Does Medicare Cover Social Workers?

In this article...
  • Find out how social workers can help older adults maximize quality of life and discover which services are covered by Medicaid federal health insurance plans.

The world is changing faster than ever, and assistance is available to help seniors, individuals who receive Social Security and people with disabilities navigate these changes. Medicare beneficiaries may be entitled to assistance from a clinical social worker, who can help you maximize your quality of life. If you've paid Medicare taxes while working or you meet other qualifying criteria for Medicare, you might benefit from financial assistance to help pay for social work. Does Medicare cover social workers? Find out below.

Does Medicare Cover Social Workers?

Generally speaking, Medicare covers social workers who provide clinical treatment that would be carried by a physician, a nurse practitioner or another medical professional. This might include counseling, therapy and some outpatient care. Clinical social workers must meet the following criteria for you to claim for their services under Medicare B:

  • Master's or doctoral degree in social work
  • At least two years of supervised clinical experience
  • Certified or licensed as required by the state they practice in

A clinical social worker is qualified to practice medicine, and it's usually only these professionals who you're eligible to claim for with Medicare B. They must offer mental health treatment services, and outpatient mental health treatment tends to be the only service performed by social workers that's fully covered by Medicare. If you have Medicare C or D, always check with your insurance provider to find out if you're entitled to further coverage.  

What Does a Social Worker Do?

Social workers perform a variety of duties, helping people of all ages navigate through the social system. They work with underprivileged children and their families to help them navigate education and enter the workplace in addition to working with older adults to connect them to resources they need and benefits they're entitled to. Social workers operate in the following areas:

  • Management and administration
  • Advocacy and community matters
  • Aging
  • Child welfare
  • Developmental disabilities
  • The justice system
  • Addiction treatment centers
  • Clinical mental health care 

Clinical social workers with a master's or doctorate degree can diagnose and treat mental illness in the same way as other medical practitioners. If you require outpatient mental health services, there's a good chance they're covered by Medicare B. Some Medicare C plans may cover additional services, but you should check with your insurance provider to make sure.

Social Workers Who Work With Older Adults

Social workers play a key role in helping older adults maintain dignity and independence in later life. Here are some of the roles they perform:

  • Service interventions: Social workers can help older adults and their families navigate the complex health and social care systems. They offer support and counseling, source equipment, suggest care strategies and help with the transition from home to a long-term care facility. 
  • Clinical interventions: Clinical social workers are often qualified to provide mental health or behavioral therapy to older adults to help them cope with any stress they experience due to aging. They can help with connecting people who are lonely, anxious or depressed with events, outings and advanced mental health treatment. 
  • Advocacy: Social workers assess and report elder abuse and can help seniors with tasks such as making applications, filling out forms and accessing benefits.

Medicare and Outpatient Mental Health Care

Outpatient mental health services are usually covered by Medicare B, which can pay for your health care expenses, such as:

  • A general review to check your risk factors for depression
  • Psychiatric evaluation and diagnosis of mental illness, plus preparation of a mental health care plan
  • A single depression screening each year
  • Diagnostic tests
  • Family counseling that supports your mental health treatment
  • Individual or group therapy or counseling, including sessions given by clinical social workers
  • Medication management and some medication
  • Assessing if your current treatment plan is serving you
  • A yearly visit to a health care professional to discuss changes in mental health  

If you're struggling with your behavioral or mental health, you can get help from a trusted clinical social worker, and in many cases, treatment should be covered by Medicare Part B. If you're unsure about coverage, you should be able to access free advice from your local Area Agency on Aging or the Administration on Aging