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Medicare FAQ: Mental Health and Substance Abuse Coverage

Medicare mental health coverage and substance abuse coverage

Posted on June 29, 2023 by Larry Johnson

If you’re suffering from long-standing mental illness, Mental health coverage is available. Call (800) 950-0608 today to speak with one of our licensed insurance agents regarding Medicare plan options in your area.

Mental Health and Substance Abuse Issues Affect More Seniors Than You May Think

Imagine there are four of you sitting in a room. At least one of you is currently living with an undiagnosed or diagnosed mental illness. If it’s you, you’re likely not getting the help you need to deal with it.

Mental health issues are very prevalent in this day and age, but they’re not a typical part of growing older. As a senior, not taking care of your mental health issues can lead to bigger issues down the road, such as substance abuse. Maintaining your mental health is just as important as maintaining your physical health, and positive mental health helps you live a happier, more productive life.

It may seem that mental health insurance coverage isn’t within your grasp. However, for those of you who are Medicare beneficiaries, Medicare offers mental health coverage that can help you get your life back on track. In this article, we’ll answer some of the most-asked questions about:

Medicare mental health treatment coverage

How Can I Get Adequate Mental Health Insurance Coverage?

We can all agree that there’s much that needs to be changed within our current healthcare system. This includes adequate mental health insurance coverage for anyone suffering with mental illness or substance dependencies. As a senior, you likely have the least access to adequate mental health coverage if you’re still on a regular health insurance plan.

While regular health insurance plans offer better mental health insurance coverage today than in the past, they still may not offer all of the benefits you need. Original Medicare, Medicare Advantage and Medicare Prescription Drug coverage plans are all designed to help you, as a senior, get the help you need to deal with mental health issues and substance abuse issues.

How Extensive is Medicare Coverage for Mental Health?

Medicare plans at all levels are designed to help manage common – and uncommon – conditions that affect you as you age. As a result, they all offer comprehensive mental health and substance abuse coverage. It must be said, though, that the amount of coverage available to you for mental health and substance abuse issues depends on the type of plan you choose.

Original Medicare, made up of Medicare Part A and Medicare Part B, covers an array of medical interventions, mental health service, and mental health treatment for those who may be dealing with mental health and substance abuse issues. Original Medicare may provide mental health coverage for any of the following:

  • Inpatient care/institutional psychiatric treatment (Part A; up to 90 days per benefit period)*
  • Partial psychiatric hospitalization
  • Cognitive Behavioral Therapy, in-person or telehealth
  • Group Therapy
  • Family Counseling
  • Mental health screenings
  • Mental health checkups

Original Medicare substance abuse treatment coverage includes the following:

  • Psychotherapy
  • Inpatient care and treatment
  • Prescription drugs administered during inpatient care
  • Screenings for alcohol misuse
  • Post-hospitalization follow-up treatment
  • Treatment services for opioid use

Original Medicare coverage for mental health service and mental health treatment and Original Medicare coverage for substance abuse treatment is quite comprehensive. However, it may not offer enough coverage to help you effectively deal with your own mental health and/or substance abuse issues. This is where options such as Medicare Advantage, Medicare Prescription Drug coverage (Part D), and Medigap supplemental insurance can be of great benefit to you.

*If you require hospitalization for more than 90 days, you’re entitled to 60 reserve days. However, once you’ve used those days, more time will not be made available. Medicare only covers 190 days of psychiatric hospitalization in all before the coverage is exhausted.

Medicare substance abuse treatment coverage

What Kind of Mental Health Insurance Coverage is Available to Me Through a Medicare Advantage Plan?

Medicare Advantage plans are required by law to offer the same coverage for mental health and substance abuse issues as Original Medicare. Sometimes, these plans can offer more coverage for mental health and substance abuse than the government-provided option.

Depending on where you live and the health insurance carrier you choose, your Medicare Advantage plan may deliver more mental health and substance abuse treatment coverage than Original Medicare. While Original Medicare will not pay for most medications to treat mental illness and substance abuse. Unfortunately, this includes antidepressant medication. However, Medicare Part D Prescription Drug coverage can help lessen the burden of prescription costs.

Sometimes, you’ll need more help than the average Medicare plan can provide. For example, no Medicare plan will help you pay the cost of copays or coinsurance. Medigap supplemental insurance, often offered by the same carrier offering your Medicare Advantage and Part D plans, can help you cover those costs.

You Don’t Have to Go Without Mental Health Service and Treatment

Like any healthcare treatment or service, mental health service and treatment can cost quite a bit of money. This often forces seniors like you to leave these conditions untreated. Doing so can be incredibly harmful to your health.


If you or someone you know is struggling with mental health care or a mental health condition, don’t hesitate to reach out to your primary care provider, social worker, clinical social worker, nurse practitioner, or other mental health provider or mental health professional today. You are not alone!

Never forget: Mental health coverage is available! If you’re looking for a Medicare Advantage plan that delivers the mental health coverage you need, give us a call today. Our licensed insurance agents can help you find a Medicare Advantage plan that works for you.

About the Author

Larry Johnson

Larry Johnson

Larry is a content writer with several years of experience in creating informative content for a variety of industries on topics that matter. He is a 2009 graduate of the University of North Carolina School of the Arts.

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