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Does Medicare cover mental health?

Yes, Medicare covers inpatient mental health services under Part A, and under Part B it covers outpatient mental health services, including evaluation and visits with a mental health provider.

Previously, Medicare charged beneficiaries more for outpatient psychiatric treatment than other physicians’ services. But in 2008, Congress passed a law that gradually reduced the copayment for those services from 50 percent to 20 percent of the Medicare-approved cost. Now Medicare pays the same share of the cost, 80 percent, for outpatient mental health services that it pays for other Part B medical services.

Does Medicare cover inpatient mental health?

Medicare Part A covers mental health services if you’re admitted as a hospital inpatient, whether at a general or a psychiatric hospital. The coverage and cost sharing are typically the same as other inpatient hospital stays: For each benefit period, you’ll pay the Part A hospital deductible, which is $1,556 in 2022; $0 coinsurance for days 1 to 60; and a $389 daily coinsurance for days 61 to 90.

You’ll also pay the $778 coinsurance for each lifetime reserve day after 90 days for each benefit period. You can use up to 60 reserve days over your lifetime. 

A benefit period begins the day you’re admitted to a hospital as an inpatient or become a patient in a skilled nursing facility. It ends when you’ve been out of the hospital or skilled nursing facility for 60 consecutive days.

However, Medicare does treat billing for mental health differently in one key way: It will cover only 190 days total over your lifetime in a psychiatric hospital that specializes in mental health conditions. Days spent in a general hospital — even if you’re being treated for a mental health condition — don’t count toward the 190-day lifetime limit.

Does Medicare cover outpatient mental health?

Medicare Part B covers mental health services you receive when you’re not a hospital inpatient, such as in a doctor’s or therapist’s office, hospital outpatient department or community health center. Medicare generally covers mental health services and visits with psychiatrists, other doctors, clinical psychologists, clinical nurse specialists, clinical social workers, nurse practitioners and physician assistants.

Health care providers who aren't medical doctors must consent to the amount Medicare approves as payment in full, called accepting assignment. But not all mental health professionals accept Medicare.

What you pay for outpatient mental health services. Once you’ve met the standard Part B deductible, $233 in 2022, you’ll pay 20 percent of the Medicare-approved amount for the services.

You can receive one depression screening each year that’s not subject to the deductible or coinsurance if you go to a primary care provider — physician, physician assistant or nurse practitioner — who accepts the Medicare-approved amount. This provider must either treat you or refer you elsewhere for treatment, but those services are not free.

Coverage for partial hospitalization. Medicare will cover partial hospitalization if you need more intense treatment than you can get in a doctor’s or therapist’s office. Oftentimes, this treatment is provided in a hospital outpatient department or mental health center where you don’t stay overnight.

Medicare Part B pays for these services, but you must meet certain requirements, including having your doctor certify that you would otherwise need inpatient treatment. And note, these providers must accept Medicare.

For partial hospitalization, you’ll pay 20 percent of each service received from a doctor or other qualified mental health professional. You may have to pay coinsurance for each day of partial hospitalization services you get as a hospital outpatient or in a mental health center.

Does Medicare cover therapy?

Yes. Medicare Part B covers individual and group psychotherapy with doctors or other licensed professionals that your state allows. It also covers a variety of other mental health services, such as:

  • Diagnostic tests
  • Family counseling, if the purpose is to help with your treatment
  • Medication management
  • Psychiatric evaluation

Where can I find Medicare mental health providers?

With traditional Medicare, you can see any eligible mental health provider who participates in the program and who accepts assignment, when required. But finding a psychiatrist who accepts Medicare patients can be a challenge. A recent Kaiser Family Foundation analysis found that 60 percent of psychiatrists are accepting new Medicare patients, compared with almost 90 percent of physicians who aren’t pediatricians, while other psychiatrists and mental health professionals refuse patients paying with Medicare or private insurance.

If you go to a provider who has opted out of Medicare, you’ll be responsible for the total bill; Medicare won’t reimburse you. A doctor who has opted out should ask you to sign a “contract” noting this, but it’s wise to ask mental health providers if they accept Medicare before you’re treated.

To find a psychiatrist or other physician in your area who accepts Medicare, go to Medicare’s physician compare website. It helps that Medicare relaxed some of its restrictions on using telehealth services during COVID, which has improved access to mental health providers.

Does Medicare cover mental health prescription drugs?

Yes. You can buy a separate Medicare Part D policy or get drug coverage through a private Medicare Advantage plan. Both plans list all drugs covered in their formularies. They’re also required to cover all anticonvulsant, antidepressant and antipsychotic medications with limited exceptions.

When choosing a Part D or Medicare Advantage plan during open enrollment, make sure the plan covers your medications and find out how much you would pay in copayments or coinsurance for your drugs. The Medicare Plan Finder can help you compare out-of-pocket costs for your drugs for all Part D and Medicare Advantage plans in your area.

Keep in mind

You can buy a Medicare supplement policy, better known as Medigap, that helps pay Medicare deductibles and copayments or coinsurance. Most Medigap policies cover the 20 percent copayment for doctor and outpatient services, including mental health visits, and the hospital deductible and coinsurance.

If you get coverage through Medicare Advantage instead of original Medicare, the plan must cover Medicare Part A and Part B services and often Part D, which vary in cost-sharing. Some charge a daily copayment for the first several days in the hospital, such as $395 for days 1-5, rather than a hospital deductible.

These plans usually have provider networks that include mental health providers. It’s important to identify the specific coverage for mental health services you need before choosing a Medicare Advantage plan.

Published August 29, 2022

     

        


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