Mental health conditions affect many people, and people who experience them later in life often have a hard time recognizing them. Without proper mental health care these conditions can be severe and even life-threatening. Fortunately, Medicare offers coverage for mental health services.
Do I Qualify for Medicare Mental Health Coverage?
If you’ve been diagnosed with a mental health condition, you most likely qualify for the mental health services that Medicare offers. Common conditions include anxiety, depression, addiction, and eating disorders. Symptoms of mental health conditions can include, but aren’t limited to:
- Loss of interest/lack of energy
- Feeling of hopelessness
- Poor appetite (weight gain or loss)
- Suicidal thoughts or actions
- Panic or fear
- Shortness of breath
- Trouble sleeping
If you or someone you know is experiencing these symptoms, proper treatment can help tremendously.
How Much Does Medicare Pay for Mental Health Counseling and Other Services?
While Medicare offers many mental health services, it doesn’t usually cover the entire costs. Original Medicare alone (Medicare Part A and Part B) typically only pay up to 80% for your inpatient or outpatient services, excluding other charges like copays and deductibles. Original Medicare also doesn’t typically cover your prescription medications. There are several solutions to help control your costs:
- Medicare Supplement Plans: Medicare Supplement plans come in a range of coverage options, and help cover the gaps in the services that Medicare pays for. For instance, if you have Medicare Supplement Plan G, you may have no other out-of-pocket costs after you pay your yearly deductible, which is $198 in 2020. You’re able to keep Medicare as your primary coverage, but they don’t offer any prescription coverage.
- Medicare Part D Prescription Plans: These plans help cover the costs of your prescription medications. They vary in coverage by carrier and zip code, and your costs may also change depending on which pharmacy you receive your prescriptions from.
- Medicare Advantage Plans: Medicare Advantage plans are primary instead of Medicare. Some of them offer prescription coverage, and they may reduce your out-of-pocket costs for mental health services compared to Original Medicare alone. If you have a Medicare Advantage plan, you should refer to it directly for details on costs and coverage.
Ultimately, what you pay for mental health counseling and similar services will vary depending on if you have Original Medicare alone, or if you have another form of coverage to help you. Keep in mind that Medicare will only cover services if your healthcare provider states that they’re medically necessary, and if they’re received according to Medicare’s guidelines, within their nation-wide network.
What Services are Included in the Medicare Mental Health Benefits?
Medicare mental health coverage is available in an inpatient or outpatient setting, depending on which is medically necessary for your treatment. The following services are examples of what’s covered by Medicare for people who need to be treated in an inpatient setting:
- Lab tests
- Room and meals
- Nursing care
- Some medications
Some of the services available to people in outpatient care include:
- Lab tests
- Some medications, if given in a medical setting
- Visits with a doctor or social worker
These are just a few examples of the services that Medicare offers. Medicare also offers an annual depression screening, which you can schedule this with your primary care physician at your convenience.
Does Medicare Cover Psychiatric Visits?
Yes, Medicare offers coverage for psychiatric visits, as well as care at psychiatric hospitals. Keep in mind that if you have Original Medicare alone, you’ll most likely have to pay out-of-pocket. If you have Medicare Supplement Plan F or Plan G, you won’t have any copayments.
Does Medicare Cover Therapy?
Medicare provides coverage for several different kinds of therapy, including:
- Family counseling, if it’s necessary for your treatment
- Medication Management Therapy
- Individual and group therapy
Again, keep in mind that you must receive these services from a provider that accepts Medicare, and according to Medicare’s standards in order to be covered for them. If you’re unsure if a service will be covered, you can always consult with your provider first.
Mental health conditions may be hard to deal with, but know you’re not alone, and that there is help. If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). TTY: 1-800-799-4TTY (1-800-799-4889). You can call and speak with a counselor 24 hours a day, 7 days a week. Call 911 if you’re in immediate medical crisis.
Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.