Does Medicare Cover Mental Health Services?

Medicare provides coverage for both outpatient and inpatient mental health care services and programs to help beneficiaries with anxiety, depression and other mental health needs. Here is what you should know.

Outpatient Coverage

If you are enrolled in original Medicare, your Part B coverage will pay 80% of the costs for mental health services after you have met the annual Part B deductible of $257. The covered services include counseling and mental health care provided outside a hospital. This includes visits to a doctor’s or therapist’s office, hospital outpatient departments or community health centers. These services can also be received via telehealth providers. The remaining 20% of costs will be the beneficiary’s responsibility or may be covered by a Medicare Supplemental (Medigap) Policy.

Medicare also gives the expanded option of getting treatment through a variety of health professionals such as psychiatrists, psychologists, clinical nurse specialists, clinical social workers, nurse practitioners, physician assistants, marriage and family therapists and mental health counselors. To be eligible for this coverage, you must choose a participating provider that accepts Medicare assignment, which means they accept Medicare’s approved amount as full payment for a service.

If you choose a nonparticipating provider who accepts Medicare but does not agree to Medicare’s payment schedule, you may be responsible for up to 35% of costs. Additionally, if you choose a provider that has opted out of Medicare, you will be responsible for the entire cost.

To locate a mental health care professional in your area that accepts Medicare, go to Medicare.gov/care-compare, click on “Doctors & clinicians” and type in your location, followed by “clinical psychologist” or “psychiatry” in the Name or Keyword box. You can also get this information by calling Medicare at 800-633-4227.

Inpatient Coverage

If you need mental health services provided in a general or psychiatric hospital, original Medicare Part A covers these services after you have met your Part A deductible of $1,676. Your doctor will determine which type of hospital setting you will need. If you receive care in a psychiatric hospital, Medicare covers up to 190 days of inpatient care for your lifetime. If you have reached your 190-day limit but need additional care, Medicare may cover additional inpatient care at a general hospital.

Additional Coverage

In addition to outpatient and inpatient mental health services, Medicare will pay for one depression screening per year which can be done in a primary care doctor’s office or clinic. If you have a Medicare prescription drug plan, most medications used to treat mental health conditions are covered too.

Medicare Advantage Coverage

If you get your Medicare benefits through a private Medicare Advantage plan, the plan will provide the same coverage as original Medicare but may impose different rules and will likely require you to see an in-network provider. You should contact your plan directly for details.

For more information, call Medicare at 800-633-4227 and request a copy of publication #10184 Medicare & Your Mental Health Benefits, or read it online at Medicare.gov.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of “The Savvy Senior” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.