Does Medicare Cover Depression Screenings?

Does Medicare Cover Depression Screenings

Due to a variety of life changes, adults over the age of 65 are at high risk for depression.

Depression is one of the most common mental health disorders in the U.S. While experiences can vary, it's estimated that more than 19 million adults in the U.S. had at least one major depressive episode, and more than 11% of adults aged 18 and older have regular feelings of worry, nervousness, or anxiety.

Nearly 56 million visits made to primary care offices have "mental disorders" as the primary diagnosis.

Though common, depression can be very serious. It can cause severe symptoms that affect not only how you feel, but also how you think, handle daily activities, work, and interact with others. There are even different types of depression, each with varying severity of symptoms and treatment recommendations.

Staying on top of your mental health and discussing any questions or concerns with your doctor is crucial to staying healthy not only mentally, but physically. Medicare covers preventive screenings and services to help you get the mental health care you need.

How often does Medicare cover a depression screening?

Medicare Part B covers one depression screening per year. If your doctor accepts assignment, you pay $0 for this screening and the Part B deductible does not apply. You do not have to show signs or symptoms of depression to qualify for the screening; however, to be covered, it must take place in a primary care setting, such as a doctor's office.

Note if during the screening your provider discovers and investigates or treats a new or existing problem, the treatment is considered diagnostic and additional co-pays or co-insurance may apply.

During this screening, you'll complete a questionnaire yourself and with the help of your doctor. The purpose of these questions is to learn if you are at risk, or currently have symptoms of depression. If your results show you're at risk, your doctor will conduct a more extensive assessment and likely refer you for additional mental health care.

Medicare depression screening questionnaire

The Patient Health Questionnaire (PHQ) is the most commonly used test for depression screening. Most depression screenings are a two-step process. The first questions you will be asked are:

  • Over the past month, have you felt down, depressed, or hopeless?
  • Over the past month, have you felt little interest or pleasure in doing things?

If you have a positive screen with these questions, it triggers your doctor to proceed in completing the full questionnaire.

Other questions may include rating on a scale of 0-3 (0 being not at all, 3 being nearly every day) how often over the last two weeks you've been bothered by the following problems:

  • Trouble falling or staying asleep, or sleeping too much
  • Feeling tired or having little energy
  • Poor appetite or overeating
  • Feeling bad about yourself
  • Trouble concentrating

Depending on your answers, your provider will assign a score. The higher the score, the more at risk you are for depression.

Medicare coverage for other mental health services

In addition to a depression screening, Medicare Part A and Part B covers other inpatient and outpatient mental health services.

Mental health care services you get in a hospital that require you to be admitted as an inpatient are covered by Part A. You can get these services either in a general hospital, or a psychiatric hospital (that only cares for people with mental health conditions).

For these inpatient services, you pay:

  • $1,632 Part A deductible for each benefit period
  • Days 1-60: $0 co-insurance per day of each benefit period
  • Days 61-90: $408 per day co-insurance per day of each benefit period
  • Days 91 and beyond: $816 co-insurance per each "lifetime reserve day" after day 90 for each benefit period, up to 60 days over your lifetime
  • Beyond lifetime reserve days: all costs

You'll pay 20% of the Medicare approved amount for mental health services you receive while a hospital inpatient. Also note that if you're in a psychiatric hospital, Part A only pays for up to 190 days if inpatient psychiatric hospital services during your lifetime.

If you receive outpatient mental health services, those are covered by Part B. In additional to a depression screening, this may include:

  • Individual and group psychotherapy
  • Family counseling
  • Testing to find out if you're getting the services you need and if current treatment is helping
  • Psychiatric evaluation
  • Medication management
  • Certain prescription drugs that aren't usually "self-administered," such as some injections
  • Diagnostic tests
  • Partial hospitalization
  • 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

You pay 20% of the Medicare-approved amount for visits to your doctor or provider, and the Part B deductible applies. If you get treatment in a hospital outpatient clinic or department, you may have an additional co-payment or co-insurance.

Your provider must accept assignment, and only certain types of health professionals are covered (such as a psychiatrics or other doctor, clinical psychologist, social worker, or nurse specialist, nurse practitioner, or physician assistant).

Finally, Part B also may cover partial hospitalization if you meet certain requirements, and your doctor certifies you would otherwise need inpatient treatment.

Why take a depression screening?

Depression is extremely common in the U.S., but you may not feel depressed. Perhaps you aren’t experiencing some of the classic "symptoms" of depression. Or, maybe you don't recognize them in yourself.

However, according to the Primary Care Companion to the Journey of Clinical Psychiatry, a large percentage of outpatient medical visits are for what complaints (significant focus on physical symptoms), which are often associated with depression and anxiety.

Getting a depression screening annually can help identify your risk of depression or give you an opportunity to talk to your provider or mental health professional about your own mental health, including treatments you may need to feel better.

There are several situations that can increase the chance of depression, many of which we have no control over. These may include:

  • Abuse
  • Age (people who are older are at a higher risk)
  • Certain medications
  • Death or loss
  • Gender (women are about 2x as likely than men to become depressed)
  • Genetics (family history of depression)
  • Substance misuse
  • Hormones

Biology is believed to play a large role in development of depression, specifically the hippocampus, which is a part of the brain that is important for the storage of memories. Another reason may be lower serotonin production, which helps boosts mood.

Just as there many reasons someone may feel depressed, symptoms also come in many forms and vary significantly from person to person. Symptoms of depression can include:

  • Feelings of sadness, tearfulness, emptiness, or hopelessness
  • Angry outbursts, irritability, or frustration
  • Loss of interest or pleasure in most or all normal activities
  • Sleep disturbances, including insomnia or sleeping too much
  • Tiredness and lack of energy
  • Reduced appetite and weight loss, or increased cravings for food and weight gain
  • Anxiety, agitation, or restlessness
  • Slowed thinking, speaking, or body movements
  • Feelings of worthlessness or guilt
  • Self-blame
  • Trouble thinking, concentrating, making decisions, or remembering things
  • Frequent or recurrent thoughts of death or suicide

If you're experiencing any of these symptoms, make an appointment with your doctor or mental health professional right away.

Or, call the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline at 1-800-HELP (4357) or TTY 1-800-487-4889. SAMHSA is a free, confidential, treatment referral and information service that is available 24/7, 365 days-a-year.

Additional resources

Eric Ruge
Florida native Eric Ruge lives by one rule: Do the right thing. His goal as a Medicare agent is helping people find the right Medicare coverage for their unique medical needs and budget. He believes everyone deserves the peace of mind they get knowing they made the right decision about their Medicare coverage. When he's not working, Eric enjoys spending time with family and friends, watching Tampa sports, and playing the occasional round of golf.


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