Mental Health And Medicare

Personal mental health is something every person needs to take seriously — seniors especially. It can be difficult to ask yourself, “Am I depressed?” or, “Should I talk to someone about my mental health?” but these are important questions. Unfortunately, these questions are often followed by another one: “Does my insurance cover mental health services?”

Good news: Original Medicare covers basic inpatient and outpatient mental health services. Some costs — like depression screenings and other preventive mental health services — are even totally covered by Medicare. Nevertheless, it’s still important to know what’s covered, what’s not and how to fill the gaps in your insurance so you can get the mental health services you need.

What does Medicare cover?

Mental health coverage extends to both Medicare Part A and Part B, depending on where and how services are rendered. Here’s a breakdown of coverages across both parts.

Part A (Inpatient)

Medicare Part A covers hospitalization for mental health-related concerns, in either a general hospital or a psychiatric hospital. This is what you will have to pay for Part A hospital care after your deductible, which is $1,600 in 2023:

• 20% of Medicare-approved inpatient costs
• $0 coinsurance for days 1 – 60 of treatment
• $400 coinsurance per day for days 61 – 90 of treatment
• $800 coinsurance per day for days 91+ of treatment, through your lifetime reserve days (up to a maximum of 60 reserve days over your lifetime)
• 100% of the treatment costs beyond lifetime reserve days

Part B (Outpatient)

Medicare Part B coverage extends to outpatient services rendered by mental health professionals, including psychologists, social workers, nurse practitioners and more. Here’s what your Part B costs may look like:

• 20% of Medicare-approved outpatient costs after you’ve met the Part B deductible ($226 in 2023)
• Any copayment or coinsurance for services rendered at a hospital outpatient clinic

And what are those services? Medicare Part B helps pay for these outpatient mental health services:

• One depression screening per year with your primary care doctor
• Individual and group psychotherapy with licensed mental health professionals
• Family counseling if needed to help with your treatment
• Psychiatric evaluation
• Diagnostic tests
• Partial hospitalization
• Medication management
• Part B also covers outpatient mental health services for treatment of substance abuse

What doesn’t Medicare cover?

While original Medicare coverage does offer seniors options for mental health, there are some important gaps to take note of — issues that may encourage you to seek more coverage.

For starters, not every mental health professional accepts Medicare. Medicare Part B only covers services rendered by a healthcare provider who accepts assignment. Medicare Part B only offers limited coverage on mental health medications, which may leave you paying out-of-pocket for your prescriptions.

How PlanEnroll can help

If you’re someone who needs more coverage and resources for your mental health, it’s important to explore healthcare plans beyond what Original Medicare can provide. Medicare Advantage and prescription drug plans, as well as Medicare Supplement plans, offer extended mental health coverage for those who need it.

• Medicare Advantage plans: Most plans include coverage for prescription drugs to Part A and Part B benefits.
• Medicare prescription drug plans: These plans can cover antidepressants, anti-anxiety medication and antipsychotics.
• Medicare Supplement plans: These plans can help cover deductibles and coinsurance costs for inpatient and outpatient.

PlanEnroll helps seniors explore these extended options and the mental health coverages within them to give seniors the peace of mind they need about getting the mental health help they deserve.

You shouldn’t be limited in your mental health services based only on what Medicare will cover! Let us help you get the coverage you need so you can get the help you deserve.

PlanEnroll is a brand operated by Integrity Marketing Group, LLC, and used by its affiliated licensed insurance agencies that are certified to sell Medicare products. PlanEnroll is not endorsed by the Center for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (DHHS), or any other government agency.