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A person’s mental health refers to their state of psychological, emotional, and social well-being – and it’s important to take care of it at every stage of life, from childhood to late adulthood. Fortunately, Medicare beneficiaries struggling with mental health conditions may be covered for mental health services through Medicare. Mental health services are a system of care that aim to assess, diagnose, treat, and counsel - in an individual or group setting - anyone who needs help alleviating mental or emotional illness, symptoms, conditions, and disorders. Find out what is included in your Medicare coverage for mental health services and get the help you or a loved one need.
Counseling and therapy are mental health services covered by Medicare Part B (Medical Insurance). This includes visits with the following health care providers who accept assignment:
Coverage: Medicare pays 80 percent of the Medicare-approved amount. You pay 20 percent of the Medicare-approved amount, the Part B deductible, and coinsurance costs.
Clinical psychologists diagnose and treat mental, emotional, and behavioral disorders - and are one of the health care providers covered by Medicare Part B.
Coverage: Medicare pays 80 percent of the Medicare-approved amount. You pay 20 percent of the Medicare-approved amount, the Part B deductible, and coinsurance costs. Check that your psychologist accepts assignment or is in your insurance providers network, otherwise Medicare will not pay for the services.
Psychotherapy, sometimes called “talk therapy,” involves talking to a licensed and trained mental health care professional - typically a psychologist - to help the patient understand and identify problems contributing to his or her mental illness.
Coverage: Medicare Part B helps pay for individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services. Medicare pays 80 percent of the Medicare-approved amount. You pay 20 percent of the Medicare-approved amount, the Part B deductible, and coinsurance costs.
Psychiatrists are trained medical doctors that can prescribe medications to treat complex and serious mental illness - and are one of the health care providers covered by Medicare Part B.
Coverage: Medicare Part B helps pay for a psychiatric evaluation. Medicare pays 80 percent of the Medicare-approved amount. You pay 20 percent of the approved amount, the Part B deductible, and coinsurance costs.
In severe cases of mental illness, a psychiatrist may determine a patient needs to be admitted to a psychiatric hospital or a general hospital for treatment – and Medicare Part A (Hospital Insurance) may help pay for inpatient mental health services during a hospital or mental health facility stay. During the hospital stay, Medicare Part B (Medical Insurance) may cover physician services provided.
Coverage: Medicare helps pay for mental health care in a psychiatric hospital up to 190 days. After this time, Medicare may pay for care in a general hospital. Out-of-pocket costs for a psychiatric hospital are the same as any other hospital for inpatient care that accepts Medicare assignment.
Medicare Part B may help pay for family counseling if the goal of the therapy is related to helping your treatment. In addition, grief and loss counseling may be covered by Medicare for qualified hospice patients and their families, if it is provided by a Medicare-approved hospice and available in that state. Medicare does not cover other types of relationship counseling, such as marriage counseling. You're only covered for mental health services from a licensed psychiatrist, clinical psychologist, or other health care professional who accepts Medicare assignment.
Medicare Part B helps pay for one depression screening per year, and it must be done in a primary care doctor’s office or primary care clinic that can give follow-up treatment and referrals. In addition, Medicare beneficiaries are eligible to receive a one-time “Welcome to Medicare” preventive visit that includes a review of potential risk factors for depression.
Coverage: A yearly depression screening and preventive visit does not cost anything if your doctor or health care provider accepts assignment.
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Last Revised 11/15/2017