As we age, we often have to cope with the loss of a loved one, a serious illness, or feelings of isolation as we lose mobility or family has moved away. When these feelings don’t go away, they can lead to depression, anxiety, or other mental health issues. Because it is just as important to take care of your mental health as it is your physical health, Medicare covers some outpatient, inpatient, and prescription drug treatments.
Outpatient Mental Health Services Covered by Medicare
Medicare Part B helps cover mental health services provided in a doctor’s or therapist’s office, clinic, or a hospital outpatient setting. These same services must also be covered by Medicare Advantage plans. Approved providers include:
- Psychiatrists
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
- Nurse practitioners
- Physician assistants
Medicare covers the following outpatient mental health services:
- An annual Wellness visit, which is a good chance to talk to your doctor or other health care provider about changes in your mental health
- A depression screening once each year
- The screening must be done in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals
- If you are new to Medicare, you get a one-time Welcome to Medicare preventive visit within the first year. This visit includes a review of your risk for depression.
- Individual and group psychotherapy with doctors (or with certain other licensed professionals, as allowed by the state where you live
- Family counseling, but only if the main purpose is to help with your treatment
- Psychiatric evaluation
- Medication management
- Certain prescription drugs that you wouldn’t normally take on your own, like some injections
- Diagnostic tests
- Testing to find out if you’re getting the services you need and if your current treatment is helping you
- A partial hospitalization program if you meet certain requirements and your doctor certifies that you would otherwise need inpatient treatment:
- This is a more intensive program of individualized and multidisciplinary outpatient psychiatric treatments as an alternative to an inpatient stay
- Outpatient mental health services for treatment of substance abuse
- More information in substance abuse coverage is provided further down in this article
Costs for Outpatient Mental Health Services if You Have Original Medicare
If you have Original Medicare, look for a mental health provider that accepts assignment, meaning they accept the Medicare-approved amount as full payment for a covered service. You will pay nothing for your yearly depression screening if the doctor or provider you see accepts assignment.
After you meet your Part B deductible, you pay 20% of the Medicare-approved amount for visits to your doctor or other health care provider to diagnose or treat your condition. If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance amount to the hospital.
Costs for Outpatient Mental Health Services if You Have a Medicare Advantage Plan
The plan must cover all of the services covered by Medicare Part B. It might even cover more. Check with your plan to see what’s covered, what, if any, cost-sharing you may have, and what providers are in-network.
Inpatient Mental Health Services Covered by Medicare
Medicare Part A or your Medicare Advantage plan helps cover mental health services that require you to be admitted as an inpatient to a hospital or a psychiatric hospital that only cares for people with mental health conditions. There’s no limit to the number of benefit periods you can have from either of these facilities. Note that Medicare Part A only pays for up to 190 days of inpatient psychiatric hospital services during your lifetime.
Your Costs for Inpatient Mental Health Services if You Have Original Medicare
For each benefit period, you will pay:
- $1,600 deductible
- Days 1-60: $0 per day
- Days 61-90: A $400 copayment per day
- Days 91 and beyond: An $800 copayment per each “lifetime reserve day” after day 90 (up to a maximum of 60 reserve days over your lifetime)
- All costs for each day after you use your lifetime reserve days
- 20% of the Medicare-approved amount for mental health services you get from doctors and other health care providers while you’re a hospital inpatient
Costs for Inpatient Mental Health Services if You Have a Medicare Advantage Plan
The plan must cover all of the services covered by Medicare Part B. It might even cover more. Check with your plan to see what’s covered, what, if any, cost-sharing you may have, and what providers are in-network.
Substance Abuse Services Covered by Medicare
Medicare covers some costs for drug and alcohol treatment. An overview of the services covered is provided below. Because there are a lot of rules about what types of providers can provide care and not all treatment is covered, you should contact Medicare (1-800-633-4227) or your Medicare Advantage plan to get more information.
Alcohol Misuse Screenings and Counseling
Medicare covers one alcohol misuse screening for adults who use alcohol, but don’t meet the medical criteria for alcohol dependency once a year. If your primary doctor or other primary healthcare provider determines you’re misusing alcohol, you can get up to 4 brief face-to-face counseling sessions each year if you’re competent and alert during counseling.
You pay nothing, if your primary doctor or other primary healthcare provider accepts assignment. If you have Medicare Advantage, contact your plan.
Opioid Use Disorders
Medicare covers inpatient, outpatient, and prescription drugs to help people recover from opioid use disorder, including:
- Medication (like methadone, buprenorphine, naltrexone, and naloxone)
- Substance use counseling
- Individual and group therapy
- Drug testing
- Intake activities
- Periodic assessments
- Opioid antagonist medications (like naloxone) approved for the emergency treatment of known or suspected opioid overdose
- Overdose education you get along with opioid antagonist medication
- Counseling, therapy, and periodic assessments both in person and, in certain circumstances, through telehealth services
- Read more about Medicare telehealth coverage
- Services received from opioid treatment program mobile units
You won’t have to pay any copayments if you get services from an opioid treatment program provider who’s enrolled in Medicare and meets other requirements. Talk to your doctor to find out where to go for these services. Your Part B deductible will apply for supplies and medications you get through an opioid treatment program provider.
Medicare Advantage plans must cover opioid treatment program services. Call your plan to find an in-network program and ask if you will have cost-sharing.
Does Medicare Cover Prescription Drugs for Mental Health?
Yes. Medicare B covers a very limited set of prescription drugs that are usually given in outpatient settings. Deductibles and 20% cost-sharing apply. If you have Medicare Advantage, check with your plan to see what drugs are covered.
Most drugs for mental health and substance abuse treatment are covered under Medicare Part D, which is either a stand-alone prescription drug plan (PDP*s) or Medicare Advantage prescription drug plan (MA-PD) you buy separately. These plans must also cover all or almost all antidepressants, antipsychotics, and anticonvulsants.
Part D plans may require prior authorization and step therapy before covering the medicines. If you have Part D, you may have to meet a yearly deductible before the plan begins paying. You could also have cost-sharing.
Take Care of Your Mental Health
Your mental health can affect your physical health, so put Medicare’s mental health benefits to work for you. Talk to your doctor today if you feel isolated, lonely, agitated, or withdrawn. Read the National Institute of Mental Health’s Tips for Talking With a Health Care Provider About Your Mental Health for tips to help prepare and get the most out of your visit.
American Exchange’s Medicare Experts Can Help Find the Right Plan For You
If you are turning 65 and need help enrolling in Medicare or Affordable Care Act health plans, we are here for you. American Exchange’s independent, licensed insurance benefits experts will listen to your needs, then compare available plans, prices, networks, formularies, and tiers. We will also let you know if you qualify for cost-saving programs. We do not work for an insurance company, so we compare all plans available in your area at no cost or obligation to you. Contact us today.
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Additional Medicare Resources
We publish a Medicare blog the 4th Tuesday of every month, and more frequently during Medicare’s Annual Enrollment Period. Be sure to read our blogs to better understand your Medicare coverage.
- How the End of the COVID Health Emergencies Affects Your Medicare Coverage
- 3 Questions People Turning 65 Ask about Medicare blog
- Confused by All the Medicare Coverage Options? blog
- Medicare Special Needs Plans Offer Targeted Benefits blog
- Medicare Basics Flyer
- Health Insurance Terms Flyer
Medicare Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
American Exchange is a licensed health insurance broker. Robert Huffaker, NPN 13568432
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