Medicare Your Coverage Options

Medicare coverage of mental health care

Written by Diane Archer

According to the Centers for Disease Control (CDC), one in five people age 55 years or older have some kind of mental health concern. They often suffer from anxiety, severe cognitive impairment, and mood disorders, including depression and bipolar disorder. If you need mental health services, Medicare covers both inpatient and outpatient mental health care in a variety of situations.

Outpatient mental health care under Medicare Part B:

  1. What kind of care do you need? Medicare covers a wide range of outpatient mental health services, including individual and group psychotherapy, family counseling if the key purpose s to help with your treatment, psychiatric evaluation, medication management and substance abuse counseling.  Medicare also covers annual screenings for depression at a primary care doctor’s office or a primary care clinic.
  2. Who provides your care? Medicare covers outpatient mental health care counseling and therapy services from many different mental health providers, including psychiatrists, clinical psychologists, nurse practitioners, clinical social workers, nurse specialists and physicians’ assistants.
  3. Where can you receive outpatient mental health services? You can receive care in a doctor’s or other health care provider’s office, a hospital outpatient department or at a community mental health center.
  4. What does Medicare cover? Unless you receive care from a medical doctor, Medicare will pay for 80 percent of your care only if your mental health care provider is Medicare-certified and takes assignment (accepts Medicare’s approved rate as payment in full).  If you’re in a Medicare Advantage plan, you must see an in-network provider and you likely will have a copay; you may also have a deductible.

Inpatient mental health care under Medicare Part A:

  1. Where can you receive inpatient mental health services? You can receive care in a general hospital or a psychiatric hospital that only cares for people with mental health conditions.
  2. What does Medicare cover? If you’re in a psychiatric hospital, Part A only pays for up to 190 days of inpatient psychiatric hospital services during your lifetime. After that, you may be able to get inpatient mental health care in a general hospital. If you’re in a general hospital, there is no lifetime limit on the amount of care Medicare will cover. Medicare inpatient coverage rules apply, whichever setting you are in. If you have traditional Medicare, you or your supplemental coverage must pick up the deductible. And, if you remain n the hospital more than 60 days, you will also have coinsurance costs. If you are in a Medicare Advantage plan, contact the plan to find out your out-of-pocket costs.

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Now available: The Ten Should-Do’s for Your Health, Purse and Peace of Mind, Chapter One of Aging, Schmaging, by Diane Archer. For a $5 contribution, you can help yourself and the people you love; you can also help support Just Care.

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