Does Medicare cover mental health care?
Original Medicare is made up of Part A (hospital insurance) and Part B (medical insurance), and includes certain coverage for mental health care when the care comes from a Medicare-assigned health-care provider. Learn more about this Medicare coverage below.
Medicare Part A covers hospital inpatient mental health care, including room, meals, nursing, and other related services and supplies. This care can be received in a general hospital or a psychiatric hospital.
Medicare has a lifetime limit of 190 days of inpatient care in a psychiatric hospital.
Medicare uses benefit periods for hospital coverage. A benefit period begins the day you're admitted as a hospital inpatient, and ends when 60 days in a row have passed since you have received inpatient care.
Your Medicare Part A costs for mental health care are listed below. Please note that the deductible and coinsurance amounts may vary year to year. You pay:
The Medicare Part A deductible - $1,288 in 2016 (the full deductible amount is applied for each benefit period)
No coinsurance ($0) for days 1-60
$322 in 2016 coinsurance per day for days 61-90
$644 in 2016 coinsurance per "lifetime reserve day" after the 90th day. Lifetime reserve days are days that you remain an inpatient beyond the 90-day hospital stay that Medicare covers. Medicare pays for your covered costs, charging you a daily coinsurance amount, for up to 60 of these days in your lifetime.
All costs after your lifetime reserve days are used up
In addition to Medicare Part A costs, you may have some costs associated with Medicare Part B even when you're a hospital inpatient (for example, doctor services).
Medicare Part B covers mental health services usually given outside a hospital, including visits with health professionals such as doctors, clinical psychologists, and clinical social workers. Some of the other mental health services that Medicare Part B may cover include, but aren't limited to:
Annual depression screenings
Certain diagnostic tests your provider orders
Partial hospitalization (a structured program of outpatient psychiatric services as an alternative to inpatient mental health care)
Individual and group psychotherapy by licensed professionals permitted by the state where therapy takes place
Family counseling as part of your treatment
Your Medicare Part B costs for mental health care are listed below. Please note that the deductible and coinsurance amounts may vary year to year. The annual depression screenings are free if you get them from a Medicare-assigned health-care provider. For other mental health services, you pay:
The Medicare Part B deductible - $166 in 2016
20% of the Medicare-approved amount of health-care provider services
A possible additional copayment or coinsurance if you receive your services as a hospital outpatient. The amount you pay depends on the service provided, but is generally 20%-40% of the Medicare-approved amount.
If you're enrolled in a Medicare Advantage plan, you still get the same coverage listed above, and your plan might include additional benefits, such as prescription drug coverage. Offered by private Medicare-approved insurance companies, Medicare Advantage plans must provide at least the same coverage as Medicare Part A and Part B (except for hospice care, which Medicare still covers). You still continue paying your Medicare Part B premium along with any premium the Medicare Advantage plan may charge.
For more information about Medicare coverage of mental health care, see Medicare and Your Mental Health Benefits.
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