Will Medicare Cover Mental Health

Does Medicare Cover Mental Health Services? | Healthline

Most seniors are at high risk for developing mental health disorders. Mental health disorders such as depression and anxiety can develop as a result of managing ongoing health conditions, chronic pain, and especially the loss of a loved one, all of which are common among seniors. 

According to the World Health Organization (WHO), more than 20% of seniors at least 60 years old have a mental health disorder. The most common mental health disorders among seniors are cognitive impairment, anxiety, and depression, according to the Centers for Disease Control and Prevention (CDC). If you or a loved one is experiencing mental health concerns, you should know how Medicare will cover your medically necessary care. 

Outpatient mental health services

Medicare Part B covers many outpatient mental health services. Individual and group psychotherapy, psychiatric evaluation, partial hospitalization, and diagnostic testing are examples of outpatient mental health services Part B may cover. 

Part B covers medically necessary outpatient services at 80% after you’ve met your annual deductible. Medicare requires specific types of medical professionals to provide these services in order for them to be covered. Professionals such as licensed psychiatrists, psychologists, nurse specialists, and physician assistants can provide mental health services under Medicare guidelines as long as they accept assignment. You may receive mental health care in a doctor’s office, a hospital’s outpatient department, or a community mental health center. 

Inpatient mental health services

Partial hospitalization means you need a level of care that requires treatment at an outpatient mental health center during the day, but you are free to go home at night. Medicare’s partial hospitalization program is one step above care in a doctor’s office but one step below inpatient care. If your mental health issues call for a more intense protocol, your doctor may recommend admitting you as an inpatient in a general or psychiatric hospital.

Medicare Part A covers inpatient mental health services similar to regular inpatient care. For example, your Part A deductible will still cover your first 60 days as an inpatient for mental health care just as it would if you were admitted to the hospital for a heart attack. Your Part A daily copays for stays lasting longer than 60 days are also the same. 

However, Part A only covers a total of 190 lifetime days of inpatient mental health services if you’re admitted to a psychiatric hospital. In contrast, there is no limit to your inpatient days in a general hospital. 

Part A only covers 60 lifetime reserve days for general inpatient care. Lifetime reserve days begin on the first day after an inpatient stay of 90 consecutive days.  Therefore, you could have any number of 90-day general inpatient stays in your lifetime, but only about two 90-day mental health inpatient stays at a psychiatric hospital.

Drug coverage and management for mental healthcare

Medicare also covers certain drugs to treat mental health disorders. However, the part of Medicare that covers your prescription drugs depends on your treatment protocol. For example, if you’re admitted as an inpatient, Medicare Part A will likely cover your medications, whereas if you’re in a doctor’s office receiving an injection, Medicare Part B may cover that prescription.

While Part A and Part B may cover some prescription drug needs, you’ll get most of your drug coverage through your Medicare Part D plan. Medicare Part D covers most of the medications you fill at retail and mail-order pharmacies. If you’re not an inpatient and not receiving medication administered by f a medical professional, you’ll look to your Part D plan for coverage.

Medicare also covers medication management and education. These programs are to ensure you’re using your medications correctly and that they are providing you the help you need. If your doctor suspects you are misusing drugs, Medicare Part B will cover treatment for drug misuse as well.

Mental health preventive screenings

Medicare Part B covers various preventive screenings at 100% if the doctor accepts Medicare assignment. For example, Part B covers one depression screening every year. A simplified depression screening is also provided during your Welcome to Medicare preventive visit. During this visit, your doctor will assess any possible risk factors you may have for developing depression. 

After you’ve been on Part B for at least 12 months, Part B will cover an annual wellness visit at 100%. You can discuss your mental healthcare with your doctor during this visit as well. If you are worried about your mental health, speak up about it to your doctor. He will be able to recommend Medicare-covered mental health services if they’re needed.