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According to the National Institute of Mental Health, mental illnesses affected over 47 million U.S. adults in 2017.
If you’re a Medicare beneficiary, you may be wondering if you’re covered for mental health services under your plan. The good news is that Medicare mental health coverage includes inpatient services, outpatient services, and partial hospitalization.
This article will take an in-depth look into what type of mental health services are covered by your Medicare plan, what types of Medicare plans are best for mental health coverage, and when to seek help for mental illness.
What parts of Medicare cover mental health services?
Medicare mental health benefits are primarily covered by Medicare parts A and B. Let’s take a look at the details of what each part covers.
Medicare Part A
Medicare Part A covers mental health services related to your inpatient hospital stays. This type of treatment is especially important for people with acute mental illness crises that may be a harm to themselves or others.
With Medicare Part A, you’re covered for the cost of the room. Part A is also good for covering:
- standard nursing care
- inpatient therapy
- lab testing and some medications
Medicare Part B
Medicare Part B covers mental health services related to your outpatient treatment, including intensive outpatient treatment programs and yearly depression screenings. This type of treatment is important for anyone who needs ongoing mental health support.
Medicare Part B is good for:
- general and specialized counseling appointments
- psychiatry appointments
- clinical social worker appointments
- diagnostic lab testing
- certain medications
- intensive outpatient care, also known as partial hospitalization, including treatment for substance use disorder
Medicare Part B also covers one annual depression screening, with additional coverage for follow-up appointments or referrals for other mental health specialists.
Other parts of Medicare
Although parts A and B cover most of your mental health needs, you can get additional coverage by enrolling in the following Medicare plans:
- Medicare Part C: automatically covers all Medicare Part A and Part B services, plus prescription drugs and other coverage areas
- Medicare Part D: can help cover some of your mental health medications, including antidepressants, anti-anxiety medications, antipsychotics, mood stabilizers, etc.
- Medigap: can help cover some fees associated with your inpatient or outpatient care such as coinsurance and deductibles
If you’re ready to seek mental health treatment, visit the Substance Abuse and Mental Health Services Administration’s website to find behavioral health treatment services near you.
Does Medicare cover inpatient mental health treatment?
You must have Medicare Part A to be covered for inpatient mental health treatment at a general or psychiatric hospital. Medicare will pay for most of your inpatient treatment services. However, you may still owe some out-of-pocket costs depending on your plan and the length of your stay.
Here are the basic costs for Medicare Part A:
- $252–458 premium, if you have one
- $1,408 deductible
- 20 percent of all Medicare-approved costs during the stay
- $0 coinsurance for days 1–60 of treatment
- $352 coinsurance per day for days 61–90 of treatment
- $704 coinsurance per day for days 91+ of treatment, through your lifetime reserve days
- beyond your lifetime reserve days, you’ll owe 100 percent of the treatment costs
It’s important to note that while there’s no limit to how much inpatient care you can receive in a general hospital, Part A will only cover up to 190 days of inpatient care in a psychiatric hospital.
Does Medicare cover outpatient mental health services?
You must have Medicare Part B to be covered for outpatient mental health treatment, partial hospitalization, and annual depression screenings.
Like inpatient care, Medicare will cover most of your outpatient treatment services but there are certain financial requirements you must meet before Medicare will pay.
Here are the basic costs for Medicare Part B:
- $144.60 premium, if you have one
- $198 deductible
- 20 percent of all Medicare-approved costs during your treatment
- any copayment or coinsurance fees if you receive services at a hospital outpatient clinic
There’s no limit to the frequency or amount of sessions that Medicare will cover for outpatient mental health counseling. However, because there are out-of-pocket costs associated with these services, you’ll have to review your own financial situation to determine how often you can seek treatment.
