Medicare covers a variety of mental health services, including a psychiatrist, therapy, and other specialists.
It can sometimes be difficult to distinguish the signs of mental health disorders, like depression, from changes related to aging. However, following retirement, you may be at higher risk for developing mental health conditions like depression and anxiety due to health and lifestyle changes, and it’s important to seek the help you need from a professional.
A psychiatrist is a medical doctor who specializes in the diagnosis, prevention, study, and treatment of mental health disorders. They work in a variety of settings, including private practices, clinics, nursing homes, rehabilitation programs, hospitals, and community agencies. Read on to learn more about Medicare’s coverage for psychiatry and other mental health services.
Does Medicare cover psychiatry?
Medicare Part A and Part B cover several services related to mental health and psychiatry, such as:
- Part A, or hospital insurance, covers healthcare costs in an inpatient setting, including a general hospital or psychiatric hospital. Medicare Part A would cover your room, meals, nursing care, therapy, lab tests, medications, and other care you may need as an inpatient. Note that Medicare will only cover up to 190 days of psychiatric hospital stays over your lifetime.
- Part B, or medical insurance, covers outpatient mental health services and care. Coverage includes psychiatric evaluation as well as individual and group therapy you get in a doctor’s office, therapist’s office, or mental health. Also included are screenings, diagnostic tests, and other services.
For Part B-covered psychiatric services, you would pay 20% of the Medicare-approved amount for visits to your doctor or provider to diagnose or treat your condition. Medicare would pay the other 80%. If you get services in a hospital outpatient clinic or department, you may have additional co-pays or co-insurance. The Part B deductible ($240 in 2024) applies.
To find a covered psychiatrist near you, you can use Medicare.gov’s Provider Search tool. Enter your city or zip code and type “psychiatry” in the search box. A list of psychiatrists who accept Medicare will appear.
Related reading: Does Medicare Cover Psychotherapy?
Do Medicare Advantage plans cover psychiatry?
Medicare Advantage plans are sold by private insurance companies. Also known as Medicare Part C, these plans are required to offer at least the same benefits as Original Medicare Part A and Part B, but most have extras like prescription drug coverage (Part D), hearing, vision, dental, and more.
Because Part C plans must offer everything Medicare does, psychiatry and other mental health care services are covered by all plans. However, there may be two differences:
- Cost sharing, including co-pays and co-insurance, may differ than with Original Medicare
- You’ll likely have to use an in-network provider for coverage, but PPO plans usually let you go out-of-network for a higher cost
Check with the individual plan to learn more about coverage, provider networks, and cost. You can also use our Find a Plan tool to review Medicare plans in your area. Just enter your zip code to get started.
Does Medigap cover psychiatry?
Medicare Supplement Insurance, more commonly known as Medigap, helps pay some of your Medicare costs, including deductibles, co-pays, and co-insurance. These plans are also sold by private insurance companies and are only available to those who have Original Medicare.
Because Medicare covers psychiatry and other similar services, Medigap will help cover those costs, so you’d pay less out-of-pocket.
Medicare coverage for other mental health services
Medicare Part B covers a number of additional mental health care services such as:
- A one-time “Welcome to Medicare” preventive visit, which includes a review of your possible risk factors for depression
- A yearly “wellness” visit where you can talk to your provider about changes in your mental health
- An annual depression screening for $0 when performed in a primary care provider’s office or primary care clinic that provides referrals and/or follow-up treatment
- Family counseling if the main purpose is to help with treatment
- Testing to find out if you’re getting the services you need, and your current treatment is helping you
- Medication management
- Certain prescription drugs that aren’t usually “self-administered”
- Diagnostic testing
- Partial hospitalization
- Some mental health services for treatment of substance abuse
The Welcome to Medicare and annual wellness visits are also $0, so you have no out-of-pocket costs for the services. The Part B deductible does not apply.
Talk with your doctor to understand any costs associated with the other services listed. Typically, though, if a service is covered by Medicare, you will pay 20% co-insurance of the Medicare-approved amount
Related reading :Does Medicare Cover Mental Health?
Medicare coverage for mental health medications
Medicare Part D (prescription drug coverage) is not a part of Original Medicare and must be purchased as a standalone drug plan or as part of a Medicare Advantage Prescription Drug Plan (MA-PD). These plans are offered by private insurance companies, so costs and benefits may vary.
If you are prescribed a medication to help treat depression or another mental health condition, check your Part D plan’s drug formulary to understand if it’s covered. Generally, Medicare requires all Part D plans to cover anticonvulsant, antidepressants, and antipsychotic medications.
If you provider prescribes a medication not covered by your plan, ask for a coverage determination or exception (with the help of your provider). Or, work with your provider to find a comparable alternative drug.
Mental health services not covered by Medicare
There are a few things Medicare will not cover related to mental health care, such active therapy designed to provide recreation, job skills testing or training unrelated to your mental health treatment, meals, support groups designed for socialization, and transportation.
Difference between a psychiatrist, psychologist, and therapist
The primary difference between a psychiatrist and psychologist is that a psychiatrist can prescribe medication while psychologists cannot.
What is a psychiatrist?
- Specializes in the study of behaviors and mental processes
- Diagnose and treat mental disorders, learning disabilities, emotional issues, developmental challenges, and behavioral problems, especially mental disorders caused by chemical imbalances in the brain
- Medical doctors with a degree in medicine
- Can prescribe medication
- Will typically refer patient to psychologist or therapist for counseling or therapy
What is a psychologist?
- Specializes in the study of behaviors and mental processes
- Help people learn to understand and handle different life problems and mental health issues
- Diagnose and treat mental disorders, learning disabilities, and behavioral problems
- Individual, family, or group
- Do not have a medical degree and are not trained in general medicine or prescribing medications
What is a therapist?
- Provide mental health diagnosis and develop a treatment plan
- Many different types of therapy including play therapy, cognitive behavioral therapy, dialectal behavioral therapy, and others
- Cannot recommend or order medications, but can refer you for evaluation for medication or other treatments
- Therapy can be short- or long-term
- Individual, family, couple, or group
- Understanding the difference between the three specialties should help you choose the right provider for your unique needs.