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How Medicare Helps with Mental Health

May is “Mental Health Awareness” Month, a time to advocate for mental health and access to care, but ensuring Medicare covers mental health services involves some research.

Mental health issues can be common as we age, and may include isolation, dementia, and anxiety disorders. Thankfully, Medicare covers a variety of mental health services, including procedures for early detection and mental illness therapy.

Are Mental Health Services Covered by Medicare?

Yes, Medicare covers inpatient/outpatient mental health services and prescriptions. However, you may be responsible for your copay, coinsurance, and deductible. Medicare Part A covers hospital mental health services and Part B covers outpatient services. Medicare Part D covers prescription drug benefits.

Inpatient Mental Health Care Coverage

Medicare Part A covers mental health care services you receive when you’re admitted as a hospital patient. For each benefit period, your costs in Medicare are as follows:

  • $1,556 deductible
  • $0 coinsurance per day for Days 1-60 and then $389 coinsurance per day for Days 61-90
  • $778 coinsurance per each “lifetime reserve day” after Day 90 for each benefit period (up to a maximum of 60 reserve days)
  • All costs each day after the lifetime reserve days
  • 20% of the Medicare-Approved Amount

Outpatient Mental Health Care Coverage

Medicare Part B covers mental health services for the following outpatient situations:

  • One depression screening per year in your primary care doctor’s office or primary care clinic
  • Individual and group psychotherapy with doctors/licensed professionals
  • Family counseling (if the purpose is to help with your individual treatment)
  • Psychiatric evaluation and testing
  • Certain prescription drugs
  • Diagnostic tests and medication management
  • Outpatient substance abuse treatment

Medicare Part D Mental Health Coverage

Part D coverage helps cover drugs you may need to treat a mental health condition, but Medicare drug plans have special rules.

Most Medicare drug plans have a formulary or a list of drugs that the plan covers. Medicare drug plans cover most antidepressant, antipsychotic, and anticonvulsant medications. If you take prescription drugs for a mental health condition, you need to find out whether a plan covers your drugs before enrolling.

Can My Drug Plan’s Formulary Change?

Yes, a Medicare drug plan can make formulary changes during the year. If this change involves a drug you’re taking, your plan must provide:

  • At least 60 days of written notice
  • A 60-day supply of the drug under the pre-change plan rules at the time you request a refill

What Mental Health Services Aren’t Covered?

While Medicare covers a variety of mental health services, it’s important for beneficiaries to know what to expect when seeking mental health care. Per Medicare, some examples of mental health services that won’t be covered include:

  • Meals
  • Transportation to/from mental health care services
  • Recreational activity therapy
  • Support groups that bring people together to talk and socialize
  • Testing that isn’t part of your mental health treatment

Remember, there’s not a one-size-fits-all treatment for mental health conditions. Your health care provider may recommend you get services more often than Medicare covers, or services that Medicare doesn’t cover at all. Ask questions so you understand the recommendations and if, or how much, Medicare will pay for them.

Are Services Like Regular Therapy Covered Under Medicare?

Medicare Part B covers outpatient mental health services like counseling services and diagnostic assessments, including but not limited to:

  • Individual and group therapy
  • Psychiatric evaluation and diagnostic tests
  • Family counseling (if the goal is to help your condition)
  • Alcohol abuse counseling (up to 4 sessions)

Keep in mind that Medicare doesn’t cover all types of therapy. For example, Medicare won’t cover marital counseling. You’re only covered for mental health services you get through a licensed psychiatrist, clinical psychologist, or another health professional who accepts Medicare assignments.

Do Medicare Advantage Plans Cover Mental Health Services?

If you get your Medicare benefits through a Medicare Advantage plan, check your plan’s membership materials or call for details about covered mental health services. These plans may also offer prescription drug coverage that follows the same rules as Plan D.

Have you ever looked to Medicare to help cover the costs associated with maintaining good mental health? Was it difficult to figure out what was covered?

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The Author

Lindsay Malzone is the Medicare expert for Medigap.com. She has been working in the Medicare space since 2017. Lindsay has a passion for sharing her expertise on Medicare to beneficiaries so they can be better prepared for healthcare costs after retirement. Her YouTube channel features various videos that help Medicare beneficiaries discover all their options.

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