Oftentimes it is hard to determine if an elderly relative or Medicare beneficiary is suffering from anxiety or depression because of the normal effects of aging, or if they have developed new mental health conditions that may require mental health counseling. When seniors are dealing with multiple health conditions, and feeling sad, depressed, or lonely, it is especially important that they have access to mental health experts who can then diagnose and treat their mental health conditions if this is indeed the issue. Fortunately, Medicare does cover several mental health benefits, including preventative mental health screenings, psychiatric and psychological treatment, and inpatient and outpatient mental health treatment programs.
Does Medicare Cover Preventative Mental Health?
Preventative mental health screenings and treatment are crucial to facilitate the diagnosis and then early treatment of mental health conditions before the patient’s mental health deteriorates further. Medicare Part B does provide the following mental health preventative services to screen for different mental health conditions:
- Medicare covers the cost for an annual screening for depression for all enrollees if the doctor involved accepts assignment from Medicare (this means that your doctor agrees to take the Medicare Approved Amount as payment in full for his services).
- Medicare covers one Alcohol Misuse Screening per year for all Medicare recipients who are not Alcohol Dependent.
- Alcohol-dependent Medicare clients could qualify for psychological counseling.
- Medicare also covers a Welcome to Medicare Visit that provides a screening for depression. This screening must be completed within your first year of starting on Medicare.
- Medicare pays for an Annual Wellness Visit at which all Medicare patients can discuss any mental health related issues with their primary care provider. At this visit, your doctor can suggest referrals for mental health treatment based on your symptoms and on any risk factors for mental health issues.
- Medicare Advantage (Part C) plans are comprehensive benefits that pay for all the same things that Original Medicare covers and is administered through private insurance companies. Advantage plans offer supplemental coverage for some services that Medicare Part A and Part B do not cover.
Does Medicare Pay for the Cost of Therapy, Counseling and Psychological Treatment?
Medicare Part B does cover outpatient mental health services that includes diagnosis and subsequent mental health treatment. Medicare Part B will pay 80% of the costs associated with diagnosis, treatment services and doctor visits. For more information visit Original Medicare Coverage (Parts A & B).
These services include:
- Diagnostic Psychological Testing and a Psychiatric Evaluation
- Outpatient Substance Abuse Support
- Medication Management
- Individualized Psychological Therapy
- Various Types of Groups Therapy Counseling for Alcoholic Abuse including (as many as 4 sessions)
In addition, annual depression screenings are free when a doctor or healthcare provider accepts Medicare assignment.
Does Medicare Cover Family and Marriage Counseling?
Marriage counseling can be essential in helping couples who are in a marriage that is struggling or failing entirely. Unfortunately, Medicare Part B does not cover either marital counseling or family counseling if it is provided by State Licensed Marriage or Family Therapists (MFTs). Medicare will, however, cover Family and Marriage counseling if it is provided by one of the following:
- A licensed Psychiatrist
- Clinical Psychologist
- Mental Health Clinical Nurse Specialist
- Clinical Social Worker, or other health care professional who accepts Medicare Assignment.
Does Medicare Cover Mental Health Care as an Inpatient?
If you are admitted to either a general hospital or a psychiatric hospital as an inpatient for a mental health condition, Medicare Part A will cover the related costs including the room, services and supplies after the deductible amount is reached for the benefit periods that are defined by the Medicare plan. Medicare will pay for 20% of approved amounts for doctor and other health related provider services while you are a hospital inpatient.
The deductible amount is currently $1,556 for 2022. There is no coinsurance required for the first 60 days of hospitalization after which there will be a $389 coinsurance amount required every day for days 61-90 and $778 for the “lifetime reserve days” which occur from day 91 and beyond (up maximum of 60 days over your lifetime). Anything beyond 190 days Medicare may offer coverage at a general hospital.
Does Medicare Cover the Cost of Prescription Medications to Treat Mental Illness?
Medicare Part D is a Prescription Drug Plan (PDP) and can be purposed for the coverage of prescription drugs used to treat a mental health condition. If you have Original Medicare, you may want to consider enrolling in Part D to address prescription drug costs. There are also Medicare Advantage plans that are administered by private insurance companies that offer prescription drug coverage as well and could be a better option for some enrollees.
Medicare Part D categorizes medications to treat certain mental health conditions in a “protected class”, which means that they must be covered and paid for by Medicare along with plan sponsors that are found in Medicare Advantage plans.
Drugs in this “Protected Class” include anti-psychotic medications, anti-depressant medications and anti-convulsant medications. You can check to see if the mental health drugs prescribed by your doctor are on your drug plan’s drug formulary and are therefore covered by your drug plan.
If your Medicare Drug Plan does not have the specific mental health drug that your doctor has prescribed for you in their treating formulary, then your doctor will have to either switch your medication to another one that is one on the formulary, or, in the alternative, your doctor can file what is called a Formulary Exception so that your mental health medication will be covered by your Medicare Drug Plan. For more information visit Medicare Part D Coverage.
Does Medicare Cover Outpatient Mental Health Treatment Programs?
Some serious mental health conditions may require long-term outpatient treatment that cannot be accomplished only with therapy sessions administered by doctors or licensed therapists. In cases where intensive mental health care is necessary, Medicare will cover the costs of structured outpatient mental health services which allow for more outpatient mental health services but bypassing the need for inpatient admission and treatment.
These types of specialized mental health therapy programs are known as Partial Hospitalization Programs and are usually run and coordinated through either a local Community Mental Health Center or through the outpatient clinic coordinator of a major local psychiatric hospital. In order to qualify for admission to a Partial Hospitalization Program, your treating medical professional will need to document that your case is of such a serious nature that if you are not admitted to that type of therapy program as an outpatient, then there is a very high likelihood that you would need to be admitted to a psychiatric ward either in a local hospital or in a free-standing Psychiatric Facility in order to receive proper mental health medication, therapy, counseling and treatment.
Does Medicare Advantage Cover Mental Health and Counseling?
Medicare Advantage plans are comprehensive benefits that pay for all the same things that Original Medicare covers and is administered through private insurance companies. However, in addition, Advantage plans offer supplemental coverage for some services that Medicare Part A and Part B do not cover. Part C plans can include prescription drug coverage as well. For more information visit Medicare Advantage (Part C) Coverage.
- Alcohol Misuse Screenings and Counseling, Medicare.
- Yearly Wellness Visits, Medicare.
- Mental Health Care Inpatient, Medicare.