If you’re looking to begin counseling or therapy appointments under your Medicare plan, here is a list of mental healthcare providers that Medicare approves:
- psychiatrist or doctor
- clinical psychologist, social worker, or nurse specialist
- nurse practitioner or physician assistant
There are many types of mental health specialists that you can visit for help. If you’re not sure who to see, talk to your doctor about which specialist may be best for you.
Symptoms of depression
As we age, we become more susceptible to health problems, which can place older adults at a higher risk of mental illnesses like depression.
depression symptoms in older adults
Common symptoms of depression in people over age 65 may include:
- losing enjoyment in hobbies and activities
- mood changes
- constantly feeling negative emotions
- appetite changes
- sleep changes
- concentration or memory problems
- other symptoms, such as fatigue, headaches, or digestive issues
- thoughts of harming oneself or others
If you’re having trouble with the symptoms above, consider reaching out to your doctor to discuss the next steps. If necessary, they can refer you to a mental health professional who can discuss your symptoms, offer a diagnosis, and pursue treatment.
The takeaway
If you have original Medicare or Medicare Advantage, you’re covered for both inpatient and outpatient mental health services. This includes hospital stays, therapy appointments, intensive outpatient care, yearly depression screenings, and more.
There are some costs associated with these services, so it’s important to choose the best Medicare plan for your needs.
Medicare enrollees face an increased risk of having mental health concerns. Fortunately, Medicare covers counseling, which can help make support more accessible for you.
Mental health programs and services are designed to help diagnose and treat mental health needs. As a beneficiary, you can take advantage of depression screenings, counseling sessions, medications, and partial hospitalization through your Medicare plan.
How much you end up paying depends on where you get service, your healthcare provider’s fees, and other insurance you may have. You can expect to pay for any deductibles and coinsurance.
This article discusses what mental health services your Medicare plan might cover and which types of plans are best for the mental health benefits you’re looking for. It also explains when and where to seek help for mental illness or Medicare concerns.
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Medicare Plans for Mental Health Services
Medicare plans include Parts A and B of Original Medicare, which the federal government manages. Medicare Advantage, or Part C plans, and prescription drug plans called Part D plans are privately run.
The government requires these plans to provide mental care coverage for enrollees.
Original Medicare vs. Medicare Advantage
Original Medicare and Medicare Advantage cover inpatient and outpatient mental health services. Both help pay for screenings, therapy appointments, and limited hospital stays.
Medicare Part A
Original Medicare includes Part A and Part B. Part A covers inpatient care in a facility and limited home health services. Such care is important for people whose mental condition makes it unsafe to remain at home.
Part A covers:
- Semi-private room costs
- Standard nursing care
- Meals
- Lab tests
- Certain medications
- Inpatient therapy
Medicare Part B
Part B covers outpatient treatment for mental health services. This can help people who need ongoing support.
Part B helps pay for:
- Yearly wellness visits
- Annual depression screenings
- Clinical social worker appointments
- Psychiatric evaluations
- Diagnostic lab tests
- Intensive outpatient care
- Certain prescription drugs
Medicare Part C
Medicare Advantage, also called Medicare Part C, typically matches the coverage offered by Parts A and B. Part C plans may cover extra telehealth benefits, grief counseling, and conflict resolution.
Some Part C plans include Part D benefits as well.
Medicare Part D and Medigap
Medicare Part D covers prescription drug benefits. Part D plans help pay for antidepressants, mood stabilizers, and most other protected mental health treatment medications.
If you do not have a Medicare Advantage plan, Medigap may also pay for some of your deductibles, copayments, and coinsurance related to inpatient or outpatient care.
What Is Covered?
Original Medicare covers visits to licensed mental health professionals who participate in Medicare. Your healthcare provider must be registered with Medicare and agree to its payment structure. The visits may be through telehealth or in a doctor’s office, clinic, or hospital.
Qualifying professionals include:
- Doctors
- Psychiatrists
- Physician assistants (PA)
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
- Nurse practitioners
Assignment
Assignment is an agreement on a provider’s part to be paid directly by Medicare and accept the payment amount Medicare authorizes for services. Your healthcare provider must accept assignment to keep your out-of-pocket costs down.
