Medicare covers many mental health services, but some out-of-pocket expenses may apply.
Mental health services can be vitally important in helping Medicare beneficiaries who have mental health conditions, such as anxiety or depression.
Medicare covers mental health treatment under both Part A and Part B. Coverage includes:
- psychiatric treatment that involves staying in the hospital, known as
- lab tests
- partial hospitalization services
In this article, we explain what mental health services Medicare covers and how much a person may need to pay for this care.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part A covers the medical services that a person may require during an inpatient stay at a general hospital, psychiatric hospital, or medical facility.
This coverage includes services and supplies relating to a person’s care, such as:
- a room
- nursing care
A person’s stay is limited to a defined benefit period, as follows:
- Upfront: A person first pays a $1,408 deductible for the benefit period.
- Days 1–60: They pay $0 coinsurance per day of this benefit period.
- Days 61–90: The coinsurance is $352 for each day of this benefit period.
- Day 91 and up to 60 days over a person’s lifetime: A person has 60 “lifetime reserve” days on which a $704 daily coinsurance is payable. If a person has already used all of their lifetime reserve days during previous hospital stays, they must cover the costs themselves.
An individual can have multiple benefit periods in a year, including separate stays in a psychiatric hospital.
A person may be responsible for copayments under Medicare Part B for doctors who see them when they are an inpatient.
Medicare Part B is the portion of Medicare that pays for medical services, such as doctor’s visits, durable medical equipment, and some prescribed medication.
Part B helps pay for several services relating to mental health conditions. This part pays for visits to a variety of healthcare professionals, including:
- clinical social workers
- nurse practitioners
A person can receive mental health services in a range of settings, such as a doctor’s office, hospital, or community mental health center.
Examples of the mental health services that Medicare Part B covers include:
- diagnostic testing
- family counseling
- individual and group psychotherapy
- medication management
- annual depression screening in a primary care setting
- partial hospitalization, where a person attends a daily treatment program
- psychiatric evaluation
Part B may also cover some types of prescription medications for mental health conditions. These are usually medications that doctors give by injection in their office rather than those that a person would take themselves.
Additionally, Part B will cover outpatient mental health services for those who have alcohol or drug use disorder. They can also obtain telehealth services from their home. The delivery of telehealth services may take place online or on the phone.
What are the costs under Part B?
Most people will pay 20% of the Medicare-approved amount for their doctor’s visit or healthcare services.
A person must first meet the Part B deductible of $198 before they pay the 20% coinsurance. Sometimes, a person may have to pay an additional copayment or coinsurance if they receive care in a hospital or outpatient clinic.
One cost exception is for an annual depression screening, which takes place at no cost as long as the provider accepts assignment.
Private insurance companies offer Medicare Advantage plans, which people may refer to as Part C.
If a person has Medicare Advantage, they should receive all of the benefits that Part A and Part B offer, and their plan may also have additional coverage for costs relating to mental health.
Medicare Advantage plans can vary, and a person may wish to look at all of the options available to them before deciding which one, if any, to purchase.
Most people qualify for Medicare when they turn 65 years of age. If a person paid Medicare taxes while working for at least 40 quarters, they could receive Medicare Part A benefits premium-free.
Some people may qualify for Medicare at a younger age due to a medical condition or disability. Examples of conditions that may qualify a person for Medicare before they turn 65 include:
- amyotrophic lateral sclerosis, or Lou Gehrig’s disease
- end stage renal disease
A doctor must officially certify that a person has a disability. A person qualifying for Medicare due to a disability will typically have a 24-month waiting period before they are eligible for Medicare benefits.
For people with end stage renal disease or amyotrophic lateral sclerosis, the waiting period is much shorter.
There are some exceptions to coverage for mental health conditions.
Medicare does not cover certain aspects of care for an inpatient psychiatric-related stay, such as:
- a private room (unless a doctor deems it medically necessary)
- private duty nursing
- a phone or television in the room
- personal care items, such as socks, razors, or toothpaste
While Medicare may pay for some long-term medications, coverage does not extend to all mental health-related prescription drugs.
Medicare Part D is the part that offers the broadest cover for prescribed medication. Part D will pay for most oral drugs that doctors prescribe.
Medicare requires that all Part D drug lists, or formularies, cover at least two of the following medications:
People may wish to review their prescription drug formulary carefully with their doctor, as this may help a doctor prescribe the most cost effective medications.
Some individuals who may have difficulty paying for medications due to a low income might qualify for Extra Help from Medicare. A person can find out more about Extra Help by calling Medicare on 800-633-4227.
Medicare covers a variety of mental health services for its beneficiaries.
Part A covers most inpatient services, while Part B covers most office visits and some medications.
Part D usually covers a wider range of prescription medications relating to mental health and well-being.
Medicare Advantage will offer all of the benefits of Part A and Part B, and it may also have some further cover options.
A person can call Medicare on 800-633-4227 to obtain pre-authorization for mental health services or to ask a question about a particular cost within their Medicare coverage.