A lot of attention is given to physical fitness and well-being, but mental health is just as important, especially as we get older. Seniors can be vulnerable to mental health issues due to risk factors such as social isolation, chronic illness, or injury. The stress of being on a fixed income or losing a loved one can contribute to depression and anxiety. Dementia is most common in people over the age of 65. According to the World Health Organization, approximately 15% of people 60 years of age or older suffer from a mental health disorder.
Medicare can help cover the costs of care to diagnose and treat mental health issues, but it can be important to discuss changes in your emotional and psychological health with your doctor. This starts with your “Welcome to Medicare” visit with your physician. This appointment takes place within 12 months of your enrollment in Medicare Part B (Medical Insurance) and allows you to discuss your current health, family history. Build a rapport with your physician and be honest about any changes you’ve experienced, especially during your “Yearly Wellness Check.” This annual appointment gives you the opportunity to follow up every 12 months with your physician, reviewing your physical, cognitive, and emotional health. Medicare recipients do not pay anything for these preventive visits and the Part B deductible does not apply as long as your doctors accept assignment.
Diagnosis and Treatment
Medicare Part B will cover one depression screening per year in your primary physician’s office or a primary care clinic that accepts assignment and can provide follow ups and referrals. The screening can include a psychiatric evaluation and diagnostic tests. If it is considered medically necessary and appropriate, outpatient mental health care may include individual, group, or family counseling. Partial hospitalization and certain medications that may not be self-administered (like injections) may be covered by Part B.
Part B will cover mental health services when you see mental health professionals, including a psychiatrist, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, and/or physician assistant who accepts assignment. You will not pay for your depression screening, but you will likely pay 20% of the Medicare-approved amount for additional doctor visits to diagnose and treat your condition. You will also be responsible for the Part B deductible. If you receive treatment in a hospital outpatient setting, you may also pay a copayment or coinsurance.
If your physician diagnoses your mental health condition and prescribes medication to help improve your condition, Medicare Part D can help you pay for the medication. If you have Original Medicare, you will need to be enrolled in a stand-alone Prescription Drug Plan (PDP) to get coverage for medications prescribed by your physician.
Many Medicare recipients choose to get their benefits through a Medicare Advantage plan. MA plans are offered by private insurance companies that contract with Medicare to provide your Part A and Part B coverage. MA plans are required to provide at least the same benefits as Original Medicare, but most plans offer additional benefits, including prescription drug coverage. Each PDP and MA-PD (Medicare Advantage with prescription drug coverage) will have a different formulary, or list of covered drugs, and costs.