Does Medicare Cover Mental Health Services?

According to the World Health Organization, about 15% of adults aged 60 or older have a mental health disorder unrelated to the normal aging process. Most of the time that means having symptoms like depression or anxiety. These symptoms are often left untreated because people don’t realize they are both treatable and covered by Medicare. 

Today, we’re going to take a look at how Medicare covers mental health services.

Inpatient Mental Health Coverage with Part A

Medicare Part A offers coverage for hospital stays, skilled nursing facility care, blood transfusions, and hospice benefits. It also includes a provision for up to 190 days of inpatient mental healthcare over your lifetime.

If you exhaust your 190-day benefit, Medicare may still provide coverage for your stay elsewhere, as this limit doesn't apply to psychiatric wards or units within general hospitals. Medicare calculates Part A cost-sharing in benefit periods, which begin each time you're admitted to a hospital or psychiatric facility and persist until your discharge. Once you spend 60 consecutive days outside the hospital, the period resets.

While Part A Medicare covers your stay, it doesn't extend to additional amenities such as private duty nursing, in-room communication devices, personal belongings, or private accommodations unless deemed medically necessary by your physician.

Your financial obligations under Part A entail paying a deductible for each new benefit period, which currently stands at $1,632 for the year 2024. Copayments escalate if your hospital stay extends beyond 60 consecutive days, reaching $408 per day after 90 days and $800 per day thereafter. Subsequently, you enter your lifetime reserve days, totaling 60, which cover your continued hospitalization beyond the initial 90-day coverage period.

Outlined below is a summary of the associated costs:

• Each benefit period: Medicare Part A deductible of $1,632

• Days 1-60: No coinsurance

• Days 61-90: $408 coinsurance per day

• Day 91-beyond: $800 coinsurance per day

Outpatient Mental Health Coverage with Part B

Medicare Part B offers coverage for a wide range of outpatient services, encompassing routine medical appointments, laboratory tests, diagnostic procedures, preventive care, and imaging services. Additionally, it extends coverage to more specialized and costly services like ambulance transportation (both ground and air), durable medical equipment (DME), chemotherapy, radiation therapy, and others.

Regarding mental health, Part B provides coverage for medical services related to mental health outside of hospital settings or inpatient facilities that accept Medicare assignment.

Depression and Mental Health Care

Part B plays a crucial role in diagnosing and treating depression. It covers an annual depression screening typically conducted by your primary care physician. If diagnosed with depression or any other mental health condition, Part B covers consultations with clinical psychologists, social workers, or psychiatrists. Therapy options include individual and group counseling, and in some cases, family counseling can be included in the treatment plan.

Substance Abuse and Treatment

Part B also addresses mental health disorders associated with substance abuse, covering an annual alcohol misuse screening for non-dependent individuals. If alcohol abuse is diagnosed, Medicare provides up to four counseling sessions at no cost. Treatment for specific drug dependencies falls under Part D coverage.

Partial Hospitalization Program

In certain situations, a structured outpatient psychiatric program, known as a partial hospitalization program, may be deemed necessary. Medicare-certified doctors can recommend this treatment, which is covered at 80% by Part B. These programs offer more intensive treatment and supervision than office-based therapy but are less intensive than hospitalization. However, they do not cover meals or transportation.

Cost-sharing under Part B includes an annual deductible along with 20% of outpatient expenses. There's no maximum limit on out-of-pocket expenses, potentially leading to significant costs. Many individuals opt for Medicare supplement insurance or Part C Medicare Advantage plans to mitigate these expenses.

Outlined below is a summary of the associated costs for 2024:

• Medicare Part B deductible: $240

• 20% of approved healthcare provider services

• Additional copayments or coinsurance for services received as a hospital outpatient, typically ranging from 20% to 40% of the service cost.

Additional Medicare Coverage with Medigap

We’ve highlighted the potential for unlimited out-of-pocket copayments, posing a significant financial burden for mental health care. To address this, individuals can explore Medigap plans, also known as Medicare Supplement plans.

Medigap plans are insurance policies designed to help cover some or all of the cost-sharing expenses. These plans kick in after Medicare approves the claim and pays its share. Ten standardized Medigap policies are available across most states.

Among the options, Medigap Plan G has been a popular choice due to its comprehensive coverage of all gaps in Medicare Parts A and B. Plan G will pick up all the costs we’ve discussed, save for the Part B deductible.

These supplements can be utilized at any healthcare provider that accepts Medicare. However, it's essential to note that not all psychiatrists accept Medicare, so it's advisable to confirm with your doctor before initiating any therapy.