People of all ages are starting to talk more openly about their mental health. Despite efforts to reduce the stigma, finding and navigating mental health services can still feel overwhelming. Many seniors may wonder, “Does Medicare cover mental health services?” The reassuring (and short) answer is, “Yes,” but like most questions about Medicare coverage, the long answer is, “it all depends.” That’s because Medicare’s coverage depends on the type of services you need and which part(s) of Medicare you’re enrolled in.
You don’t have to navigate Medicare’s coverage for mental health services alone! Your trusted, independent Medicare agents at Wandacare are here to walk you through what’s covered and help you better understand your options for the mental health care you need.
What Therapy, Counseling, and Mental Health Services Are Covered by Medicare?
Your Medicare benefits provide support for mental health care by covering critical therapies, counseling, and services. To ensure Medicare covers the care you need, the mental health services must meet these qualifying parameters:
- Treatment must be considered medically necessary with the purpose of diagnosing, treating, or managing a mental health condition.
- Services must be prescribed and provided by a Medicare-approved healthcare provider, including psychiatrists, psychologists, licensed clinical social workers, and clinical nurse specialists.
- Therapy or counseling sessions must be part of a mental health treatment plan and documented appropriately.
Based on these qualifications, the mental health services and care covered by Medicare include:
Annual Depression Screening
As part of Medicare coverage for preventive care, you can receive one free depression screening per year with a primary care doctor. Based on the outcomes of this annual depression screening, your primary doctor can then provide follow-up treatments and/or referrals for needed mental health care, including diagnostic testing, psychiatric evaluation, individual or group therapy sessions, and family counseling.
Diagnostic Testing
Based on the findings of your annual depression screening or doctor referral, Medicare covers psychiatric evaluations, diagnostic tests, and other services designed to assess your mental health. This covers testing for both diagnosis and follow-up to ensure that your mental health treatment plan is working or if additional services are needed.
Individual and Group Therapy
If follow-up treatment includes therapy, Medicare covers individual or group therapy—up to 20 outpatient therapy sessions per year. Individual therapy covers one-on-one counseling with a Medicare-approved licensed mental health professional. This includes psychotherapy sessions addressing issues like depression, anxiety, PTSD, and other mental health disorders. Group therapy sessions consisting of multiple patients meeting together with a licensed therapist focus on coping strategies, support and management of mental illness symptoms as a community.
Family Counseling
Family counseling is covered only when it directly supports the Medicare patient’s treatment plan. For example, if participation of family members is deemed essential to improving the patient’s mental health outcomes, Medicare will cover the sessions.
Behavioral Health and Disorders Treatment
Mental health services you receive as part of alcohol and substance use disorder treatment, smoking cessation, and STI prevention—including counseling, therapy and medication management—are eligible for Medicare coverage. Medicare also covers behavioral therapy and counseling sessions for obesity.
How Do Medicare Parts A, B, and Advantage Plans Cover Mental Health Services?
While Medicare covers these qualifying health services, the coverage may be under different “parts” of Medicare, depending on the type of care and where and how it is administered. Understanding which parts of Medicare cover which services is key to getting the care you need without unexpected costs.
Here’s how mental health coverage is spread across Medicare’s parts:
Medicare Part A: Inpatient Mental Health Services
Medicare Part A covers inpatient hospitalization care, including inpatient mental health care at a general hospital or a psychiatric hospital. There is a lifetime limit of 190 days for inpatient psychiatric hospital stays but no limit on general hospital care. This coverage includes a semi-private room, meals, nursing care, and any medications or therapy you receive during your hospitalization.
You are responsible for paying the Part A deductible and any coinsurance costs, with Medicare Part A covering the rest.
Medicare Part B: Outpatient Mental Health Services
Part B is the medical insurance component of Medicare covering typical healthcare services, including outpatient mental health services. This encompasses most of the mental health services highlighted, all provided in an outpatient setting—annual depression screening, diagnostic testing, psychiatric evaluation, individual or group therapy sessions, family counseling, and substance use disorder/behavioral health sessions.
Medicare Part B also covers “intensive outpatient program services,” which offer more intensive psychiatric care, counseling, and therapy over longer sessions than what you receive in a doctor’s or therapist’s office. While still provided on an outpatient basis, these services must be administered in a hospital, federally qualified heath center, community mental health center, rural health clinic, or through an opioid treatment program to be covered by Medicare Part B.
In covering outpatient mental health services, Medicare Part B pays 80% of the approved cost, and you are responsible for the remaining 20% after meeting the yearly Part B deductible.
Medicare Part C: Medicare Advantage Plans
Medicare Advantage Plans (or Medicare Part C), which are offered and managed by private insurance companies approved by Medicare, must provide at least the same coverage for mental health services as Original Medicare (or Parts A and B).
Many Advantage Plans provide additional or supplemental benefits beyond what is covered by Parts A and B. This can include coverage for integrated case managers to coordinate services and care, telehealth sessions, additional therapy sessions with a broader focus (like conflict resolution or grief counseling), and alternative mental health therapies, like acupuncture. As Medicare Advantage Plans operate with a network of providers, they may also offer a greater choice of mental health professionals to choose from.
Every Medicare Advantage plan is different, so it’s important to review and compare plans and know your specific plan’s benefits, provider network, and out-of-pocket costs to understand the mental health services it provides.
Wandacare Can Help with Medicare Mental Health Coverage in Lakeland
Have questions or concerns about Medicare’s coverage for mental health services? Wandacare has you covered! Our team of expert advisors can assist you in navigating the mental health professionals, facilities, and support services available to Medicare beneficiaries in greater Lakeland and Polk County.
Wandacare is ready to help you access and maximize your Medicare mental health benefits.
Schedule your personalized consultation with Wandacare today!
