The largest health insurance coverage plan in the U.S. is Medicare, servicing nearly 64 million Americans as of 2020. As mental health conditions such as anxiety and depression continue to affect the aging population, a common question we get is, “Does Medicare cover mental health?”
While the short answer is yes, insurance is never completely straightforward. In this article, we will try to unpack exactly what is covered and what is not.
Let’s dive in!
Medicare mental health coverage
Medicare covers a range of mental health services and programs to help diagnose and treat mental health conditions. This includes outpatient and inpatient mental health care, as well as prescription drugs for mental health conditions.
Under Medicare Part B, medicare mental health benefits include:
- One depression screening per year through a primary care doctor or clinic that can provide follow-up treatment and referrals
- Individual and group psychotherapy with doctors or certain other state-licensed professionals
- Family counseling, if the main purpose is to help with your treatment.
- Ongoing testing to find out if you’re getting the services you need and if your current treatment is helping
- Psychiatric evaluation
- Medication management
- Certain prescription drugs that aren’t usually self-administered, like some injections
- Partial hospitalization, such as the services you receive from healthcare providers while in the hospital
- A one-time “Welcome to Medicare” preventive visit within the first 12 months of attaining Medicare Part B. This includes a review of your potential risk factors for depression.
- A yearly wellness visit
In addition to these services, Medicare also covers opioid treatment programs and alcohol misuse screening and counseling.
What to know before receiving mental health services
To take advantage of Medicare mental health benefits, it’s critical to visit a doctor or specialist that accepts assignment. An assignment is an agreement your doctor, provider, or other supplier makes to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.
To ensure you don’t walk away from your appointment with a big bill, ask your doctor or psychiatrist if they accept assignment beforehand.
For some of the above benefits, such as your wellness visit or depression screening, you will pay nothing as long as your doctor accepts assignment. However, for others, your regular deductible and coinsurance will apply.
Does Medicare cover outpatient mental health?
Yes, under Medicare Part B, medicare mental health benefits include outpatient mental health services. This includes services at a clinic, doctor’s office, or therapist’s office and services provided in a hospital’s outpatient department.
Does Medicare cover inpatient mental health?
Yes, Medicare covers inpatient mental health as well, under Part A. These benefits cover services from both general and psychiatric hospitals, including:
- Nursing care
- Therapy or other treatment for your condition
- Lab tests
- Other related services and supplies
It’s important to note that these benefits are limited to 60-day periods and each 60-day period requires a new deductible. Additionally, inpatient care at a psychiatric hospital is only covered up to a lifetime maximum of 190 days. However, there is no maximum on inpatient care at a general hospital.
Does Medicare cover counseling for anxiety?
Medicare covers counseling for anxiety with a licensed professional under Medicare Part B. However, your Part B deductible and coinsurance will apply.
In order to receive coverage for counseling services, you’ll need to ensure you visit a professional who accepts assignment. Qualified professionals include:
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
- Nurse practitioners
- Physician assistants
Original Medicare vs Medicare Advantage
Medicare Advantage plans are required to cover everything that original Medicare covers, but they typically offer additional benefits as well.
However, Advantage plans vary from state to state and even county to county so visit Medicareadvantage.com to compare various providers in your area.
Depending on which plan you choose, you may be able to enhance your mental healthcare benefits which for someone with a chronic mental health disease may be worth considering.
For more information on the specifics of your plan, refer to your Mental Health Benefits manual for Original Medicare or Medicare Advantage.
How to get a mental health diagnosis
If you are struggling with mental health and need help, reach out to your primary care doctor to discuss your symptoms. They can order tests, help diagnose the problem, and refer you to a specialist if necessary.
If you don’t have a primary care doctor, you can also reach out to a psychiatrist, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, or physician assistant. Generally, medicare covers services from all of these professionals to diagnose and treat mental health conditions.
How to improve mental health
The quality of our mental health impacts our day-to-day lives, and when there’s a problem, it can sometimes be debilitating. It can make us feel vulnerable to seek treatment, but doing so is critical to identify the underlying cause and improve.
To improve your mental health, discuss a treatment plan with your doctor. They may prescribe medication, recommend therapy, or both. Through therapy, it’s often possible to develop habits to improve mental health naturally.