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Does Medicare Cover Cognitive Behavioral Therapy for Insomnia?

"Does Medicare Cover Cognitive Behavioral Therapy for Insomnia?" text over image of dictionary definition of insomnia

With a Medicare plan, the possibility of getting Cognitive Behavioral Therapy for insomnia is within reach. Call our licensed agents today at (800) 950-0608 to find Medicare plans in your area that help cover Cognitive Behavioral Therapy for insomnia.

Just the Essentials:

  • Medicare covers a variety of mental health treatments and services.

  • Cognitive Behavioral Therapy (CBT) is covered by Medicare.

  • Telehealth CBT treatments are covered for eligible beneficiaries in certain rural areas.

  • Medicare Advantage and Medicare Part D Prescription Drug coverage can help you cover what Original Medicare (Medicare Part A and Medicare Part B) do not.

Have You Been Feeling More “Down” Than Usual Lately?

Feeling a little “down” every now and then is normal. Life is great at throwing curveballs at us that can put us in a sour mood, especially when you’ve reached your senior years. However, if you’ve been feeling more “down” than usual lately, and the feeling isn’t going away, it can signify a bigger issue.

Mental health issues affect a wide portion of the world’s population. They’re especially prevalent in senior citizens. In 2019, a study by the Substance Abuse and Mental Health Services Administration (SAMHSA) showed that one in five senior adults in the United States are dealing with a mental illness, substance use disorder, or both. When you think about it, that means most seniors in the U.S. are dealing with some form of mental illness.

It takes many older adults some time to realize that they need help with their mental health. Once you come to the realization that you need help, you may wonder: does Medicare cover therapy? Let’s find out what types of mental health treatment Medicare will cover for seniors, including Cognitive Behavioral Therapy for insomnia and other issues.

What Are Some Signs of Decline in Mental Health?

A decline in the condition of mental health will always look different depending on the person. Some are able to mask their symptoms better than others. Others will present visible symptoms immediately. Some common signs to look for if you believe you’re seeing a decline in mental health, or you believe you’re seeing the mental health of a loved one deteriorate, include:

  • Social withdrawal
  • Lack of interest in hobbies that you once enjoyed
  • Decreased interest in hygiene or self-care
  • Disruptions in sleeping patterns (occurrence of insomnia or of sleeping too often)
  • Substance abuse
  • Thoughts of suicide or self-harm

If you notice that you’re showing any of these symptoms, or that a loved one is showing symptoms, seek help right away. Getting treatment for mental health issues is key to maintaining a positive and healthy quality of life.

Does Medicare Cover Therapy?

If you’re suffering from mental health issues of any kind, there isn’t enough that can be said about the benefits of therapy. Psychotherapy, which is also known as talk therapy, can be a major help for those who are dealing with mental trauma or issues with mental health. For those of you in need of this crucial service, the question remains: does Medicare cover therapy?

For beneficiaries of Original Medicare, Medicare Part A and Medicare Part B, Medicare Part B commonly covers psychotherapy treatment of any type, the most popular and widely-recognized of which is Cognitive Behavioral Therapy, or CBT. This includes:

  • Cognitive Behavioral Therapy for Insomnia
  • Trauma-Focused Cognitive Behavioral Therapy
  • Cognitive Behavioral Therapy for Anxiety

In order for your therapy sessions to be covered, they must be provided by mental health professionals who accept Medicare assignment. Qualifying mental health professionals accepted under Medicare’s criteria include licensed psychiatrists or clinical psychologists.

For those in rural areas who do not have easy access to mental health services, Medicare Part B will pay for a limited number of psychotherapy telehealth sessions. In order for Medicare Part B to cover these sessions, you must:

  • Be located in a rural area outside of a Metropolitan Statistical Area (MSA).
  • Be located in a rural area that’s designated as a Health Professional Shortage Area (HPSA).
  • Have access to an active telecommunication system that allows you to communicate with a therapy professional in real time via audio and video (i.e. Skype or Zoom).

A Closer Look at Cognitive Behavioral Therapy

Cognitive Behavioral Therapy, also referred to as CBT, is perhaps the most popular form of psychotherapy available. Instead of forcing you to confront behaviors brought on as a result of trauma or other mental health issues, CBT focuses on helping you develop effective coping skills to counter harmful thought and behavioral patterns. In other words, CBT is meant to help you practice self-care by learning to adopt more positive thoughts and behaviors.

CBT serves different purposes depending on the mental health issues that a client is tackling. For instance, someone who suffers from severe separation anxiety or social anxiety may work with a therapist who utilizes Cognitive Behavioral Therapy for anxiety. 

This form of CBT helps those dealing with anxiety to learn how to acclimate to the situations that cause them to become anxious. For example, the individual with social anxiety may work with their therapist to devise a plan which helps them feel more in control of an anxiety-inducing situation, such as going to gatherings and interacting with others for a certain amount of time.

For those dealing with trauma-related issues, such as Post-Traumatic Stress Disorder, trauma-based Cognitive Behavioral Therapy can help you overcome situations and moments that trigger traumatic responses. 

Veterans of foreign wars, for instance, may be overwhelmed and triggered by fireworks and other loud noises. Trauma-based Cognitive Behavioral Therapy will help you create a plan to bring yourself back into the present and out of a traumatic flashback episode during these events and occurrences.

CBT can also help with individual symptoms related to mental health issues, such as insomnia. Cognitive Behavioral Therapy for insomnia can help you learn effective habits that make it easier for you to wind down and calm your mind and body before a chosen bedtime. This makes it easier for you to get proper sleep, which is vital to maintaining positive mental health.

Which Mental Health Services Will Medicare Not Pay For?

While Original Medicare will cover most mental health treatments, there are some that it will not. For instance, Original Medicare will not cover the costs of most prescription medications. Medicare Part D Prescription Drug coverage may cover the cost for certain medications for mental health issues. However, it’s always best to check your Part D plan to make sure that the medication you need is covered. There are certain medications that even Part D plans will not cover.

If you require psychiatric hospitalization, Medicare Part A covers that, for the most part. Psychiatric hospitalization is covered for up to 190 days. If you require a stay longer than that, you’ll end up paying the costs out-of-pocket. Medicare Part B will cover psychiatric day programs. It will not cover hospitalization or institutional care, and it will not cover hospital deductibles or copayments.

Extra Help Paying for Mental Health Treatment is Available

Are you in need of treatment for mental health issues, but you feel that Original Medicare may not cover what you need? Worry not – you have options for extra coverage available. Those who are not interested in a Medicare Advantage plan can look into Medigap supplemental insurance to help “fill the gaps” of what Original Medicare will not cover. This includes any copays related to psychiatric hospitalization or institutional care, which can be expensive.

If you’re willing to look at Medicare Advantage (Medicare Part C) plans, they can be a major help. Medicare Advantage plans cover most everything that an Original Medicare plan covers, and often more. For instance, let’s say you need Cognitive Behavioral Therapy for insomnia, but you don’t have a way to get to your therapy sessions. Medicare Advantage plans often offer coverage to help you find transportation to and from therapy sessions.

Before you choose a Medicare Advantage plan, it’s a good idea to read up and compare the available plans in your area to make sure they offer the coverage you need. You can start this process for free by entering your zip code into our free plan finder tool below. If you have questions about any Medicare plans that you find, please feel free to call our experienced, licensed agents at (800) 950-0608. They’ll be more than happy to help you find the answers that you need!

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