As the country has progressed with understanding mental health conditions, and with the fallout of the Covid crisis and lockdowns, the government has taken a number of steps to change Medicare to cover more mental health issues. Rules have been relaxed to an extent and coverages have changed. So, the short answer to the question is “yes” Medicare does cover mental health services. But, there is a lot more to it. Different arts of Medicare cover different conditions, medications and treatments. And, there are certain rules on how and what is covered.
The Basics
Most mental health and dual diagnosis (substance abuse) services are handled specifically by Medicare Part B, or “original Medicare”. Part B will not cover inpatient services, but we will discuss how that is covered and we in a moment. If you are seeking mental health treatments, then the first thing you need to know is that the government is specific about what providers will be covered. These include the following: medical doctors, physician assistants, psychiatrists, clinical practitioners, clinical social workers, nurse practitioners, family therapy, and mental health counselors.
If you prefer to receive mental health treatment from a provider who is not listed as an approved option, then you can use a provider who accepts assignment. This is just the very basic information on how Medicare covers mental health treatments. Let’s break it down even further.
Inpatient
As with any type of medical treatment and services, inpatient mental health is handled by Medicare Part A. It can be used at both psychiatric and general hospitals, but there are some stipulations. For example, the most inpatient mental health treatment days allowed a patient under Medicare Part A is 190 in a lifetime. In other words, if you need more than 190 days of mental health treatment, even if in separate events, then you will have to pay all expenses out of pocket starting with day 191.
Medicare Part A will not cover the following mental health inpatient costs: private nursing, in-room entertainment (phone and television), private rooms, and personal items that you may need during your stay.
Outpatient
Outpatient mental health services are covered by Medicare Part B, or original Medicare. The coverages are extremely specific. First, there is the welcome to Medicare meeting and the depression screening. Part B will cover both. During the welcome to Medicare meeting, you will be screened for risk factors of depression. The program will also cover one depression screening per year ongoing.
Other services covered by Medicare Part B include individual and group psychotherapy, mental health testing and evaluations, family counseling (as long as the Medicare patient is the main person being treated), some medications and medication management, and intensive outpatient dual diagnosis programs.
Certain things are not covered by Medicare Part B, including transportation to mental health facilities, support groups, and job skills training.
Costs
Costs of mental health treatment closely follow the rules of any standard medical treatments through the various parts of Medicare. But, this part can be somewhat confusing, so here is a cost breakdown.
The welcome to Medicare visit, the yearly depression screenings, and yearly wellness visits are all covered 100% by Medicare Part B with no cost to you. Hospitalizations and other inpatient treatments are covered by Medicare Part A and are subject to a deductible along with a daily copay. Screening and treatment for opioid abuse and tobacco cessation are both fully covered as well, but any needed medical supplies may be subject to deductibles.
Other types of mental health treatments, like regular counseling, will be subject to standard copays and deductibles, meaning a patient can expect to pay 20% of the cost of any of those treatments.
Telehealth
One of the biggest changes to Medicare mental health treatments has been the approval of telehealth for therapies and screenings. Because of the isolation caused by Covid, many people have turned to telehealth to continue to receive treatments. Because of an attempt to avoid spreading covid, the federal government has chosen to allow telehealth at least for the time being.
Important things to remember include: you will still need to pay any copays and deductibles required, you may be required to visit a facility in person at times, and telehealth coverage could change in the future, so it is important to keep up to date on all rules and regulations.
Medicare Advantage
So far, we have discussed original Medicare, but what about patients who have private Medicare Advantage? Because private insurers are required to offer the same minimums as original Medicare, then Medicare Advantage does cover mental health treatments. In fact, depending on the policy, insurers may go even further and cover therapies not handled under original Medicare. If you are seeking Medicare Advantage and mental health is a concern for you, then taking the time to shop around various insurers can be important to finding the coverage you need.
Medicare Part D
Prescription drug coverage is the same for mental health medications as it is for any other drugs. Approved medications will be covered all or in part.
If you are already covered by Medicare and you are seeking mental health treatment, or you are shopping for Medicare and know you will need mental health care, then knowing what is and is not covered will be very important to you. Also, knowing your costs can be important to ensuring you can stay within your budget. While coverage can be somewhat confusing, the rules of inpatient and outpatient treatments are very similar to standard care under Medicare Parts A and B.
