Mental health is a component of your overall health that includes your mental, emotional and social wellbeing. Challenges to your mental health can happen at any time and may require short or longer term treatment. Original Medicare covers certain mental health care options including screenings and different types of inpatient and outpatient care. To help answer your questions and make sure you get the care you need, we have compiled a guide to your Medicare and mental health.
Mental Health Screenings and Evaluations
Mental health screenings are tests that your healthcare provider can use to help diagnose potential problems. As a Medicare beneficiary you are entitled to annual screenings for depression and alcohol misuse. You are also free and encouraged to bring up mental health concerns during your one time “Welcome to Medicare” preventive visit, which should include a screening for depression. Your annual “Wellness Visit is another convenient time to bring up mental health issues that may be concerning you. If you would like to be screened without incurring additional costs, choose a provider that accepts Medicare assignment and make sure the service is provided in a primary care setting—such as your regular doctor’s office.
If your doctor believes you could benefit from a psychiatric evaluation—usually to diagnose more serious mental health conditions—they will refer you to a psychiatrist and Medicare will pay up to 80% of the cost of this service. If you have a Medicare Supplement Insurance plan it may cover the remaining amount.
Outpatient Counseling and Therapy Services
Counseling and therapy sessions offer structured opportunities for you to talk about your mental health concerns with a professional specifically trained to assist you. Medicare covers individual and group psychotherapy to help you with your mental health conditions. In order for Medicare to cover these services is must be provided by a professional with one of the following qualifications:
- Clinical psychologist
- Clinical social worker
- Psychiatrist or other doctor
- Clinical nurse specialist
- Nurse practitioner
- Physician assistant
Counseling requirements also vary by state, so it is a good idea to check that the professional you want to see is authorized in your state. Medicare does not limit the number of counseling sessions available to you, but you may be responsible for 20% of the cost of services, if you don’t have supplemental coverage. Original Medicare may cover 100% of counseling costs for certain circumstances such as grief and loss counseling for hospice patients and their families and alcohol misuse counseling, if it’s provided in a doctor’s office or other primary care setting. Any counseling service that would be covered by Medicare in person, is also covered via telehealth. Outpatient counseling specifically for painkiller/opioid abuse are also covered.
Original Medicare will also cover outpatient “medication management” sessions, to help you with the prescription drugs that may have been prescribed for your mental health condition. You may also be entitled to monthly “behavioral health integration service” sessions. These sessions provide assessment, support and planning resources to help you manage your condition on an ongoing basis.
Inpatient and partial hospitalization
For more serious mental health issues—that cannot be managed in an outpatient setting—you may require inpatient hospitalization. These mental health services are covered by Original Medicare if you meet certain requirements and your doctor believes this care is required. Out-of-pocket costs associated with inpatient care include the Part A deductible—$1,408 as of 2020—and 20% of the costs of the mental health care you receive while hospitalized.
Partial hospitalization is another option for treating mental health concerns. These types of programs—which are covered under Medicare Part B—offer structured mental health services that are more intensive then what you could receive in a doctor’s office, but do not require overnight stays. If you are referred to a program of this type keep in mind that to be covered they must accept Medicare assignment. Also, associated meals and transportation will not be covered by Original Medicare.
Maintaining and improving your mental health is a big part of your overall healthy lifestyle. Being aware of the resources available to you is the first step in proactively dealing with any mental health issue you may encounter and making sure you get the best possible care to help you recover. When it comes to Medicare and mental health, it’s always great to take advantage of your what your plan helps cover.