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Mental health is just as important as physical health. Yet, for many Americans over 65, declining mental health stands in the way of truly enjoying their later years. Recent statistics show that 1 in 5 older adults (65+) battle symptoms of anxiety, depression, or both.1
The good news is that Medicare helps pay for various mental health services. Here’s a look at what’s covered.
Yes, Medicare Part B covers mental health care you receive as an outpatient, meaning when you’re not admitted to a hospital as an inpatient. Some examples of outpatient settings where Part B would cover mental health services are doctors’ or mental health therapists’ offices, hospital outpatient clinics, and community mental health centers.2
Mental health services covered under Medicare Part B include:2
In addition to mental health care, Medicare Part B helps pay for outpatient treatment services for substance use disorders related to drugs or alcohol.4 These include:
For Medicare to cover outpatient mental health services, the provider must accept Medicare assignment.2 This means they agree to receive Medicare’s approved payment amount.
Medicare provides coverage for one free yearly depression screening when performed by a primary care provider who accepts Medicare assignment.8 Annual wellness visits and alcohol misuse screenings are also fully covered.9,10
For these services to be covered to the extent that Medicare pays, you must first meet the annual Medicare Part B deductible for all other covered outpatient mental health services subject to Part B cost sharing. Then, you pay 20% of the Medicare-approved amount as coinsurance for each visit or service. Additional copayments or coinsurance may also apply if care is provided in a hospital outpatient setting.
To reduce your out-of-pocket costs for outpatient mental health services, consider a Medigap (Medicare supplemental insurance) plan or see if you qualify for a Medicare Savings Program.
Yes, Medicare Part A covers inpatient mental health services when you’re admitted to either a general hospital or psychiatric hospital. Coverage includes inpatient care and any services provided by health care professionals during the hospital stay.11
While you can receive mental health services in a general or psychiatric hospital under Medicare, there are differences in coverage based on the facility.
In a general hospital, you have access to unlimited benefit periods for mental health services. A benefit period refers to how Medicare measures your use of hospital and skilled nursing facility services. Each benefit period begins when you enter a hospital or skilled nursing facility. It ends when you haven’t received care as an inpatient for 60 days in a row. There are no lifetime limits on the number of benefit periods covered in a general hospital.
For psychiatric hospitals, Medicare still covers multiple benefit periods but only pays for up to 190 days total over your lifetime. After reaching this 190-day limit, you must pay out-of-pocket for any additional mental healthcare in a psychiatric hospital.
When admitted for inpatient mental health treatment, you pay the following per benefit period:11
Additionally, for any services provided by doctors or other clinicians during an inpatient stay, you pay 20% of the Medicare-approved amount, as these are covered under Medicare Part B.11
To help minimize out-of-pocket costs for mental healthcare not covered by Medicare Part A, consider Medicaid if you qualify, Medigap plans, or hospital charity care programs. Unlike Original Medicare, most Medicare Advantage (MA) plans have an annual limit on out-of-pocket spending for covered medical services, including inpatient mental health care.12 But it’s important to understand the out-of-pocket costs for any MA plan you’re considering, as they do vary by plan. MA plans also tend to have prior authorization requirements.12
Yes, you can get mental health prescription medication coverage through a stand-alone Medicare Part D plan or an MA plan that includes prescription coverage.13
Medications injected or infused in the doctor’s office or clinic are covered under Medicare Part B, not Part D.2
It’s a good idea to review your medications and potential out-of-pocket costs each year during open enrollment. Medicare Part D and MA prescription medication benefits can vary year-to-year and across plans.
The specific medications covered and your out-of-pocket expenses depend on your insurance plan’s covered medication list – or formulary – and pricing tiers.
To get help paying for mental health prescription medications, look into:
Medicare Advantage plans cover mental health services similar to Original Medicare but with some key differences:16
Nearly all (98%) MA plans required prior authorization for certain mental health and substance use disorder services in 2022.12 Carefully check the specifics of each plan’s mental health benefits before you enroll. Ensure your medications, therapists, doctors, and care costs will be covered.
While Medicare covers many mental health services, benefits for the following are not included:13
Maggie Aime is a health, wellness and medical personal finance writer. With over 25 years in healthcare and a passion for education, she draws on her rich experience across nursing specialties, case management, revenue management, medical coding, and utilization review nurse consultant roles to create content that informs, inspires, and empowers. She’s passionate about educating people about all aspects of disease prevention, health and wellness, and how to navigate the US healthcare system. She’s the owner of The Write RN, LLC.
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