Medicare Mental Health Coverage
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As we age, we often experience new stressors related to ongoing loss, physical and mental decline, and financial constraints. Around 15% of adults over 60 suffer from mental disorders—the most prevalent being dementia and depression. Treatment for mental health conditions like depression and anxiety is essential for improving quality of life and overall health because our physical and mental health are intertwined. For example, those with chronic health conditions tend to experience more stress and higher levels of depression. Untreated depression can result in more negative outcomes.
The good news is that Medicare helps cover the costs of diagnosing and treating mental health disorders.
Coverage for outpatient mental health services
Outpatient mental health services include visits to mental health professionals without overnight hospitalization. Medicare provides coverage for various screening, preventive, and outpatient treatment services.
Screening and prevention
Medicare pays for one depression screening per year as well as annual wellness visits during which your doctor may ask about symptoms of depression, anxiety, and other mental health conditions.
Treatment
If you’re diagnosed with a mental health disorder that requires treatment, Medicare will help cover the cost.
Individual and group therapy
Services such as individual or group psychotherapy, also known as “talk therapy,” are covered by Medicare. Therapy sessions can be in person or through virtual (telehealth) visits. Family counseling may also be covered if the primary purpose of the counseling is to help with your treatment.
Substance misuse treatment
Medicare provides additional coverage for opioid use disorder and alcohol misuse. Management for opioid use disorder, including medications such as methadone, buprenorphine, naltrexone, and naloxone, are covered as outpatient services. In-person and virtual counseling are also covered. If you use alcohol but don’t meet the medical criteria for alcohol dependency, Medicare covers one misuse screening each year. If it’s determined that you are misusing alcohol, you may receive up to four counseling sessions per year.
Structured outpatient programs
Partial hospitalization, a structured outpatient program with no overnight stay, is covered as an outpatient service. This alternative to inpatient treatment allows for a more intensive treatment program without the need for overnight supervision in a hospital setting. Partial hospitalization may include patient education and training specific to a condition and occupational therapy if needed.
Coverage for inpatient mental health services
Inpatient mental health services include mental health treatment in a general or psychiatric hospital. Medicare coverage for inpatient mental health services is similar to coverage for typical hospital stays and includes coverage for semi-private rooms, meals, general nursing, medications, and other hospital services and supplies that are part of the inpatient stay.
How much can you expect to pay for mental health services?
Outpatient mental health
For most outpatient services, after you meet your Part B deductible, Medicare will cover 80% of the cost of covered services. You’re responsible for the remaining 20% (your coinsurance). The costs of the following services are covered differently.
Screenings
Medicare will pay for one depression screening per year and one alcohol misuse screening per year if your healthcare provider accepts Medicare assignment.
Opioid use disorder treatment
Once you’ve met your Part B deductible, you won’t owe anything for opioid use disorder treatments—as long as you receive them from a provider who’s enrolled in Medicare.
Inpatient mental health
For inpatient mental health service coverage, Medicare doesn’t start to pay its share until after you’ve met the Part A deductible for each new benefit period. Because you may visit the hospital and have multiple benefit periods in one year, you may have to meet the deductible multiple times in a single year. Once you’ve met your deductible, there’s no daily copayment until you’ve been hospitalized for over 60 days.
Beginning on day 61 of your inpatient stay, you are responsible for a daily copayment of $400 a day for days 61-90. Beginning on day 91, daily copayments increase to $800, and each day counts toward your “lifetime reserve” days. Once you use up your total lifetime reserve of 60 days, you are responsible for 100% of the cost of inpatient care.
Medicare beneficiaries receiving inpatient care are also responsible for 20% of the Medicare-approved amount for mental health services from doctors and other providers they receive while hospitalized. The number of these visits can vary based on each individual’s specific needs.
Mental health costs differ if you have Medigap or Medicare Advantage
If you have a Medigap plan, you’ll pay significantly less for mental health services. To understand what you’ll pay, explore the benefits offered by each Medigap plan type.
If you have a Medicare Advantage plan, it must have at least the same level of coverage as Original Medicare. Your specific costs will vary depending on your specific plan.
If you ever have any questions about what’s included with your specific Medicare coverage, we’re here to help! Chapter’s Medicare Advisors can help you understand your insurance and explore other options.