Does Medicare Cover Mental Health? Coverage Advice for Medicare Plans
Discover what common mental health treatments various Medicare health insurance plans cover, including therapy and prescription medication for depression and anxiety.
Mental health is an increasing concern for older adults, according to the American Psychological Association. It notes that in 1970, 4 million older Americans had mental and behavioral problems, but experts predict that number will nearly quadruple to 15 million by 2030.1
Just like physical ailments, mental health problems like depression and anxiety are treatable under your Medicare coverage. Thankfully, Medicare covers many common mental health treatment options. In this article, we outline how each part of Medicare covers mental health, including what you can expect it to cost and how you may be able to use a Medicare Supplement (Medigap) plan to help pay for your Medicare costs.
Medicare Part A
If your doctor gives an official order that you need inpatient care for your mental health, Medicare Part A covers your inpatient treatment.
You're covered for mental health treatment at the following facilities that accept Medicare:
- Acute care hospitals
- Critical access hospitals
- Long-term care hospitals
- Psychiatric facilities
These facilities help people with acute mental health issues that may put themselves or other people at risk. Medicare limits coverage for inpatient mental health care in a psychiatric hospital to 190 days over your lifetime. However, you can receive unlimited covered care at a general hospital with mental health facilities.
If you’re a Medicare beneficiary admitted as an inpatient with mental health concerns, Part A covers:
- Your hospital room (semi-private, unless a private room is necessary)
- Standard nursing care
- Inpatient therapy
- Laboratory testing
- Medications that form part of inpatient treatment
What You’ll Pay
Under Medicare Part A, you can expect to pay the following for inpatient mental health treatment:
- $1,484 deductible for each benefit period in 2021
- $371 coinsurance per day for stays between 61 and 90 days
- $742 coinsurance for each “lifetime reserve day” for stays more than 90 days
- All costs for stays beyond your lifetime reserve days
Medicare waives the coinsurance cost for covered inpatient stays of 60 days or less, though you need to meet the Part A deductible every time you’re admitted as an inpatient.
If you’re discharged from one inpatient hospital stay and are readmitted within 60 days for a second stay, you won’t need to meet your deductible again for the second stay. If you’re readmitted for inpatient care more than 60 days after you stopped receiving inpatient care a first time, however, you will be in a new benefit period and will have to meet the Part A deductible all over again.
It’s important to note that most Medicare Supplement plans cover all or at least part of your Part A deductible, no matter how many benefit periods you experience in a single year.
Medicare Part B
Medicare Part B covers outpatient treatment for mental health concerns. This treatment is vital for managing chronic mental health conditions and addressing minor mental health problems before they become major concerns. You might receive this treatment at:
- A doctor’s or health care provider's office
- A hospital outpatient department
- A community mental health center
Some of the mental health services Medicare Part B covers include:
- Intensive outpatient mental health treatment programs, including programs for substance abuse disorder, individual and group psychotherapy and partial hospitalization
- Annual depression screening at primary care doctor’s office or clinic that can provide follow-up treatment and referrals
- Annual “Wellness” visit to assess cognitive function and mental health, once you’ve had Medicare longer than 12 months
- Annual alcohol misuse screening
- Appointments with mental health professionals who accept Medicare assignment, including doctors, general and specialized licensed counselors (including family counselors if required for your mental health), psychologists, psychiatrists and clinical social workers. You can continue receiving these treatments under Medicare for as long as they’re deemed medically necessary.
- Psychiatric evaluation
- Lab testing for diagnosis and monitoring treatments
- Certain medications, including injectable drugs that can’t be self-administered
- A “Welcome to Medicare” preventive visit
What You’ll Pay
Under Medicare Part B, you can expect to pay the following for outpatient mental health treatment:
- $203 yearly deductible in 2021
- 20% of the Medicare-approved amount for each service after meeting Part B deductible
- Copayment or coinsurance fees for services at hospital outpatient clinics or departments
Again, it’s important to keep in mind that each type of Medicare Supplement plan covers all or at least part of your Part B coinsurance or copayment costs.
Medicare Part D
Medicare Part D can help pay for the medications commonly used to treat mental health conditions.
All Part D plans must cover antidepressants and antipsychotics approved by the Food and Drug Administration. In addition, Part D plans usually cover other common mental health prescription drugs, including anti-anxiety medications and mood stabilizers.
Most Part D plans cover the generic versions of these types of drugs, which contain the same active ingredients as name-brand medications. You can expect to pay a low copayment amount for each course of medication.
Medicare Advantage (Part C)
Medicare Advantage plans (also called Medicare Part C) offer the same mental health coverage as Original Medicare (Medicare Part A and Part B). They also usually have the same prescription drug coverage as Medicare Part D plans.
Medicare Advantage plans often offer additional benefits that Original Medicare doesn’t cover, such as hearing, vision and dental care. If you have a Medicare Advantage plan, you’ll likely face the same or similar deductibles, copays and coinsurance amounts as you would with Original Medicare, depending on the plan you have.
Medicare Advantage is not the same as Medicare Supplement Insurance, and you can’t have a Medicare Advantage plan and a Medicare Supplement plan at the same time.
Medicare Supplement (Medigap)
Medicare Supplement plans are often called Medigap plans, and they can help cover some or all of the out-of-pocket costs of treating your mental health after Medicare Part A and Part B make their contributions.
These expenses might include:
- The Part A deductible for an inpatient stay at a hospital with a mental health department
- The Part B copay or coinsurance for covered therapy sessions
- Daily Part A coinsurance costs for inpatient stays that last longer than 60 days
These out-of-pocket Medicare costs can add up quickly. Having a Medicare Supplement plan can help make your health care spending more predictable and can help protect you from surprise medical bills.
Medicare Plus a Medicare Supplement Plan Can Help You Save Money for Mental Health Treatment
Navigating mental health problems can be challenging, but Medicare helps ensure you have one less thing to worry about.
Original Medicare can cover common treatment options, and a Medicare Supplement plan can help ease your financial burden during this already stressful time by paying for certain Medicare deductibles, coinsurance, copays and more. That means you can focus on improving your mental health without worrying about the cost of treatment.
A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
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