Mental health can be an issue regardless of a person's age. In fact, it’s estimated that more than 25% of the adult population struggles with their mental health. And issues relating to mental health can have an enormous impact on your ability to navigate and enjoy life (especially in your golden years).
So if you rely on Medicare coverage, you might wonder “Does Medicare cover mental health counseling?” And the good news is that Medicare does cover a wide variety of mental health services.
This guide will help you understand what you can expect from Medicare coverage for mental health and answers common questions about this coverage.
As we mentioned, Medicare does cover mental health care. There are two kinds of mental health treatment: outpatient and inpatient. With outpatient care, you see a doctor or therapist from time to time. Inpatient care involves living in a facility or institution.
Keep in mind that Original Medicare will have specific coverage levels with copayments or coinsurance.Medicare Advantage plans have to offer at least as much coverage as Original Medicare and often may offer more coverage, and potentially lower cost shares. .
Counseling is a common outpatient treatment for a variety of mental health conditions. Is mental health therapy covered by Medicare? Yes, it is!
Outpatient care is covered under Medicare Part B. The coverage will only apply if the therapist accepts an assignment from Medicare. You’ll pay your Part B deductible (if it hasn’t already been paid) and then 20% of the Medicare-approved amount for the counseling services.
There are specific types of treatment that are not covered. These may include:
If you have a Medicare Advantage plan, you will get at least as much coverage as Original Medicare. There may also be additional benefits. You’ll want to check with your specific plan.
If you need counseling for mental health, don’t be afraid to get the care you need!
There is no specific limit to the outpatient therapy sessions covered by Medicare, provided they are necessary and there is a reasonable expectation that the treatment will help you improve. If you require inpatient mental health care in a hospital or institution, there is a lifetime limit to the number of days Original Medicare will cover.
Your Medicare Advantage plan may have different guidelines, although they shouldn’t be more restrictive than Original Medicare. Be sure you talk to your insurance provider directly to ensure your therapist is in the network and to find out how therapy sessions are covered.
Depression is one of the most common mental health diagnoses. Unfortunately, the number of American adults struggling with depression or anxiety significantly increased during the COVID-19 pandemic.
With Medicare, you can get one depression screening per year at no cost to you as long as your provider accepts an assignment from Medicare. If you need therapy or counseling, you’ll pay your Part B deductible (if it hasn’t already been paid) and then 20% of the Medicare-approved cost per session. Learn more about the latest updates to Medicare deductibles and premiums.
Medicare Advantage plans will offer similar arrangements but may have additional benefits as well. You’ll want to talk to your insurer before you set up your depression screening and therapy appointments. The most important part of getting coverage through Medicare Advantage is to use the provider network that is part of the plan.
Is psychiatric treatment covered by Medicare if you need to be hospitalized? Inpatient care is covered by Medicare under Part A.
Similar to other inpatient hospitalization, you’ll pay a $0 deductible for each day up to 60 within a benefit period. Days 61-90 will have a $389 per day charge in 2022. Beyond 90 days per benefit period, you’ll need to use your lifetime reserve days, which you only have 60 of in your lifetime. This article can provide additional information about Medicare costs.
Overall, mental health hospitalization is limited to 190 days over your lifetime. After that, Original Medicare will not provide coverage and you’ll need to pay 100% of your costs.
In addition to the inpatient hospitalization costs, you’ll also pay 20% of the Medicare-approved amount for therapy or other mental health services you get while you’re in the hospital. These are covered by Medicare Part B. Prescription drugs may be covered under Medicare Part D or Part A.
If you have a Medicare Advantage plan, you may have similar limits or they may be more generous. You’ll need to check with your specific plan for details.
How much does mental healthcare cost with Medicare? With Original Medicare, you’ll pay the normal copayments or coinsurance for either inpatient or outpatient care. For example, a therapy session will cost you 20% of the Medicare-approved amount, as long as your deductible has been paid and your therapist accepts the assignment.
With Medicare Advantage, you may have different deductibles, copayments, or coinsurance. You’ll need to talk to your insurance company to find out the details. It’s a good idea to do this before you commit to treatment so that you can ensure you know what to expect.
If you have any additional questions about Medicare and mental health coverage, or you’d like to talk to a licensed agent to choose the right Medicare plan for your needs, we're here to help. Contact us today!