Does Medicare Cover Mental Health?

Mental Health Affects Us All

If you’re a senior citizen coping with mental health problems, you’re not alone. Research conducted by the American Psychological Association (APA) shows that 15 to 20 percent of Americans 65 and older have experienced some degree of depression.

Mental health issues, such as depression and anxiety, can put a lot of stress on your overall health and wellness. They can lead to:

• A compromised immune system.
• An increase in the potential of physical illness or infection.
• Decreased interest in hygiene or self-care.
• Substance abuse issues, or substance abuse relapse.
• Thoughts of suicide or self-harm.

If you’re a senior citizen dealing with mental health problems, mental health treatment is crucial to maintaining a positive quality of life. However, you may be unsure of whether or not you have access to mental health treatment with your Medicare plan.

Does Medicare cover mental health?

Certain aspects of mental health treatment are covered by Original Medicare (Parts A & B), while others are covered by Medicare Advantage (Part C) and Medicare prescription drug coverage (Part D). 

Does Medicare cover therapy?

Medicare Part B covers a variety of outpatient mental health treatment services. Individual and group therapy are among the services covered. Part B will also cover family counseling if its goal is to help your condition improve. Additionally, Medicare Part B may cover up to four sessions of alcohol abuse counseling.

However, not all therapy services are covered by Medicare. Medicare only provides mental health insurance for therapy provided by a licensed psychiatrist, clinical psychologist, or other health professionals who accept Medicare assignment. It will not cover marital or pastoral counseling.

Does Medicare cover psychiatry?

Medicare Part B does cover some outpatient psychiatric services. Some of the psychiatric services covered by Medicare Part B include:

• Psychiatric evaluations
• Medication management
• Some prescription medications that are not “self-administered” (medications that you would not take on your own)

In addition to therapy and other psychiatric mental health treatment, Medicare Part B covers preventative mental health care. Some of the preventative mental health treatment measures that you can take advantage of with Medicare Part B include:

• Annual depression screenings with your primary care physician (PCP)
• A one-time “Welcome to Medicare” preventive visit
• An annual “Wellness” visit with your PCP

Are you in need of coverage for mental health treatment? Enter your zip code above to find mental health insurance and Medicare plans that may be available in your area.

What Aspects of Mental Health Treatment are Covered by Medicare Parts C & D?

Answering the question of how much Medicare mental health coverage you’ll get from a Medicare Advantage (Part C) can be a bit complex. Primarily, this is because Medicare Advantage (Medicare Part C) plans are sold by private insurance companies. This means that the level of Medicare mental health coverage you get out of them may vary.

Overall, Medicare Part C typically covers health care needs beyond what Original Medicare covers. For many plans, this may include transportation to and from appointments and special needs plans (SNP) that may offer coverage for mental health treatment that is not covered by Parts A and B.

A Medicare Advantage Part D plan is a prescription drug plan that acts as a supplement to Original Medicare. Plan D can help you pay for necessary medications to keep mental health problems under control, provided these medications are prescribed by a doctor and available as part of your plan’s formulary.

What Aspects of Mental Health Treatment Will Medicare Not Cover?

So, does Medicare cover mental health? Well, as you can see, the answer depends on several factors.

While your Medicare plan may help you cover the cost of certain mental health treatments, it is not a “catch-all” mental health insurance plan. Unfortunately, Medicare mental health coverage is not always comprehensive, and therefore there may be certain services and treatments that it will not cover.

For instance, most prescription drug costs are not covered by Original Medicare. If you’re in need of a specific prescription medication for a particular mental health issue, you must check to make sure your Medicare Part D plan will cover the cost. There may be particular medications that your Part D prescription plan may not cover.

While Original Medicare may cover partial psychiatric hospitalization, it is important to understand the limitations that may arise depending on your exact level of coverage. 

Medicare Part A covers psychiatric hospitalization up to 190 days, while Medicare Part B covers what is essentially a “day” program – it will not cover long-term hospitalization or institutional care. It also will not cover hospital deductibles or copays.

If you have a Medicare Part C plan, it may cover mental health treatment that Original Medicare does not. The best way to discover what may or may not be covered by your Part C plan is to go over it in detail with a Medicare Advantage expert.