Medicare and Mental Health Coverage

May is Mental Health Month, making it the perfect time to learn more about Medicare’s coverage of certain mental health tests and services.

Whether you’re in need of a screening, therapy, or medication, Medicare is here to support your overall well-being. Here’s what you need to know about Medicare and mental health coverage.

Mental Health Care and Older Adults

Conditions like depression and anxiety can happen to anyone at any time. While older adults are at an increased risk, it doesn’t mean depression is a normal part of aging.

Depression is more common in people who have other illnesses, and we know that about 80% of older adults have at least one chronic health condition. Also, those who require home healthcare are at an increased risk of major depression (CDC).

Other factors like loneliness and social isolation, stress, lack of physical activity, and functional limitations can increase the risk of depression.

Talk to your doctor if you have any of the following mental health symptoms:

• Sad, empty, or hopeless feelings
• Loss of self-worth like worries about being a burden
• Social withdrawal and isolation
• Little interest in things you used to enjoy
• Lack of energy
• Trouble concentrating
• Trouble sleeping
• Weight loss or loss of appetite
• Increased use of alcohol or other drugs
• Thoughts of ending your life

Medicare helps support your mental health by offering coverage for a variety of services.

Does Medicare Cover Mental Health Care?

Medicare Part B covers mental health services, such as screenings, counseling, reviews with your provider, telehealth, and more.

Plus, mental health visits you get from a doctor, psychiatrist, psychologist, social worker, nurse specialist, nurse practitioner, or physician assistant are covered under Medicare Part B.

Under Medicare Part B, you’ll need to meet the deductible before Medicare starts paying for approved services. Additionally, Part B has a 20% coinsurance, meaning you’d be responsible for paying 20% of any approved services.  

If you have a Medicare Supplement, the 20% coinsurance is likely covered (depending on which Medicare Supplement plan you have).

In 2022, those with the popular Medicare Supplement Plan G would only be responsible for paying the $233 Part B deductible. All other out-of-pocket costs are covered by their Medigap plan.

No-Cost Mental Health Services Offered by Medicare

In some cases, Medicare offers no-cost mental health services. Here’s a list of the 100% free mental health services you can get from Medicare, whether you have a supplemental policy or not:

• Depression screening: Medicare Part B fully covers one depression screening per year.  
• Welcome to Medicare preventative visit: Within the first 12 months of having Medicare Part B, you can get a free doctor visit that includes a review of your potential risk factors for depression.
• Yearly Wellness visit: once every 12 months, you can visit your doctor or other health care provider at no cost. It’s a good time to talk about changes in your mental health. ‍
• Alcohol misuse screening & counseling: Medicare Part B fully covers an alcohol misuse screening once per year, as well as up to 4 brief face-to-face counseling sessions per year (if you qualify).

What Mental Health Services Are Approved by Medicare?

Medicare covers a variety of screenings, services, and programs that aid in the treatment and recovery of mental health and substance use disorders.

If you have a behavioral health condition (like depression, anxiety, or another mental health condition), Medicare may pay your provider to help manage that condition if they offer the Psychiatric Collaborative Care Model.

This model is a set of integrated behavioral health services, including care management support that may include:

• Care plan for behavioral health conditions
• Ongoing assessment of your condition
• Medication support
• Counseling
• Other treatment your provider recommends

Your health care provider will ask you to sign an agreement to get this set of services on a monthly basis. You pay a monthly fee. The Part B deductible and coinsurance apply.  

If you have a Medicare Supplement, you’re likely only responsible for meeting the Part B deductible of $233 in 2022.

Medicare Coverage of Therapy and Counseling

Medicare covers mental health care services like counseling and therapy to help with conditions like depression and anxiety.  

Coverage includes services generally provided in an outpatient setting (like a doctor’s or other health care provider’s office, or hospital outpatient department), including visits with a psychiatrist or other doctor, clinical psychologist, clinical nurse specialist, clinical social worker, nurse practitioner, or physician assistant.  

Covered mental health care includes partial hospitalization services, which are intensive outpatient mental health services provided during the day. Partial hospitalization services are provided by a hospital to its outpatients or by a community mental health center.  

Generally, you pay 20% of the Medicare-approved amount and the Part B deductible applies for mental health care services. If you have a Medicare Supplement, it will likely cover that 20% coinsurance, meaning you’re only responsible for the small Part B deductible.

Note: Medicare Part A covers inpatient mental health care services you get in a hospital.

Medicare Coverage of Telehealth Mental Health Care

Medicare covers certain telehealth services provided by a doctor or other health care provider who’s located elsewhere using audio and video communication technology, like your phone or a computer.  

You can get certain Medicare telehealth services without being in a rural health care setting, including services to treat a substance use disorder or a co-occurring mental health disorder (sometimes called a “dual disorder”) in your home.  

Note: a dual disorder is a person who has both a mental disorder and an alcohol or drug problem.

You pay 20% of the Medicare-approved amount for your doctor or other health care provider’s services. The Part B deductible applies. For most of these services, you’ll pay the same amount you would if you got the services in person.

Remember: if you have a Medicare Supplement, the 20% coinsurance is likely covered, meaning you’re only responsible for paying the Part B deductible.

Conclusion

Medicare Part B helps cover mental health care. If you have a Medicare Supplement, your out-of-pocket costs will be even less.

But don’t let cost stop you from getting the help you may need. Services like depression screenings and a yearly visit with your doctor are fully covered by Medicare, regardless of whether you have a supplemental plan or not.

If you have any questions about your costs in Medicare, give our office a call!

Related: How Counseling Can Help Illinois Seniors with Anxiety, Grief, & Marriage