According to the National Institute of Mental Health, mental illnesses affected over 47 million U.S. adults in 2017.
If you’re a Medicare beneficiary, you may be wondering if you’re covered for mental health services under your plan. The good news is that Medicare mental health coverage includes inpatient services, outpatient services, and partial hospitalization.
This article will take an in-depth look into what type of mental health services are covered by your Medicare plan, what types of Medicare plans are best for mental health coverage, and when to seek help for mental illness.
Medicare Part A
Medicare Part A covers inpatient hospital care, including related mental health services. This includes both general and psychiatric hospital stays. With Medicare Part A, you’re covered for the cost of the room, as well as:
- standard nursing care
- inpatient therapy
- lab testing and some medications
Medicare Part B
Medicare Part B covers outpatient care, including related mental health services. This coverage includes both regular outpatient and intensive outpatient care. With Medicare Part B, you’re covered for:
- general and specialized counseling appointments
- psychiatry appointments
- clinical social worker appointments
- diagnostic lab testing
- certain medications
- intensive outpatient care, also known as partial hospitalization, including treatment for addiction
Medicare Part B also covers one annual depression screening, with additional coverage for follow-up appointments or referrals for other mental health specialists.
If you’re ready to seek mental health treatment, visit the Substance Abuse and Mental Health Services Administration’s website to find behavioral health treatment services near you.
You must have Medicare Part A in order to be covered for inpatient mental health treatment at a general or psychiatric hospital. Medicare will pay for most of your inpatient treatment services. However, you may still owe some out-of-pocket costs depending on your plan and the length of your stay.
Here are the basic costs for Medicare Part A:
- $252–458 premium, if you have one
- $1,408 deductible
- 20 percent of all Medicare-approved costs during the stay
- $0 coinsurance for days 1-60 of treatment
- $352 coinsurance per day for days 61-90 of treatment
- $704 coinsurance per day for days 91+ of treatment, through your lifetime reserve days
- beyond your lifetime reserve days, you’ll owe 100 percent of the treatment costs
It’s important to note that while there’s no limit to how much inpatient care you can receive in a general hospital, Part A will only cover up to 190 days of inpatient care in a psychiatric hospital.
You must have Medicare Part B in order to be covered for outpatient mental health treatment, partial hospitalization, and annual depression screenings.
Like inpatient care, Medicare will cover most of your outpatient treatment services but there are certain financial requirements you must meet before Medicare will pay.
Here are the basic costs for Medicare Part B:
- $144.60 premium, if you have one
- $198 deductible
- 20 percent of all Medicare-approved costs during your treatment
- any copayment or coinsurance fees if you receive services at a hospital outpatient clinic
There’s no limit to the frequency or amount of sessions that Medicare will cover for outpatient mental health counseling. However, because there are out-of-pocket costs associated with these services, you’ll have to review your own financial situation to determine how often you can seek treatment.
If you’re looking to begin counseling or therapy appointments under your Medicare plan, here is a list of mental healthcare providers that Medicare approves:
- psychiatrist or doctor
- clinical psychologist, social worker, or nurse specialist
- nurse practitioner or physician assistant
There are many types of mental health specialists that you can visit for help. If you’re not sure who to see, talk to your doctor about which specialist may be best for you.
Medicare mental health benefits are primarily covered by Medicare parts A and B. However, you can receive additional assistance for coverage and fees by enrolling in the following Medicare plans:
- Medicare Part C, which automatically covers all Medicare Part A and Part B services, plus prescription drugs and other coverage areas
- Medicare Part D, which can help cover some of your mental health medications
- Medigap, which can help cover some fees associated with your inpatient or outpatient care
If you’re beginning mental health treatment this year, you may be wondering what mental health services each Medicare plan covers. Let’s look at each of the Medicare plans and what coverage they offer.
Part A (hospital insurance)
Medicare Part A will cover mental health services related to your inpatient hospital stays. This type of treatment is especially important for people with acute mental illness crises that may be a harm to themselves or others.
Part B (medical insurance)
Medicare Part B will cover mental health services related to your outpatient treatment, including intensive outpatient treatment programs and yearly depression screenings. This type of treatment is important for anyone who needs ongoing mental health support.
Part C (Medicare Advantage)
Medicare Part C is an alternative insurance option, managed by private insurance companies, for people who want Part A and Part B coverage plus more. With Medicare Part C, you’ll be covered for all the mental health services that original Medicare covers, all under one plan.
Part D (prescription drugs)
- anti-anxiety medications
- mood stabilizers
- any other medications deemed necessary during your treatment
If you need help with your mental health medications, you can add Medicare Part D on to your original Medicare plan.
Medigap (supplemental insurance)
Medigap can help with some costs associated with your inpatient and outpatient medical care, such as:
- any other costs associated with your treatment after Medicare has paid out
If you need help with your mental health treatment costs, you can add a Medigap policy onto your original Medicare plan.
As we age, we become more susceptible to health problems, which can place older adults at a higher risk of mental illnesses like depression.
depression symptoms in older adults
Common symptoms of depression in people over 65 may include:
- losing enjoyment in hobbies and activities
- mood changes
- constantly feeling negative emotions
- appetite changes
- sleep changes
- concentration or memory problems
- other symptoms, such as fatigue, headaches, or digestive issues
- thoughts of harming oneself or others
If you’re having trouble with the symptoms above, consider reaching out to your doctor to discuss the next steps. If necessary, they can refer you to a mental health professional who can discuss your symptoms, offer a diagnosis, and pursue treatment.
If you have original Medicare or Medicare Advantage, you’re covered for both inpatient and outpatient mental health services. This includes hospital stays, therapy appointments, intensive outpatient care, yearly depression screenings, and more.
There are some costs associated with these services, so it’s important to choose the best Medicare plan for your needs.
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