion of the cost. In addition, Medicare will only pay for mental health services given by an approved provider who is part of the network associated with your specific plan.
This article will highlight the types of mental health services typically covered by Medicare and other vital considerations. As a licensed Medicare insurance agent, I help my clients understand their coverage and ensure they get the most out of their plans.
Medicare Plans and Mental Health Services
Original Medicare is considered Parts A and B, which is also federally provided. Medicare Advantage is Part C, prescription drug plans are Part D, and both are offered through private insurance companies. Different mental health services may be covered depending on which of these you have.
However, the federal government requires all Medicare plans to provide basic mental health coverage for inpatient and outpatient care.
Part A
As part of Original Medicare, Part A covers inpatient mental health services provided at a hospital. It also covers some limited home health services. Part A also covers:
- Meals and lodging at a mental health facility
- Nursing care
- Lab tests
- Inpatient therapy
- Certain medications
Part B
The second part of Original Medicare covers outpatient mental health services, such as visits to a doctor, psychologist, or other licensed mental health professional. This applies to individual therapy, family therapy, and group therapy. It also covers psychiatric evaluation and medication management. Part B also applies to:
- Medical tests
- Psychiatric evaluations and screenings
- Limited prescription drugs
- Lab tests
- Wellness visits and depression screenings each year
Part C
Medicare Advantage plans, also known as Part C, are offered by private insurance companies and typically cover the same services as Original Medicare (Parts A and B). However, they may include additional benefits, depending on the plan, such as:
- Telehealth benefits
- Grief counseling
- Conflict resolution
- Marriage counseling
Part D
Prescription drug plans are offered through Part D. It applies to medications like antidepressants and antipsychotics that your doctor prescribes.
Suppose you don’t have a Medicare Advantage plan. In that case, you may want to consider getting one, as they usually provide more comprehensive coverage in terms of mental health services than Original Medicare.
Medigap, or a Medicare Supplement Insurance plan, can also help you pay for out-of-pocket costs related to mental health services, such as copayments, coinsurance, and deductibles.
How Much Will I Pay for Outpatient Mental Health Care?
Most Medicare plans pay a percentage of the cost of mental health care. However, you’ll usually be responsible for some out-of-pocket expenses. Once you meet the Medicare Part B deductible, Part B will cover 80% of the cost, and you’ll be responsible for the other 20%.
The 2023 Medicare Part B deductible is $226. If you have Medigap, the plan can help to cover any additional costs.
How Much Will I Pay for Inpatient Mental Health Care?
If you have Original Medicare, Part A will cover services of your admission to a psychiatric or general hospital for 190 days of inpatient care per lifetime. However, if you have a Medicare Advantage plan, you’ll likely get more coverage than what’s provided by Original Medicare.
A deductible of $1,600 must be met before Part A will cover any inpatient mental health care. In addition, if you have Original Medicare, the first 60 days will have no coinsurance.
After that, you’ll be responsible for a 2023 coinsurance of $400 per day for days 61 through 90. Then, the coinsurance is $800 until you run out of lifetime days. You are responsible for all costs after you meet the lifetime limit.
If you have a Medicare Advantage plan, your coinsurance and deductibles may vary, depending on the plan. Medigap can help you with any additional costs as well.
What Isn’t Covered By Original Medicare?
While Original Medicare provides some mental health services, you should be aware of the exclusions and out-of-pocket expenses. Medicare doesn’t cover the following:
- Private nursing
- Hemodialysis for schizophrenia
- Transportation
- Pastoral counseling
- Outpatient meals
- Recreational activities
- Private room costs
Does Medicare Cover Substance Abuse Treatment?
Medicare doesn’t just cover mental health services — it also covers substance abuse treatment. Part A will cover inpatient treatment at a hospital or rehabilitation facility, while Part B covers outpatient services.
Medicare will also help pay for drug testing, screening, rehabilitation, detoxification, drug withdrawal treatment, monthly care management, and counseling. However, there may be some out-of-pocket costs associated with these services.
Do All Mental Health Providers Take Medicare?
Like with Medicaid health insurance, not all mental health providers accept Medicare. Therefore, it’s essential to check with the provider directly before scheduling an appointment to ensure they take your type of insurance.
You can also use the official Medicare website or call 1-800-MEDICARE (1-800-633-4227) to find providers in your area who accept Medicare.
In Summary
Medicare does cover mental health services, from telehealth to addiction counseling. It also covers inpatient and outpatient care for mental health disorders. However, some exclusions and out-of-pocket costs may be associated with these services.
To get the most coverage, you should consider getting a Medicare Advantage or Medigap plan if you have Original Medicare. These plans can help cover any additional expenses related to mental health services.
As always, checking with your provider and insurance plan before scheduling an appointment is essential to make sure they accept your type of coverage.
No matter your situation, Senior Insurance Solutions can help you find the best plan to cover your mental health needs. I am an independent Medicare insurance agent who will work with you to find the right plan and get the most coverage for your mental health services. Contact me today for more information!
