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Medicare Coverage for Mental Health Services

Q.  I heard that seeing a psychiatrist will cost me more than I pay for other Medicare services.  Is this true?  And if so, isn’t it discrimination?

A. Medicare used to discriminate by charging beneficiaries a lot more for outpatient psychiatric treatment than other physicians’ services. But that has now changed.  In 2008, Congress passed a law that gradually reduced the copayment for these services—from 50 percent of the Medicare-approved cost in 2008 and earlier years down to the standard 20 percent in 2014.       

So now and in the future Medicare will pay the same share of the cost (80 percent) for outpatient mental health services that it pays for other Part B medical services. If you have supplemental insurance (medigap), the policy will cover your 20 percent share of the cost.

However, it is also true that some psychiatrists do not accept Medicare (or even any insurance in some cases).  So be aware that if you go to a psychiatrist who has opted out of Medicare, you will be responsible for the total bill and Medicare won’t reimburse you.  A doctor who has opted out should ask you to sign a contract to that effect, but it’s always wise to ask any doctor—before being treated—whether he or she accepts Medicare payment. For details of what doctors can charge you in different situations, see Ask Ms. Medicare: Seeing a Doctor ‘On Assignment’.”  If you need to find a psychiatrist (or another physician) in your area who accepts Medicare payment, go to Medicare’s “Physician Compare” website.

Two other recent changes in Medicare mental health services are worth knowing:

  • Medicare now covers screenings for depression.  These tests are available once a year and are free of charge if you go to a primary care provider who accepts the Medicare-approved amount as full payment.  This provider—whether a physician, physician assistant or nurse practitioner—must be able to give treatment or refer you elsewhere for treatment, but those services are not free. 

  • Medicare now posts information about care in inpatient psychiatric facilities on its Hospital Compare” website, which allows you to compare hospitals according to certain measures of quality that have been collected by Medicare and reported by patients and their families. 

However, one form of discrimination was not changed by the 2008 law and still persists:  Your Medicare Part A coverage for time spent as an inpatient in psychiatric hospitals—those that specialize in mental health conditions—is limited to 190 days over your whole lifetime.  But there is no such limit on Medicare coverage for care in general hospitals. So any days you spend in a nonpsychiatric hospital—even if you’re being treated for a mental health condition—do not count toward the 190-day lifetime limit. Out-of-pocket costs are the same in either type of hospital.

In some circumstances, Medicare covers “partial hospitalization,” which means receiving treatment at a hospital’s outpatient department or clinic or at a community mental health center during the day (but not spending the night there). Your charge for this type of service varies according to the treatment provided, but under Medicare rules it cannot be more than 40 percent of the Medicare-approved amount.

For more details, see the official publication “Medicare & Your Mental Health Benefits”.

Patricia Barry is a senior editor for AARP Integrated Media and the author of “Medicare For Dummies” (Wiley/AARP, October 2013).

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