Does Medicare Cover Counseling?
Medicare covers a variety of mental health services. This includes diagnosis, counseling, and medication. Read our guide to find out what Medicare benefits cover counseling.
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Key Takeaways:
Medicare provides mental health benefits under Part A, Part B, Part D, and Medicare Advantage plans.
Benefits covered include therapy, counseling, mental health screening, and hospitalization.
If you or a loved one is in a crisis, the National Suicide Prevention Lifeline provides free counseling services 24/7. Call 1-800-273-TALK, or for TTY call 1-800-799-4899.
To keep your costs manageable, go to mental health providers who accept medicare assignments and charge Medicare-approved amounts.
Your Medicare Part A benefits include inpatient mental health care.
Depending on your needs, you may receive treatment either in a psychiatric hospital, or a general hospital. In either case, your Part A benefits would cover:
Lab tests
Medications
Room and meals
Nursing care
Therapy
Inpatient rehabilitation for alcohol and substance abuse
Medicare Part B helps to cover outpatient mental health services from providers such as:
Psychiatrist
Clinical psychologist
Clinical social worker
Nurse practitioner
Labs as requested by your doctor
Doctor services when admitted in the hospital
Some services covered by your Part B benefits include:
Free annual depression screening
Individual and group therapy
Family counseling
Partial hospitalization for structured outpatient psychiatric services
Alcohol abuse screening
What is the Cost of Mental Health Care Through Medicare?
It is important to go to a service provider who accepts Medicare assignments to avoid unnecessary charges.
Part A (hospital) costs — Whether you are admitted in a general hospital or a psychiatric hospital, your out-of-pocket costs in 2020 would be:
$1,408 deductible
$0 coinsurance for the first 60 days you are admitted
$352 coinsurance daily from day 61 until day 90 of your inpatient stay
These costs apply to one benefit period. A benefit period starts on the day you get admitted for inpatient care, and ends after you go for 60 days without receiving inpatient care.
If you receive inpatient care after this period has passed, you begin yet another benefit period. This means you would need to pay a new deductible and other charges. You do not have limits to the number of benefits period you may have for your mental health care needs. If you receive care in a psychiatric hospital instead of a general hospital, your lifetime limit is 190 days.
If your inpatient stay exceeds 90 days, you pay $704 each day within your lifetime reserve days. These lifetime reserve days refer to 60 reserve days that Medicare adds to your lifetime limit if you are admitted in hospital longer than 90 days.
Part B (doctor) costs — When you need to see certain doctors, receive outpatient care, or buy medical supplies, Part B covers 80% of the costs. Unless you have a Medicare Supplement plan, you pay:
$198 deductible
$144.6 standard premium or more depending on your income
20% of medicare-approved coinsurance costs
How to Lower Your Out-Of-Pocket Costs
A Medicare Supplement plan can help lower your costs by covering deductibles, coinsurance, and copayments. You may also add a prescription drug plan (Part D) to help cover the cost of your medication. While Part D premiums vary by plan and zip code, the deductible cannot exceed $435 in 2020. Your prescribed drugs will also affect the cost of coinsurance and copayments. Although drug plans do not have to cover all medications, they are required to cover:
Antidepressants
Anticonvulsants
Antipsychotics
Mental health benefits and costs vary between Medicare Advantage plans. Medicare Advantage plans do provide basic Part A and Part B benefits, and bundle Part D drug benefits.
When Should You Seek Counseling?
Mental health conditions can happen to anyone. Pay attention to how you are feeling and talk to your doctor if you:
Have thoughts about ending your life or harming yourself
Feel a loss of self-worth, such as from feeling like a burden
Have increased your alcohol or drugs consumption
Want to withdraw socially and have no enjoyment in things you were interested in
Experience loss of appetite and weight loss
If you or a loved one is in a crisis call National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) for crisis counseling. If you are a TTY user, call 1-800-799-4889. Your counseling with this service is:
Free and confidential
24 hours a day, seven days a week
If you need emergency medical assistance, call 911.
Grace Kisirkoi works in higher education and is a writer who specializes in finance.
