Medicare helps cover outpatient and inpatient mental health care.
It can also help cover prescription drugs that may be needed for mental health treatment.
Keep reading to learn more about what mental healthcare services are covered under Medicare, and what’s not.
Medicare Part A (hospital insurance) helps cover inpatient mental health services in either a general hospital or a psychiatric hospital.
Medicare uses benefit periods to measure your use of hospital services. A benefit period starts the day of inpatient admittance and ends after 60 days in a row of no inpatient hospital care.
If you’re admitted to a hospital again after 60 days of not being hospitalized, a new benefit period starts.
For general hospitals, there’s no limit to the number of benefit periods you can have for mental health care. In a psychiatric hospital, you have a 190-day lifetime limit.
Medicare Part B (medical insurance) covers many services provided by a hospital’s outpatient department as well as outpatient services often provided outside a hospital, such as visits to:
- therapists’ offices
- doctors’ offices
- community mental health centers
Although coinsurance and deductibles may apply, Part B also helps pay for such services as:
- depression screening (1x per year)
- psychiatric evaluation
- diagnostic tests
- individual and group psychotherapy
- family counseling (for helping with your treatment)
- testing to ascertain appropriateness and effect of services and treatment
- partial hospitalization (a structured program of outpatient psychiatric services)
- review of your risk of depression (during your Welcome to Medicare preventative visit)
- yearly wellness visits (which are a good opportunity to speak with your doctor about your mental health)
Mental health professional services
Medicare Part B helps cover mental health services and visits with health care providers who accept “assignment”, or the approved amount. The term “assignment” means that the provider of the mental health services agrees to charge the amount that Medicare has approved for services. You should ask the provider if they accept “assignment” before agreeing to services. It is in the best interest of the mental health service provider to notify you if they do not accept assignment, however, you should confirm this before signing any agreements with the provider.
You may want to visit the Centers for Medicare and Medicaid Services’ Physician Compare, to find a doctor who accepts Medicare services. A list of professionals or group practices in the specialty and geographic area you specify, along with detailed profiles, maps, and driving directions are available.
Health professional types covered include:
- medical doctors
- clinical psychologists
- clinical social workers
- clinical nurse specialists
- physician assistants
- nurse practitioners
Medicare Part D (prescription drug coverage) are plans run by private companies approved by Medicare. Since each plan can vary by coverage and cost, it’s important to know the details of your plan and how it applies to medication for mental health care.
Most plans have a list of drugs the plan covers. Although these plans are not required to cover all medications, most are required to cover medications which may be used for mental health care, such as:
If your doctor prescribes a drug that your plan doesn’t cover, you (or your representative, such as the prescriber) can ask for coverage determination and/or an exception.
Mental health care services typically not included under Medicare parts A and B are:
- private room
- private duty nursing
- in-room television or phone
- personal items (toothpaste, razors, socks)
- transportation to or from mental health care services
- job skill testing or training that isn’t part of mental health treatment
- support groups (as differentiated from group psychotherapy, which is covered)
Medicare helps cover outpatient and inpatient mental health care in the following ways:
- Part A helps cover inpatient mental health services.
- Part B helps cover mental health services and visits with health care providers.
- Part D helps cover medication for mental health care.
Be sure to review details about the type and extent of coverage with your provider to determine which particular services are covered and to what degree.
For example, for Medicare to cover costs, all mental health care providers must accept the approved amount for health care services as full payment.