If your doctor or supplier accepts assignment, they will only charge you the Medicare deductible and coinsurance amounts. They’ll submit your claim to Medicare and won’t charge you for doing so.
What Isn’t Covered?
While Medicare offers extensive coverage for mental health, it has limits you should be aware of. Many plans come with some exclusions, lifetime maximums, and substantial out-of-pocket costs.
Original Medicare does not cover costs for the following mental health expenses:
- Adult day health
- Private duty nurse charges
- Hospital room phone or television costs (if any)
- Toiletries such as toothpaste, socks, or razors
- Additional costs for a private room if not medically necessary
- Report preparation or data interpretation
- Pastoral counseling
- Transportation
- Outpatient meals
- Recreational activities
-
Hemodialysis
for treating
schizophrenia
Coverage for Other Types of Counseling
Depression and anxiety aren’t the only issues that Medicare can help you address. Plans also cover treatments for substance use disorder and co-occurring mental illnesses.
However, Medicare will only cover types of counseling that directly address your specific mental health condition.
Substance Use Disorder
Substance use disorder (SUD) is a chronic mental illness. Medicare plans treat SUD as they would diabetes or heart disease.
Medicare Part B covers certain inpatient and outpatient services for SUD, including:
- Monthly care management
- Drug testing
- Counseling to prevent or stop tobacco use
- Opioid use disorder treatment
- Alcohol use disorder screenings
- Individual and group therapy
- Medication
- Treatment for co-occurring mental health disorders
- Drug withdrawal treatment
Opioid Treatment
Original Medicare covers the total cost of opioid use disorder treatment if you receive it from a program that’s enrolled in Medicare.
Services from a hospital outpatient setting may require an extra copayment or coinsurance on your part.
Alcohol Use Disorder
Medicare provides alcohol use disorder screening and therapy for people who use alcohol but aren’t dependent. If alcohol misuse is detected, Medicare may cover up to four counseling sessions per year.
Medicare also covers:
- Detoxification
- Rehabilitation
- Advance care planning
- Behavioral health integration into primary care to better plan and monitor care
You pay nothing for alcohol misuse screening and counseling if your healthcare provider accepts assignment.
Marriage and Family
Medicare Part B plans help cover family counseling. The main purpose must be a medically necessary part of your mental health treatment, though.
Medicare does not typically provide marriage counseling or couples counseling.
Specific Mental Health Services
You can access mental health care through Medicaid in a variety of formats and locations. Ask a healthcare provider which option is best for you or your loved one.
Inpatient Services
Medicare will cover inpatient services if the person needs intense care only available in an inpatient setting. Plans will help pay for treatments at inpatient psychiatric facilities, critical access hospitals, and psychiatric units in hospitals.
Medicare Part A pays for up to 190 days of inpatient care in a psychiatric hospital. Part B helps cover a portion of doctor or specialist fees related to inpatient care for mental illnesses.
Outpatient Services
If your doctor accepts assignment, your yearly depression screening will be free. You’ll need to pay the Part B deductible and 20% of the Medicare approved amount for doctor’s visits to diagnose and treat mental illness.
Medicare covers outpatient psychiatric hospital expenses for the following services and supplies if they are:
- Medically necessary for diagnostic study
- The patient is expected to improve
- Provided under a plan of care (a written plan where your healthcare provider lists the type of services you need, the span in which services are needed, and the predicted outcomes of treatment)
- Supervised and monitored by a doctor who prescribes and monitors the services
Partial Hospitalization Program (PHP)
PHPs are structured programs providing intensive outpatient mental health care. Medicare covers this service in hospital outpatient centers and community mental health centers (CMHCs).
PHPs provide mental health care less than 24 hours a day to people who are:
- Discharged from inpatient hospital treatment and need continued inpatient support
- At risk of needing to enter a hospital
If the healthcare provider accepts assignment, you may still pay part of the Medicare-approved amount for each service. You may also have to pay coinsurance for each day of PHP services.
