Medicare Coverage of Therapy and Mental Health Services
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Declining health and the challenges of managing multiple diseases can put seniors at risk for mental health conditions like depression or anxiety. If you’re struggling with thoughts of suicide or constant feelings of sadness or hopelessness, talk with a doctor about getting the help you need.
Medicare covers many benefits to care for your mental well-being, including psychological counseling, preventive screenings, and outpatient treatment programs. Here’s an overview of Medicare’s mental health coverage.
Medicare preventive coverage
Preventive care can help identify patients who are at risk for mental health problems, so that they get necessary treatment sooner. Medicare Part B covers many preventive services, including screenings to access your risk for certain mental health conditions.
Medicare covers the following preventive benefits:
- Annual depression screening: All people with Medicare can get one free evaluation for depression per year as long as the doctor accepts Medicare assignment.
- Alcohol misuse screening: Some people with mental health problems may struggle with alcohol or drug abuse. Medicare covers one alcohol misuse screening per year. All Medicare enrollees who are not alcohol-dependent may qualify. If you’re alcohol-dependent, you may qualify for counseling (see below).
- ‘Welcome to Medicare’ visit: This introductory preventive visit includes a review of your risk for depression. You’ll need to have the exam within the first year of getting Medicare.
- ‘Wellness’ visit: During this annual visit, your doctor will evaluate your physical and mental health, and you’ll have the opportunity to bring up any mental health concerns with your physician. Your doctor may make recommendations based on your risk factors or refer you for additional treatment.
Medicare outpatient mental health coverage
Medicare Part B covers mental health services you get as an outpatient, such as through a clinic or therapist’s office.
Medicare covers counseling services, including diagnostic assessments including, but not necessarily limited to:
- Psychiatric evaluation and diagnostic tests
- Individual therapy
- Group therapy
- Family counseling (if the goal of therapy is to help your condition)
- Alcohol abuse counseling (up to four sessions)
Additional eligibility requirements may apply to qualify for these benefits. Keep in mind that Medicare doesn’t cover all types of therapy. You’re not covered for marital counseling or counseling with a pastor. You’re only covered for mental health services you get through a licensed psychiatrist, clinical psychologist, or other health professional who accepts Medicare assignment.
Some people with mental health conditions may require more intensive treatment than a doctor or therapist can offer. Medicare also covers outpatient treatment programs, where beneficiaries can get more rigorous or structured mental health services without being admitted for inpatient care. These programs are known as partial hospitalization programs and are typically run through a hospital’s outpatient unit or a community mental health facility. You may be eligible for a partial hospitalization program if your doctor verifies that you’d otherwise need to be hospitalized as an inpatient.
Medicare inpatient mental health coverage
If your condition requires an inpatient stay, Medicare Part A covers general hospital and psychiatric hospital services. There’s a cap on Medicare coverage for inpatient services if you stay at a psychiatric hospital (versus a general hospital): Medicare Part A will only cover psychiatric hospital care for up to 190 days in your lifetime. Even when you’re admitted to a hospital as an inpatient, Medicare Part B covers doctor services you get during your hospital stay.
Even when you’re admitted to a hospital as an inpatient, Medicare Part B covers doctor services you get during your hospital stay.
Medicare prescription drug coverage
Medicare Part D covers prescription drug benefits you may need for treatment of your condition. Original Medicare, Part A and Part B, doesn’t include drug coverage, although Medicare Part B covers some medications that can’t be self-administered, such as drugs given by injection. For other prescription coverage, however, beneficiaries with Original Medicare must enroll in a separate Medicare Part D prescription drug plan. Medicare Advantage enrollees can get drug coverage through a Medicare Advantage Prescription Drug plan, which includes Medicare Part A, Part B, and Part D benefits under a single plan.
Certain drugs that treat mental health conditions are in protected classes under Medicare Part D, including antipsychotic drugs, antidepressant drugs, and anticonvulsant drugs. With some exceptions, Medicare Part D prescription drug plans must cover most medications in these drug classes.
To find out if a Medicare Advantage or Medicare prescription drug plan covers your medications, look up the plan’s drug formulary (or drug list). If your plan doesn’t cover a medication you take, ask your doctor about switching to a similar drug that’s covered by the plan or file a formulary exception with your plan. Keep in mind that Medicare Part D prescription drug plans can vary in copayments and coinsurance costs, even if they cover the same medications.
This article is for informational purposes only. Nothing in it should be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.