Medicare and Mental Health

Even though older Americans are less likely to report mental health struggles than younger people, these issues can affect us throughout our lives. In an analysis of 2023 data from the U.S. Census Bureau, the health policy nonprofit KFF found that one in five U.S. adults age 65 or older said they lived with symptoms of anxiety or depression. Often, our emotional well-being declines as we face situations like losing loved ones, stepping away from a career, coping with illnesses, or adjusting to a lower income.  

Most U.S. citizens and permanent residents over 65 get healthcare coverage through either Original Medicare, the federally administered health insurance program for older Americans and people with certain disabilities, or a Medicare Advantage plan from a private insurance carrier. If you or a loved one need counseling, therapy, or psychiatric treatment, it could be vital to learn how Medicare helps to access mental health services. 

Do You Need Mental Health Services? 

According to the National Institutes of Health (NIH), any of these symptoms might indicate that you would benefit from mental health care: 

• Difficulty feeling happiness or other positive emotions 
• Struggling to sleep or to stay awake 
• Feeling sad, hopeless, anxious, or stressed 
• Thinking about death or suicide 
• Feeling restless or unable to concentrate 
• Abusing drugs or alcohol 
• Experiencing frequent pain, such as headaches 
• Digestive problems 
• Participating in dangerous activities 
• Feeling angry or irritable 
• Thinking obsessively or acting on compulsions 
• Behaving in ways that concern family and friends or damage relationships 
• Other changes to your mood, appetite, or energy level 

If you’re concerned about your mental health, your primary healthcare provider may be able to provide resources, help you develop a treatment plan, and refer you to a specialist.  

Either Medicare Part B (the part of Original Medicare that provides medical insurance) or a Medicare Advantage plan (which is required to match Original Medicare coverage) will cover outpatient services that could reveal a need for mental health treatment. These include annual depression screenings, psychiatric evaluation, diagnostic tests, and a yearly wellness visit. 

Outpatient Mental Health for People on Medicare 

Other mental health services covered by Medicare Part B or a Medicare Advantage plan include: 

• Individual or group psychotherapy 
• Intensive outpatient programs 
• Partial hospitalization 
• Family counseling as part of mental health treatment 

Before you set your first appointment with a mental health provider, you should make certain they take your insurance. If you’re on Original Medicare, ask the office whether they accept assignment, which means they take the Medicare-recommended amount as full payment. If you’re on a Medicare Advantage plan, you likely need to see providers who are in your network to take full advantage of your coverage. 

As of 2024, the Centers for Medicare and Medicaid Services (CMS) expanded the providers whose services can be covered and the environments where patients can see them. Medicare beneficiaries may see any of the following for mental health reasons: 

• Clinical psychologist 
• Psychiatrist
• Clinical social worker 
• Clinical nurse specialist 
• Nurse practitioner 
• Physician assistant 
• Marriage and family therapist 
• Mental health counselor 

A covered appointment with a mental health professional could happen at a doctor’s office, but also a hospital outpatient department or a community mental health center (including Federally Qualified Health Centers and Rural Health Clinics). By loosening requirements, CMS set out to make care more accessible and meet a wider range of individuals’ needs.  

For example, Victoria Kress, a licensed counselor and professor, explained to NPR that someone with a background like hers could make a difference in the lives of people on Medicare. 

“I think our focus on developments, our focus on mental health, our focus on being holistic, our focus on wellness is really unique to the older adult population,” she said. “I think it really resonates with them.”

For patients who prefer to attend appointments from home or have trouble finding a local providers, the online therapy provider Talkspace now offers covered services through both Original Medicare and Medicare Advantage plans in several states.

If you’re interested in a holistic approach to mental health, you may also want to look at the supplemental benefits that are included in certain Medicare Advantage plans. Some plans offer gym memberships, fitness classes, and at-home companion care services that might improve your overall emotional well-being. 

Medicare Coverage for Psychiatric Drugs 

Psychiatric drugs are an essential part of treatment for many people living with mental disorders. In 2020, the Centers for Disease Control and Prevention (CDC) found that more than 17% of U.S. adults over 65 had taken medication for their mental health in the past year. 

To get coverage for most medications, people on Original Medicare need a Medicare Part D prescription drug plan. Private insurance carriers offer these plans, and the coverage details vary. Before choosing one, you should confirm that any psychiatric drugs you’re taking regularly are on the formulary (the list of covered drugs) and learn about the costs involved. Typically, enrollees are responsible for a monthly premiums, an annual deductible, and a copay or coinsurance when they fill a prescription. 

Medicare Advantage plans usually include Part D prescription drug coverage. Just as with a standalone Part D plan, it’s a good idea to check what drugs will be covered and how much you’ll pay for a regular supply of any current prescriptions. Keep in mind that you may need to go to preferred pharmacies in your Medicare Advantage plan’s network to get the most out of your coverage. 

Medicare and Inpatient Mental Health 

If you or a loved one need to be admitted to a hospital because of mental health challenges, your stay can be covered by Part A of Original Medicare (which provides hospital insurance) or a Medicare Advantage Plan.  

As of 2024, people on Original Medicare who enter a hospital or skilled nursing facility pay a $1,632 deductible per benefit period.  That period starts the day you’re admitted and ends after you go 60 days in a row without receiving inpatient care. Once you’ve met your deductible, you’re charged the following copayments for your stay: 

• Days 1–60: $0 per day 
• Days 61–90: $408 per day 
• Days 91 and beyond: $816 per “lifetime reserve day” after day 90 (you can use up to a maximum of 60 reserve days over your lifetime)  
• After using up the lifetime reserve days: Patient is responsible for all costs. 

In addition, you’ll be responsible for 20% of the Medicare-approved cost for mental health services you receive from healthcare providers during your stay.  

You may receive care either in a general hospital with mental health facilities or a psychiatric hospital. For psychiatric hospital stays, note that Part A will only pay for a total of 190 days of inpatient services throughout your lifetime. Also, Medicare won’t pay for private duty nursing, a phone or TV in your room, any personal items like toothpaste or socks, or a private room unless it’s considered medically necessary. 

Medicare Advantage plans are required to provide at least the same coverage as Original Medicare, but some details may differ based on your plan. 

It’s vital to care for your mental health at every age by managing stress, maintaining relationships, and, if needed, sticking to a treatment plan. If you or a loved one are over 65 (or have a qualifying disability), Medicare coverage may play a crucial role in accessing the care and prescription drugs you need to lead a fuller life. 

About GoHealth 

GoHealth is a leading health insurance marketplace and Medicare-focused digital health company. Enrolling in a health insurance plan can be confusing for customers, and the seemingly small differences between plans can lead to significant out-of-pocket costs or lack of access to critical medicines and even providers. GoHealth combines cutting-edge technology, data science, and deep industry expertise to build trusted relationships with consumers and match them with the healthcare policy and carrier that is right for them. Since its inception, GoHealth has enrolled millions of people in Medicare plans and individual and family plans. For more information, visit GoHealth.com.