Does Medicare Cover Mental Health Issues?
Learn what Medicare enrollment options you have if you need coverage for mental health services. Our guide breaks down your plan choices and what you can do to save on expenses.
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Key Takeaways:
If you are covered by Medicare, you can obtain mental health services in either an outpatient or inpatient setting.
Medicare Part A covers a stay in a psychiatric or general hospital.
Medicare Part B pays for mental health appointments from a qualified doctor.
Medicare Part D helps to pay for prescription drugs for mental health conditions.
You may be responsible for some costs, even if you have Medicare.
Mental health refers to the state of your emotional and psychological status. Medicare covers many mental health conditions for beneficiaries.
If you are a Medicare beneficiary and have a mental health condition, you are eligible for services including diagnosis, assessments, treatments, and counseling in both individual and group settings.
Read on to learn how Medicare covers mental health issues and where you or a loved one can go for care.
What are Some of the Mental Health Conditions Medicare Covers?
Mental health problems can happen to you at any time in your life.
If you are covered by Medicare, and you exhibit any of the conditions below, talk to your physician and seek care for mental health services:
You are overly sad, feel hopeless, are anxious, or depressed
You are having trouble sleeping or concentrating
You are feeling isolated and removed from society
You have no interest in the things that you used to enjoy
You have trouble sleeping or are losing weight due to a loss of appetite
You have suicidal thoughts or a feeling of no self-worth
You find that you are drinking too much alcohol or taking drugs to ease your suffering
If your doctor believes that you have a mental health condition, and you're covered by Medicare, you can obtain mental health services in either an outpatient or inpatient setting. Mental health services are covered by both Medicare Part A, your hospital insurance, and Medicare Part B, your outpatient insurance.
What Inpatient Mental Health Services Does Medicare Part A Cover?
Medicare Part A covers stays in a psychiatric or general hospital for beneficiaries with mental health conditions. It covers up to 190 days of a visit over a person's lifetime.
Medicare Part A also covers costs for therapy, lab tests, nursing care, and other mental health services, as well as the cost of the hospital room and meals.
What Outpatient Mental Health Services Does Medicare Part B Cover?
Medicare Part B pays for mental health appointments from a qualified doctor. It covers outpatient mental health services from:
A healthcare provider's office
Hospital outpatient departments
Community mental health centers
Medicare Part B helps to pay for:
One depression screening every year. This is required to be performed in a primary care clinic or doctor's office that provides follow-up treatments and referrals
Specific lab and diagnostic tests
Evaluations by a psychiatrist
Certain medications and prescription drugs
Partial hospitalizations
Drug testing
Treatment for the misuse of alcohol and drugs
Group and individual psychotherapy
Family counseling, if it is determined this will help
Medicare Part B also covers annual "Wellness" visits. This way, your doctor can discuss any changes in your mental health each year.
Does Medicare Part D Cover Costs For Mental Health Prescriptions?
Medicare Part D (drug coverage) helps to pay for prescription drugs authorized by your doctor for a mental health condition. All Medicare drug plans must cover antidepressants, anticonvulsants, and antipsychotic medications.
For those on a limited income, Extra Help may be available from Medicare to cover prescription drugs. Find out how to qualify or call 1-800-MEDICARE (1-800-633-4227).
What Mental Health Services Does Medicare Not Cover?
Private nursing care
Costs for a private room
A television or phone in your hospital room
Items for personal care like razors, toothpaste, shampoo, socks, etc.
What Costs Are You Responsible For?
If you use Original Medicare without a supplement, you will be liable for a $1,408 deductible for each benefit period.
You won't have to pay for any coinsurance during the first 60 days of treatment. After that, and up to 90 days, you will be liable for $352 of coinsurance each day.
After 91 days, you must pay $704 of coinsurance per each lifetime reserve day (an additional 60 days of coverage). Beyond this, you must pay all costs for care. Plus, you must pay 20 percent of the cost of mental health services while you're an inpatient.
If your doctor advises that you need services that Medicare doesn't cover, or that you need them more often than Medicare provides, you may have to pay for some or all of the costs.
Ensure that you understand what Medicare pays for and doesn't, so you'll be informed about your payment responsibilities.
Beyond Medicare: Will Medicaid Cover Any Mental Health Services?
Medicaid is the biggest payer for mental health services in the United States. It provides healthcare coverage for some low-income citizens, their families and children, pregnant women, and seniors with disabilities. Medicaid covers adults below a certain income level in some states throughout the U.S.
Medicaid has prioritized the need for:
Mental health services for children, youths, and their families
Substance abuse services
Mental Health Parity and Addiction Equity Act (MHPAEA) applications to Medicaid programs
If you believe you may qualify for Medicaid, visit your state's Medicaid website. If you are eligible, coverage for mental health services and other forms of healthcare can start right away.
Jackie Trovato is a healthcare and legal writer with nearly 40 years of experience.