Community Mental Health Centers (CMHCs)
In addition to services offered at PHPs, community mental health centers offer an alternative to hospitalization. These facilities provide:
- 24-hour emergency care with follow-up
- Day treatment, partial hospitalization, or rehab in line with the patient’s needs
- Screening for admission to a state mental health facility
Telehealth
Medicare Part B helps cover telehealth office visits, consultations, and psychotherapy. You’ll pay the Part B deductible and 20% of the amount Medicare approves for your healthcare provider’s services.
In most cases, telehealth costs are about the same as costs for in-person visits.
Prescriptions
Medicare may cover some medications to treat mental illness in inpatient or outpatient care. You must enroll in a Medicare-approved Part D drug plan to get drug coverage.
Most Part D plans list the drugs they pay for. They must cover most antidepressants, antipsychotics, anticonvulsants, and opioid use disorder treatment drugs.
Using the Medicare Helpline
Medicare gives you special rights and resources for protecting them. These include:
- The Medicare Beneficiary Ombudsman (MBO)
- Your State Health Insurance Assistance Program (SHIP)
- The Competitive Acquisition Ombudsman (CAO)
- The Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO)
These resources provide information and advice to make informed healthcare decisions that best meet your needs and situation. They can also help you address and work through grievances with Medicare providers.
Call 1-800-MEDICARE (1-800-633-4227) to ask questions or get help with a complaint. You can also contact your state’s elder helpline for assistance.
Summary
Medicare helps millions of older Americans access quality health care. Mental health counseling and programs come with every plan. Free annual wellness visits give you and your healthcare provider a chance to discuss how you’re doing emotionally and help prevent or ease mental issues. Your plan should also pay for a free depression screening each year.
Medicare plans provide a wide range of outpatient services, including individual and group therapy, prescription medications, and diagnostic testing for depression, drug and alcohol misuse, and other psychiatric conditions. In-person and virtual appointments are covered as well.
If you should face an emotional crisis requiring care in a medical facility, help is here. Medicare can bear much of the cost of inpatient care, too.
Make Sure Your Provider Accepts Medicare
Bear in mind that your healthcare provider must be registered with Medicare and agree to its payment structure. Before agreeing to any service, confirm with your plan that the service will be covered.
A Word From Verywell
Medicare helps make mental health therapy and treatment more affordable for seniors. Your plan can help you obtain confidential advice and medical care for managing your emotional health in the healthiest way possible.
Your mental health is as important as your physical health, and it affects your overall well-being, too. Emotional problems and substance use disorders need and deserve urgent medical attention just like physical ailments do.
If you or a loved one is having mental health issues, call a Medicare plan provider, a medical professional, or helpline right away. You can also call your local United Way, community center, or Area Agency on Aging for free or low-cost counseling options.
Mental Health Helpline
If you or a loved one is struggling with mental health concerns, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
Frequently Asked Questions
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Does Medicare reimburse you for therapy?
Medicare does not reimburse you for therapy or counseling. Yearly wellness checks and depression screenings are available at no cost with your plan. For other services, you’ll pay your Part B deductible and 20% of the Medicare-approved amount above the deductible.
Learn More:
Understanding Medicare Part B
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How do you find therapists that accept Medicare?
It can be challenging to find a therapist that accepts Medicare because of complicated paperwork and low reimbursement rates. If possible, start seeing a mental health professional who takes Medicare before enrolling in the program.
Check your Medicare plan for telehealth therapists or collaborative care practices. These specialists often accept Medicare and other kinds of insurance.
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Do you need to visit your general practitioner before seeking therapy?
With Medicare, you do not need to visit a general practitioner before seeking mental health therapy or counseling. Annual mental health checkups are free. Be certain that your provider accepts Medicare assignment before your appointment.
