Medicare covers a wide variety of mental health services, including therapy.
Over the past few decades, insurance companies have come to recognize the importance of mental health as regards overall health. As a result, a variety of inpatient and outpatient mental health services are covered by insurance. And Medicare – America's federal health insurance program for seniors – has expanded mental health benefits considerably over the past 20 years.
Before we get into Medicare coverage for mental health services, though, we ask you to seek help right away if you experience any of the following:
- Suicidal thoughts
- An unexplained lack of energy
- Becoming socially withdrawn and isolated, such as not wanting to engage in activities you previously enjoyed or spend time with family or friends
- Feeling sad, hopeless, or empty
- Feelings of self-loathing or worthlessness
- Having difficulty concentrating
- Increased use of drugs or alcohol
- Not sleeping well, such as having trouble falling or staying asleep, or feeling sleepy during the day
- Unexplained weight loss or loss of appetite
Your Medicare Part B benefits include mental health care, so please, don't wait to talk to your doctor.
Outpatient Mental Health Services Covered by Medicare
Original Medicare includes two parts. Medicare Part A covers inpatient services that you'd receive in a hospital or skilled nursing facility (SNF). Medicare Part B provides outpatient care, meaning care you typically receive outside of a hospital setting. Mental health providers covered by Medicare Part B include:
- Clinical psychologists, clinical social workers, and clinical nurse specialists
- Nurse practitioners
- Physician assistants
Part B also helps pay for lab tests and durable medical equipment deemed medically necessary by your healthcare provider. It may also cover partial hospitalization services in the event you need "intensive coordinated outpatient care."
As with your physical health, mental health coverage depends on your provider accepting assignment. This means they have agreed to accept the rate Medicare approves for covered services. Your out-of-pocket costs may include the Part B deductible and 20 percent coinsurance.
If you have a Medicare Supplement Insurance plan (more commonly known as Medigap), make sure your healthcare provider knows. This ensures proper payment of your medical bills.
Mental Health Care Services Covered by Medicare Part B
Your Part B benefits include:
- One yearly screening for depression, when performed in a primary care doctor's office or primary care clinic that provides referrals and/or follow-up treatment. You pay nothing for your annual depression screening. Go to Medicare.gov for more details.
- Alcohol misuse screening and counseling for Medicare beneficiaries who are not considered alcohol dependent. Includes up to four face-to-face counseling sessions per year. Telehealth services are also available. You have no out-of-pocket costs assuming your provider accepts assignment.
- Diagnostic tests.
- Family counseling, assuming it is related to your mental health treatment.
- Medication management.
- Opioid use disorder treatment services, including counseling, drug testing, individual and/or group therapy, and medication. Counseling and therapy services may be in-person or via telehealth. You pay nothing for these services if you use a Medicare-enrolled opioid treatment program.
- Partial hospitalization.
- Psychiatric evaluation.
- Psychotherapy – either individual or in a group setting – assuming the provider is licensed to practice in your state. (See the list of mental healthcare providers above.)
- Some prescription medications that are usually administered by a healthcare provider, such as injections.
- Testing to determine whether your treatment is helping and if you could benefit from additional services.
- Your one-time Welcome to Medicare visit (must occur within your first 12 months as a Medicare Part B beneficiary).
- Your yearly Medicare wellness visit (available after you've had Medicare Part B for 12 months).
Your Welcome to Medicare and annual wellness visits are both covered 100 percent, meaning you have no out-of-pocket costs for these services. In addition, the Part B deductible does not apply.
Medicare Part B and Partial Hospitalization
Partial hospitalization allows patients to avoid inpatient care while still receiving the more intensive psychiatric services their condition requires. Care is provided during the day, with the patient returning home at night.
Medicare Part B covers partial hospitalization when it is provided in either a community mental health center or hospital outpatient department setting. In addition, your doctor must certify that, without partial hospitalization, inpatient care would be required.
Outpatient Services Not Covered by Original Medicare
Original Medicare does not cover:
- Activity therapy designed to provide recreation
- Job skills testing or training unrelated to your mental health treatment
- Support groups designed for socialization (this is not the same thing as group therapy)
Inpatient Mental Health Services Covered by Medicare
Medicare Part A helps pay for mental health care services received as a hospital inpatient. This means that you have been admitted and are not under observation status. (If you aren't sure, ask a member of staff to verify whether you are an inpatient – even if you've been there overnight or for over 24 hours.)
As an inpatient, your Medicare Part A coverage includes:
- Lab tests
- Nursing care
- Therapy and other treatments for your condition
Medicare Part A also covers related services and supplies required for your treatment.
Please note that Medicare Part A only covers 190 days throughout your lifetime for inpatient care in a psychiatric hospital. Your out-of-pocket includes the Part A deductible per benefit period and coinsurance starting on day 61.
A benefit period begins when you are admitted as an inpatient and ends once you go 60 days without receiving inpatient care.
Outpatient Services Not Covered by Original Medicare
Original Medicare does not cover the following outpatient mental health services:
- A phone or TV in your room
- A private room if it has not been deemed medically necessary by your provider
- Personal care items like toothpaste and razors
- Private nursing
Medicare Prescription Drug Coverage for Mental Health Care
Original Medicare does not include prescription drug coverage (except in limited cases, as in medications administered by a healthcare professional). These benefits are available through a Medicare Part D prescription drug plan (PDP).
To get Medicare Part D, you may join either a standalone prescription drug plan or a Medicare Advantage Prescription Drug plan (MA-PD). Private insurance companies provide these plans, which means that costs and benefits vary.
If your mental health care provider prescribes medication to help treat your condition, your first step should be checking your Part D plan's drug formulary. This is the list of prescription medications covered by your plan. Medicare requires all Part D plans to cover anticonvulsant, antidepressant, and antipsychotic medications. In other words, insurance companies cannot discriminate against Medicare beneficiaries who have a mental health condition.
When comparing Part D plans, create a list of prescription medications you take. Then, check the drug formulary to be sure it includes your prescriptions.
Medicare Part D plans typically make changes to their formulary throughout the year. For example, the FDA may pull a drug or approve a safer version of a medication, prompting prescription drug plans to change their formularies.
When the drug formulary changes, your PDP is required to notify you at least 30 days before making the change. Alternatively, they may notify you of the change the next time you fill your prescription, providing a final 30-day supply of your medication.
If your healthcare provider prescribes a medication that isn't covered by your Part D plan, you can ask for a coverage determination or exception. Your provider can assist you.
Medicare Advantage and Mental Health Care
Medicare Part C, more commonly known as Medicare Advantage (MA), allows Medicare beneficiaries to combine their Part A and Part B benefits into a single health insurance plan. MA plans are sold by private insurance companies and resemble the group health plans many of us had through an employer.
Every Advantage plan must provide the same benefits you get with Original Medicare. However, most of them provide additional coverage as well. The most common is prescription drug coverage, which is included with around 90 percent of MA plans. Coverage and costs vary, so look at the plan carefully to understand which extra benefits it includes.
You cannot have both Medigap and a Medicare Advantage plan.
Our Find a Plan tool makes it easy to compare your Medicare plan options. Just enter your location to start reviewing Medicare plans in your area.