What Mental Health Services Does Medicare Cover?
- Medicare covers both inpatient and outpatient mental health services. Learn more about the costs and benefits available for mental health treatment through Medicare.
Medicare provides coverage for a wide range of services to treat physical illnesses and injuries. But how does the nation’s single largest health insurance program cover mental health care?
Medicare covers both inpatient and outpatient mental health services, along with certain preventive services, prescription medication and more.
If you need immediate access to mental health services, please use the phone numbers and resources listed here to get in touch with someone who can help.
Does Medicare Pay for Inpatient Mental Health Care?
Inpatient mental health care administered at a general hospital or psychiatric hospital is covered by Medicare Part A.
There is no lifetime limit to the number of days a Medicare beneficiary can receive covered mental health treatment during inpatient hospital stays at a general health hospital.
When treated at a psychiatric hospital, Medicare coverage of mental health care is limited to 190 days over the course of your lifetime.
If you receive inpatient care that is covered by Medicare, you will be responsible for the Medicare Part A deductible, which is $1,408 per benefit period in 2020. If your inpatient hospital stay lasts longer than 60 days, you’ll then be required to pay additional Part A coinsurance costs.
Does Medicare Cover Mental Health Therapists?
Medicare Part B covers outpatient mental health services such as visits to a therapist and other services, which include:
- Individual and group psychotherapy with doctors or other licensed mental health care providers
- Family counseling when the main purpose is to assist with your mental health treatment
- Tests to determine if you are receiving the services you need and if those services are effective
- Psychiatric evaluations
- Diagnostic tests
- Partial hospitalization, which involves a structured program of psychiatric services as an alternative to inpatient care
Medicare coverage of Mental health services does come with some out-of-pocket costs.
Once you meet your annual Medicare Part B deductible ($198 in 2020), you’re typically required to pay a 20% coinsurance payment for the remaining costs of your covered mental health services.
Medicare Advantage (Medicare Part C) plans sold by private insurance companies but are required by law to provide all of the same basic benefits offered by Original Medicare (Medicare Part A and Part B). This means all of the inpatient and outpatient services detailed above are also covered by Medicare Advantage plans.
Most Medicare Advantage plans also offer prescription drug coverage, which Original Medicare doesn’t typically cover. If you enroll in a Medicare Advantage plan that covers prescription drugs, you can find out from your plan carrier whether or not your plan covers your mental health medication.
Medicare Covers an Annual Depression Screening
Medicare Part B also provides coverage for preventive services related to mental health care for early detection of mental health issues.
You may be covered for one depression screening each year when performed in a primary care doctor’s office or primary care clinic equipped to provide follow-up treatments and referrals.
During your one-time “Welcome to Medicare” preventive care visit, you’ll be screened for your possible risk factors for depression along. Your doctor can then follow up with you each year during your annual wellness visit to screen you for depression and gauge your mental health progress.
Medicare Coverage of Prescription Medication for Mental Health
Medicare Part B, Part D and Medicare Advantage may provide coverage for medications used to treat mental health.
- Part B provides benefits for drugs that are administered by a professional in a doctor’s office, hospital or other professional care setting. The types of medications Part B may cover can include injections along with a medication management program. Medicare Part B won’t typically cover prescription drugs you get from a retail pharmacy.
- Medicare Part D prescription drug plans and Medicare Advantage plans with drug coverage may cover medications used to treat mental health issues. The specific drugs covered will typically vary by plan. These types of Medicare plans are sold by private insurance companies.
Does Medicare Cover Behavioral Health and Substance Abuse Treatment?
Medicare may cover the management of a behavioral health condition if the health care provider offers the Psychiatric Collaborative Care Model. This is a set of integrated services that provides care planning for behavioral health conditions, ongoing assessments, medication support, counseling and other treatments.
Part B covers an alcohol misuse screening once per year for those who use alcohol but don’t meet the medical criteria for dependency. If it’s determined that you are misusing alcohol, you can receive up to four in-person counseling sessions each year.
Various treatments for substance abuse may be covered by Medicare Part A, Part B, Part D or Medicare Advantage for those who meet certain restrictions. These services may include:
- Patient education
- Post-hospitalization follow-ups
- An opioid treatment program
- Methadone and other prescription drugs.
- Structured Assessment and Brief Intervention (SBIRT), which includes screenings, interventions and treatment referrals
If you have any further questions about mental health services covered by Medicare, you may call 1-800-MEDICARE (1-800-633-4227). You can also learn more about resources to help seniors facing mental health issues by reviewing our senior mental health resource guide.