Mental Health Care: What Does Medicare Cover?

Mental Health Care After Retirement

Mental Health and Aging

Millions of Americans suffer from mental health concerns like depression. But did you know aging can bring a host of new mental health risk factors?

How aging affects your mental health

Although there are many types of mental illness, depression is the most common problem in older adults. In fact, 6. 5 million Americans over age 65 have depression, according to the National Alliance for Mental Illness.

Of course, depression can strike at any age. But as we get older, we begin to face new challenges. Retirement, empty nest syndrome, the death of a loved one, and chronic pain can all be triggers for depression.

What’s more, depression may not look the same as we age. Instead of sadness, you might feel irritable or tired. You and your loved ones might not even recognize you’re depressed. In an interview with AARP magazine, Helen C. Kales, a psychiatrist with the Veterans Affairs Ann Arbor Healthcare System, says depression can be underdiagnosed in older people.

“[O]lder depressed adults often have not received the help that they needed," Kales told AARP. But, she goes on to add, “Depression in older adults is generally highly treatable."

So, what’s covered under Original Medicare?

If you’ve been treated for depression or other mental illness before, your care was likely covered by a traditional commercial insurance plan, such as through an employer. (We’ll call that your “old plan.”) As you transition to Medicare, you might be wondering how your coverage will compare.

Inpatient care is covered under Medicare Part A. When mental health treatment is provided in a psychiatric hospital, you’re limited to 190 days over your lifetime. This limit doesn’t apply to care received in a general hospital.

Medicare Part B covers a variety of outpatient mental health services, including individual and group therapy sessions. The good news? As long as your doctor thinks treatment is necessary, there’s no limit on the number of therapy sessions you can have. This may be broader coverage than you had in your old plan.

You can also get coverage for family counseling, assuming it’s related to your diagnosis. Other covered services include psychiatric evaluations, depression screenings, and alcohol and opioid misuse treatment, although these are not unlimited.

What about coverage for mental health prescription drugs?

Here’s some more good news: Medicare may cover more prescription drugs than you’re used to.

Thanks to Obamacare, your old plan has to cover at least one medication in each mental health “drug category.” Antidepressants and mood stabilizers are both examples of drug categories . That means your old plan must include an antidepressant like Prozac or Zoloft – but not necessarily both. (Many plans, of course, do.)

Medicare coverage is broader. Any Medicare Part D plan must cover all antidepressants, antipsychotics, and anticonvulsants, with few exceptions. This is true whether you buy Part D as a standalone plan or it’s included in your Medicare Advantage policy.

Learn more about the different parts of Medicare.

Will I get even more coverage under Medicare Advantage?

All Medicare Advantage plans provide the same basic coverage as Original Medicare. But depending on which Advantage plan you choose, you may end up with even broader benefits. For example, some plans offer treatments like conflict resolution and grief counseling.

Your Medicare Advantage plan might also include SilverSneakers. This program gives you access to free exercise classes, online or in-person. Exercise can be an effective treatment for depression, anxiety, and other issues.

You might also be able to enroll in a Special Needs Plan (SNP) for mental health. These plans include more of the doctors and treatments needed by people with mental health concerns. What’s more, they often come with care coordinators who can help you stay on top of managing your condition.

In any Medicare Advantage plan, you’ll have to get a referral to see mental health specialists – and they’ll most likely have to be in your plan’s network. That’s one of the main differences between Original Medicare and Medicare Advantage.

Ways to improve your mental well-being

There are tons of (free!) ways a person can improve their overall mental health. Here are a few ideas:

  • Get regular exercise. Something as simple as a brisk walk can help decrease depression and anxiety. It can also increase your self-esteem and ability to concentrate.
  • Eat a healthy diet. Even what you eat can affect mental health. A diet filled with fruits, veggies, lean proteins, and whole grains may lower depression and anxiety.
  • Catch enough Zzz’s. Poor sleep can be a contributing factor or trigger for mental health disorders. Try to get 7 or 8 hours a night.
  • Keep in touch with friends (and make new ones!) If you can’t meet face-to-face, plan a video call or send a text. A strong support network has been proven to boost one’s mood and overall well-being.
  • Volunteer for a cause you care about. Participating in a charitable activity builds self-esteem and purpose, reduces stress, and increases happiness.

When to get help

There’s a lot you can do to improve your mood and safeguard your mental health. However, it’s important to get help if you’re experiencing any of the following:

  • Suicidal thoughts
  • Confused thinking or inability to concentrate
  • Withdrawal from friends, family, and activities you previously enjoyed
  • Feeling sad, hopeless, or empty
  • Feelings of self-loathing or worthlessness
  • Increased use of drugs or alcohol
  • Trouble falling or staying asleep, or feeling unexplained fatigue during the day
  • Unexplained weight loss or loss of appetite
  • Marked changes in your personality

If you or someone you know is having thoughts of suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255, which is available 24 hours a day (En Español: 1-888-628-9454; Deaf and Hearing impaired: Dial 711 then 1-800-273-8255). Or reach out to the Crisis Text Line by texting HOME to 741741.

Do you have Medicare questions? We have answers.

When it comes to Medicare, one plan definitely does not fit all. At ClearMatch, it’s our mission to match you to the policy that best serves your unique needs. It’s all we do, and we do it better than anyone. Check out our extensive library of articles for answers to your Medicare questions. Or, compare plans in your area to get started finding the policy that’s right for you.

Additional resources

Gloria Alcius
Gloria Alcius has been a Licensed Health Insurance Advisor since 2011. She enjoys building relationships with her clients and helping them better understand their Medicare options. Gloria’s goal is giving each customer peace of mind, knowing they have the right health insurance for their unique needs. In her spare time, Gloria enjoys spending time with her family, cooking, and traveling.


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