Mental Health Coverage with Medicare

Medicare offers some coverage of mental health services, including visits with Medicare-approved clinicians to treat concerns such as depression and anxiety and preventive visits to assess whether further treatment is needed.

Mental health is vital to overall well-being, and Medicare Part B will cover many of your mental health services.

For starters, Medicare Part B — which provides medical insurance — fully covers several preventive services that can assess the state of your mental health to see if you have a condition that qualifies for coverage.

• Part B allows you to get one depression screening per year. The screening is provided at no cost to you if it’s performed in a primary care setting (such as a doctor’s office) by a Medicare-approved clinician who can either provide further treatment if needed or refer you to someone else for further treatment.
• Part B also fully covers the cost of an annual wellness visit that can assess your mental health.

Note: As with all preventive treatment offered by Medicare, if a covered visit goes beyond assessment and includes treatment, that portion of the visit could be labeled as “diagnostic” and lead to you possibly being responsible for related costs.

Preventive services provided by Medicare Part B can help identify issues with mental health, but that’s only one part of the equation. As of January, 2024, Part B covers a lengthy list of outpatient mental health services when administered by Medicare-approved professionals:

• Visits with:
  • Psychiatrists or other doctors
  • Clinical psychologists
  • Clinical social workers
  • Clinical nurse specialists
  • Nurse practitioners
  • Physician assistants
  • Marriage and family therapists
  • Mental health counselors

• One depression screening per year.
• Individual and group psychotherapy.
• Psychiatric evaluation.
• Testing to determine whether you’re receiving the services you need and your current treatment is helping you.
• Family counseling, when mainly intended to help with mental health treatment.

• Medication management.

• Certain prescription drugs that aren’t usually self-administered, like some injections.

• Diagnostic tests.

• Treatment for alcohol and drug use.
• Partial hospitalization for covered services.
• Intensive outpatient program services.
• A “Welcome to Medicare” preventive visit to a Medicare-approved doctor during the first year you have Part B, followed by annual wellness visits.

As is the case with most services covered by Part B, Medicare pays 80 percent of approved mental health services after you meet the Part B annual deductible. You pay 20 percent of the cost for approved mental health services. You pay nothing for the annual depression screening if your healthcare provider accepts the Medicare-approved amount as full payment.

Some Medicare mental health coverage may fall under Part A of Original Medicare.

Part A, commonly known as hospital insurance, will cover the portion of Medicare-approved mental health services that require inpatient hospitalization. Medicare Part A will cover 100 percent of hospital-specific costs for the first 60 days of a stay — after you pay the deductible for that benefit period. You must pay coinsurance for Days 61-90, and your daily coinsurance rate increases if you stay beyond Day 90 and begin using your 60 lifetime reserve days.

For expenses during the hospital stay that fall under Part B — first among them, the doctors’ services themselves — Part B pays 80 percent after your annual deductible.

While Part A will cover unlimited benefit periods for mental health in a hospital setting, lifetime days in a psychiatric hospital are limited to 190.

Inpatient stays in a psychiatric hospital follow the same coverage rules as any other hospital stay (you pay the benefit period deductible; Part A pays for Days 1-60; you pay coinsurance for additional days). But for your lifetime, Medicare Part A limits you to a total of 190 days in a psychiatric hospital. After Day 190, Part A doesn’t help with any psychiatric hospital costs.

What Is Partial Hospitalization for Mental Health?

Part B of Original Medicare may cover partial hospitalization, which Medicare defines as a structured outpatient treatment that is “more intense than the care you get in a doctor’s or therapist’s office. You get this treatment during the day, and you don’t have to stay overnight.”

Part B may cover occupational therapy and individual training and education about your qualifying condition as part of the covered treatment at a hospital’s outpatient department or community mental health center. It won’t cover related transportation or meals.

How Can Original Medicare Beneficiaries Get More Financial assistance for Mental Health?

While Part B is the part of Original Medicare that most often assists with expenses related to a mental health condition, Part A can be helpful for a couple of reasons.

As previously stated, Part A helps with coverage if you have a mental health issue that requires hospitalization. Part A also can work in conjunction with Part B to control out-of-pocket expenses related to mental health by opening the door for you to enroll in a Medigap supplemental plan provided by a private insurance company.

Medigap plans fill in some of the gaps in Original Medicare coverage. Among the 10 Medigap plans that provide standardized supplemental coverage, all pay at least 50 percent of Part B coinsurance and copays (eight pay 100 percent).

Having Part A and Part B of Original Medicare qualifies you to switch to a Medicare Advantage plan. Provided by private insurance companies with guidance from the federal Medicare program, Medicare Advantage plans substitute for Original Medicare. These plans are required to match the coverage from Parts A and B, but they may also feature additional benefits in areas like mental health and preventive services.

Medicare Advantage plans come in many shapes and sizes. Still, one constant is an out-of-pocket maximum that defines the most money you can have to pay out of pocket in a plan year (Original Medicare doesn’t have an out-of-pocket maximum, although two Medigap plans do).

If additional coverage for mental health is a priority for your healthcare journey, a GoHealth licensed insurance agent can help you identify a Medicare Advantage plan that fits your needs.