Medicare Coverage of Mental Health Care | GoMedigap

Medicare and Mental Health

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Medicare and Mental Health

Mental health conditions affect copious amounts of people leading up to, and over the age of 65. These conditions can include but are not limited to, depression and anxiety. Without proper mental health care, these conditions can be severe and even life-threatening.

The Center for Disease Control reports that suicide is the eighth leading cause of death of people aged 55-64, and the seventeenth leading cause of death of people aged 65 and over (source). While mental health conditions are not a normal or guaranteed part of aging, mental health care is essential as you get older.

Thankfully, Original Medicare covers an annual depression screening to help you stay on top of your mental health.

When you enroll in Medicare at age 65, you can elect to enroll in Medicare Part B (Medical Insurance) in addition to the standard Medicare Part A (Hospital Insurance). Medicare Part B covers your outpatient medical needs, which includes one depression screening per year.

As long as you enroll in Part B, this screening comes at no additional cost to you. You will pay nothing for the depression screening if your doctor accepts assignment. This means that your doctor will, or the law requires them to accept the Medicare-approved amount for the services you need as full-payment.

What Is a Mental Health Condition?

A mental health condition, or mental illness, is a condition that affects a person’s mood and well-being. Every day functions or tasks can become hard to perform. Thinking or actions may become impaired. The most common mental health conditions include depression and anxiety.

Depression, anxiety, and other mental health conditions have many symptoms, including but not 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
  • Nausea
  • Trouble sleeping

If you are feeling any or some of these symptoms, it might be time to go to your health care provider and ask for your one covered depression screening. At this screening, if a doctor diagnoses you with depression, anxiety, or any other condition, they might propose a variety of options or services to help treat your mental health condition.

What Services Does Original Medicare Cover?

If a doctor determines that your symptoms are severe enough, hospitalization may be an option. As a hospital inpatient, your Medicare Part A plan will help cover any costs associated with your stay. This includes:

  • Medications
  • Room
  • Lab tests
  • Nursing care
  • Therapy

Your mental health condition might not be severe enough to require hospitalization, but you should take it just as seriously. Your Medicare Part B plan helps cover out-of-hospital costs and services such as:

  • Seeing a psychiatrist
  • Seeing a clinical psychologist or social worker
  • Lab tests

If you elected to enroll in Medicare Part D (Prescription Drug Coverage) in addition to Original Medicare, Part D helps cover any prescription drugs used to treat your mental health condition.

What Will I Have to Pay?

As mentioned, your Medicare Part B plan will help cover the costs associated with treatment of your mental health condition. Usually, as long as you have already met your yearly Part B Deductible, you will pay 20% of the Medicare-approved amount. Again, this is only if your doctor accepts assignment.

If you receive services from a hospital outpatient department or clinic, you might have to pay an additional copayment or coinsurance to the hospital (source). Original Medicare does not cover the cost of meals, transportation, or support groups. These will all be out-of-pocket costs.

Mental health conditions are hard to deal with, but know you are not alone. While there might not be one single “cure,” these conditions are treatable when you seek proper help. Reach out to a doctor or call or text a suicide hotline if you are in immediate crisis.

How Can GoMedigap Help?

There are additional costs such as copays, coinsurance, your Part B deductible, and excess charges for doctors who do not accept Medicare assignment. Under certain plans, Medigap covers these costs for you, without the out-of-pocket stress. Reach out to one of our trained and licensed agents at (800) 310-2550 to discuss more about the mental health benefits you receive through Medicare, and how a Medigap policy can help.

In Crisis?

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.

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