Here are the factors to consider when selecting a Medicare plan if you have a mental health condition.
What is an assignment?
An assignment is an agreement between Medicare and a health professional, binding the health professional to accept the payment Medicare approves for a certain service. The health professional must not charge you more than the Medicare deductible and coinsurance.
Not all healthcare professionals accept assignment, so it’s important to ask your doctor if they do or to look for a doctor who does.
Medicare Part B (medical insurance) covers outpatient mental health services, including services from a:
- psychiatrist or other doctor
- clinical psychologist
- clinical social worker
- clinical nurse specialist
- nurse practitioner
- physician assistant
For Medicare to cover the cost of seeing a healthcare professional, they must accept assignment and be in network.
Some healthcare professionals, like clinical social workers and clinical nurse specialists, always accept assignment. Deductibles and copays may still apply, even if your healthcare professional accepts assignment.
What does it mean to be in network or out of network?
When a healthcare professional, hospital, or pharmacy is part of a Medicare plan, they are considered in network.
Some outpatient services that Medicare covers include:
- yearly depression screening
- individual or group psychotherapy
- family counseling, if the main purpose is to help with your treatment
- psychiatric evaluation
- medication management
- certain prescription injections
- diagnostic and monitoring tests
- partial hospitalization
- one-time Welcome to Medicare preventive visit within the first year of enrollment
- yearly wellness visit
A Medicare Advantage (Part C) plan may offer additional benefits, such as certain types of counseling.
Original Medicare (parts A and B together) doesn’t cover prescription medications.
If you need coverage for your mental health condition, consider getting Medicare Part D, which is prescription drug coverage available as an add-on to original Medicare. You can instead choose a Medicare Advantage plan that includes psychiatric drugs. Each drug plan has a formulary, which is a list of the medications it covers.
Generic drugs usually cost less than brand name ones. Medicare Part D covers medications such as:
- antidepressants
- anti-anxiety medications
- antipsychotics
- mood stabilizers
Medicare pays for 90 days of in-patient hospitalization during each benefit period.
Medicare beneficiaries who need to be in a hospital for more than 90 days in a benefit period can use some of their 60 lifetime reserve days.
Original Medicare covers inpatient and outpatient treatment for alcohol use and substance use disorders.
Medicare Part A pays for inpatient substance misuse treatment and Medicare Part B pays for outpatient substance misuse treatment. Coverage is possible if your healthcare professional accepts assignment. You will still need to cover your copays and premium.
Services covered include:
- psychotherapy
- patient education
- post-hospitalization follow-up
- inpatient prescription drugs, including methadone
- structured assessment and brief intervention (SBIRT)
Medicare Advantage plans can offer extra benefits to members, such as:
- telehealth mental health care services
- outpatient meals
- private duty nurses
- mental health hotlines
- lifestyle benefits, like gym memberships
- transportation to or from mental health care services
- support groups
- expanded coverage for things included in original Medicare, such as drug coverage
Medicare can help you pay for mental health care and treatment. It’s important to confirm that your healthcare professionals are in network and accept assignment to cover your treatments.
If you have questions about Medicare coverage for mental health services, call 800-MEDICARE or contact your plan provider.