Does Medicare cover mental health?

You can receive one depression screening each year as a Part B preventive service 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. The screening must take place in a primary care setting, such as a doctor’s office, that can provide follow-up treatment or referrals. But those additional 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 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:

• Depression screening, one free each year.

• 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 accepts assignment, but finding a psychiatrist who accepts Medicare patients can be a challenge. A 2022 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. New legislation extends telehealth benefits for Medicare beneficiaries through 2024, even after the end of the COVID public health emergency.

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, but the out-of-pocket costs can be different. For example, some plans charge a daily copayment for the first several days in the hospital, such as $325 for days one to four, 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.

Updated July 26, 2023