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Understanding Medicare Coverage for Mental Health and Substance Abuse Services

are mental health services and substance abuse services covered by medicare?

Did you know that Medicare plans offer coverage for many of the mental health services you may need? Call our licensed agents today at (800) 950-0608 to learn more about Medicare plans in your area offering comprehensive coverage for mental health services.

Just the Essentials:

  • Mental health and substance abuse issues affect seniors today more than ever.

  • Both Original Medicare (Medicare Part A and Medicare Part B) and Medicare Advantage plans cover mental health and substance abuse treatment and services.

  • Medicare Prescription Drug coverage (Medicare Part D) may cover certain prescription medications meant to improve mental health.

  • Speak with one of our experienced licensed agents to find Medicare plans offering mental health and substance abuse coverage near you.

which mental health services are covered by medicare?

Does Medicare Cover Mental Health Services?

When we think about treatment for mental health and substance abuse issues, one demographic is usually a small part of the conversation, or absent from it altogether. More seniors today than ever are dealing with mental health and substance abuse issues for many reasons. Whether they’re still refusing to deal with past issues or anxious about the state of today’s world, many seniors are feeling severe mental strain, which can lead to attempting to cope with unhealthy substances.

Some seniors may come to the conclusion on their own that they need substance abuse treatment, mental health services, or both. Others may need to be coaxed – gently – by family members. In severe cases, if the person can no longer act on their own volition, you may need to obtain a Medical Power of Attorney to help them get the treatment that they need.

Seniors with mental health or substance abuse issues often have certain reservations about substance abuse and mental health services and treatments. One of those reservations has to do with the sometimes steep cost of substance abuse and mental health services. This includes seniors who are covered by Medicare, who may be unaware of the coverage that the insurance provides for the services they need.

This begs the question: does Medicare cover mental health services? Will it also cover substance abuse treatment? As it turns out, Medicare plans do provide coverage for certain mental health services. Let’s dive deeper to learn more about what Medicare will or will not cover in regards to substance abuse and mental health services.

Does Medicare Part B Cover Mental Health Services?

Okay, so we’ve asked the key question: does Medicare cover mental health services? We know that the answer is “yes”, so now it boils down to the parts of Medicare. As in, does Medicare Part B cover mental health services, or are they covered by Medicare Part A?

All parts of Medicare cover mental health services and substance abuse treatment, to a degree. Medicare Part A will cover hospitalization as a mental health service, but only for a certain number of days. Medicare Part B won’t cover any part of that hospitalization, but it will cover most of the outpatient mental health services and substance abuse treatment that you need.

Medicare Part B may cover any of the following::

  • Outpatient therapy services
  • Psychiatric evaluations
  • Medication management
  • Provider-administered medications
  • Alcohol abuse counseling (up to four sessions)
  • Opioid use cessation and prevention
  • Depression screenings
  • Counseling to prevent and cease tobacco use (up to eight sessions)
  • Telehealth services
are mental health services covered by medicare?

What Mental Health Services Does Medicare Cover?

Substance abuse and mental health services are covered to an extent by all parts of Medicare. We already know that Medicare Part B covers most outpatient services. So, in all, what mental health services does Medicare cover? You’re also likely wanting to know, does Medicare pay for mental health services?

Yes, Medicare can help you pay for substance abuse and mental health services. What they’ll cover depends on the type of plan you have.

Medicare Part A is hospital insurance, which means it covers hospitalizations up to a given amount of days, as well as treatments and services delivered during your hospital stay. That includes mental health services on a sliding coverage scale for up to 90 regular days. If you require hospitalization for anywhere between 91 and 150 days, you go into what are known as “lifetime reserve days”. These can be rather costly.

After you’ve used all of your lifetime reserve days, you’ll be responsible for covering all costs for mental health services delivered in a hospital out of your own pocket. You’ll also be responsible for 20% of the Medicare-Approved amount for mental health services received from healthcare providers as a hospital patient. If you require only partial hospitalization for substance abuse and/or mental health services, Medicare Part B can help cover those costs.

Medicare Advantage, also known as Medicare Part C, covers all of the mental health services that are covered by Original Medicare. Depending on your area and your plan type, you may receive more coverage and benefits for substance abuse and mental health treatment than you would with Original Medicare.

As for prescription drugs needed to help you maintain a healthy mental state, many mental health medications and medications for substance abuse patients are covered by the Medicare Prescription Drug plan, also known as Medicare Part D. If you need help covering costs for copays and coinsurance, a Medigap supplemental plan may be of good use to you.

will medicare pay for mental health services?

How Much Will Medicare Pay for Mental Health Services?

If you’ve gotten this far, you’re probably wondering, “Does Medicare pay for mental health services?” If the answer is yes, then how much will medicare pay for mental health services? Again, the answer depends on your plan, and the frequency of services needed.

For those of you who need inpatient mental health services or substance abuse services that may be covered by Medicare Part A, you’ll pay a $1,600 deductible for each benefit period. The scale for what Medicare Part A will cover completely or in part can be found below:

  • Hospitalization up to 60 days: $0 per day
  • Hospitalization for 61 days, up to 90 days: $400 copay per day
  • Lifetime reserve days (Day 91 up to 150): $800 copay per day
  • You pay all costs after you run out of lifetime reserve days

Those of you who only need partial hospitalization, which is covered by Medicare Part B, will pay a percentage of the Medicare-Approved Amount for each service you receive from a healthcare provider. Once you’ve met your deductible, you’ll also be required to pay coinsurance for each day of services received in a hospital outpatient setting or community mental health center.

As for Medicare Advantage, Medicare Prescription Drug Coverage, and Medigap costs, those will all depend on your individual plan. Check your plan information or your formulary for information pertaining to coverage for mental health services, substance abuse services, and prescription medications for mental health conditions.

Are There Free Mental Health Resources Available?

Certainly! The internet is full of great resources that offer treatment search tools, crisis management, and general information regarding your mental health conditions or substance abuse issues. A good place to start would be the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA also offers a helpline for individuals who struggle with mental health and substance abuse issues, as well as their families.

MedicareInsurance.com is also a valuable resource for those of you seeking to learn more about what Medicare may or may not cover in regards to mental health and substance abuse services. Feel free to check out our FAQ and News sections for resources that discuss potential costs and coverage. Our friendly licensed agents are also available and ready to help answer any questions you may have.