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.
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.
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:
Medicare Part B covers mental health services for the following outpatient situations:
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.
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:
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:
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.
Medicare Part B covers outpatient mental health services like counseling services and diagnostic assessments, including but not limited to:
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.
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?