Does Medicare Cover Counseling Services?
Does Medicare cover outpatient counseling services for its beneficiaries? Since the death of my sister last year, I have struggled with depression and anxiety and would like to get some help.
Yes, Medicare covers both outpatient and inpatient mental health services to help beneficiaries with depression, anxiety and many other needs. Here is what you should know.
If you have original Part B Medicare, your coverage will pay 80% (after you have met your $198 Part B deductible) for a variety of counseling and mental health care services that are provided outside a hospital, like individual or group therapy, family counseling and more. Medicare also covers services for treatment of beneficiaries who struggle with alcohol and drug abuse.
You, or your supplemental insurance, are responsible for the remaining 20% coinsurance due. Medicare gives you the option of getting treatment through a variety of mental health professionals such as psychiatrists, psychologists, clinical social workers and clinical nurse specialists.
To get this coverage, you will need to 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 rate, you may have to pay more. If you choose an "opt-out provider" that does not accept Medicare payments at all, you will be responsible for the entire cost of treatment.
To locate a mental health care professional in your area that accepts Medicare assignment, use Medicare's online Physician Compare tool. Go to Medicare.gov/PhysicianCompare and type in your ZIP code, or city and state, then type in the type of professional you want to locate, like "psychiatry" or "clinical psychologist" in the search box. You can also get this information by calling Medicare at 800-633-4227.
If you need mental health services in either a general or psychiatric hospital, original Medicare Part A covers this too (after you have met your $1,408 Part A deductible). Your doctor should determine which hospital setting you need. If you receive care in a psychiatric hospital, Medicare covers up to 190 days of inpatient care for your lifetime. If you use all your lifetime days but need additional care, Medicare may cover additional inpatient care at a general hospital.
In addition to the outpatient and inpatient mental health services, Medicare also covers annual depression screenings that must be done in a primary care doctor's office or clinic. Annual depression screenings are 100% covered. If you have a Medicare prescription drug plan, most medications used to treat mental health conditions are covered too.
If you happen to get your Medicare benefits through a private Medicare Advantage plan, they must provide the same coverage as original Medicare. However, they may impose different rules and will likely require you to see an in-network provider. You will need to 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 you can 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 Living" 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.
Yes, Medicare covers both outpatient and inpatient mental health services to help beneficiaries with depression, anxiety and many other needs. Here is what you should know.
Outpatient Coverage
If you have original Part B Medicare, your coverage will pay 80% (after you have met your $198 Part B deductible) for a variety of counseling and mental health care services that are provided outside a hospital, like individual or group therapy, family counseling and more. Medicare also covers services for treatment of beneficiaries who struggle with alcohol and drug abuse.
You, or your supplemental insurance, are responsible for the remaining 20% coinsurance due. Medicare gives you the option of getting treatment through a variety of mental health professionals such as psychiatrists, psychologists, clinical social workers and clinical nurse specialists.
To get this coverage, you will need to 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 rate, you may have to pay more. If you choose an "opt-out provider" that does not accept Medicare payments at all, you will be responsible for the entire cost of treatment.
To locate a mental health care professional in your area that accepts Medicare assignment, use Medicare's online Physician Compare tool. Go to Medicare.gov/PhysicianCompare and type in your ZIP code, or city and state, then type in the type of professional you want to locate, like "psychiatry" or "clinical psychologist" in the search box. You can also get this information by calling Medicare at 800-633-4227.
Inpatient Coverage
If you need mental health services in either a general or psychiatric hospital, original Medicare Part A covers this too (after you have met your $1,408 Part A deductible). Your doctor should determine which hospital setting you need. If you receive care in a psychiatric hospital, Medicare covers up to 190 days of inpatient care for your lifetime. If you use all your lifetime days but need additional care, Medicare may cover additional inpatient care at a general hospital.
Additional Coverage
In addition to the outpatient and inpatient mental health services, Medicare also covers annual depression screenings that must be done in a primary care doctor's office or clinic. Annual depression screenings are 100% covered. If you have a Medicare prescription drug plan, most medications used to treat mental health conditions are covered too.
Medicare Advantage
If you happen to get your Medicare benefits through a private Medicare Advantage plan, they must provide the same coverage as original Medicare. However, they may impose different rules and will likely require you to see an in-network provider. You will need to 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 you can 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 Living" 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.
Published January 10, 2020
