Medicare covers mental health treatment and will also cover procedures for early detection and therapy.

You may obtain psychotherapy, counseling, psychiatric care, and other services as a beneficiary under Medicare. We’ll look at how Medicare covers mental health in this section.

How Does Medicare Cover Mental Health Services?

Mental health care is covered by either Medicare Part A or Part B. You are covered under Part A if you are admitted to a hospital as an inpatient for psychiatric care.

Medicare also covers outpatient visits to a doctor to diagnose and treat a mental illness under Medicare Part B.

How Much Will Medicare Pay for Mental Health Services?

Original Medicare will pay the standard 80% for inpatient services.

Medicare covers mental health care and includes psychotherapy, counseling, and psychiatric care. In addition, there are other mental health services such as day treatment programs, hospitalization, and ambulatory mental health services.

Ambulatory mental health services provide evaluation and treatment on an outpatient basis. Medical and surgical treatments used to diagnose and treat mental illness are also covered by Medicare.

What Is The Medicare-approved Amount For Mental Health Services?

Mental health does have an annual limit for mental health services for people not inpatient care in a hospital.

Conditions that have limits include treatment of mental, psychoneurotic, and personality disorders, and diagnosis is not included in the limitation. Medicare will pay for outpatient mental health care is limited to 62.5% of expenses per calendar year.

Inpatient Psychiatric Care

Medicare Part A will help cover inpatient mental health care when admitted to a general hospital for psychiatric care. The same part of Medicare will also help pay for your hospital stay and will help cover some of the costs for medications and treatments you receive while you’re in the hospital.

Outpatient Psychiatric Care

Medicare Part B will help cover outpatient psychiatric care when you visit a doctor to diagnose and treat a mental illness.

Original Medicare will pay for some of the costs of the doctor’s visit, including medications and treatments you receive during the visit.

Outpatient Mental Health Coverage

Part B covers your regular doctor’s appointments for mental health conditions. You may visit clinical psychologists, psychiatrists, social workers, counselors, and other medical specialists under this plan.

There are no annual alcohol or substance abuse screenings covered by Medicare. You can get therapy in a therapist’s office or at a clinic.

Medicare Advantage Coverage for Mental Health

All Medicare Advantage plans cover mental health services. Coverage on a Medicare Advantage plan will usually include fixed copays for most services, making it a predictable option.

Medicare Supplement Coverage for Mental Health

Medicare supplement plans cover mental health services and pay for your portion of the costs of Medicare’s benefits. Depending on the supplement you choose, you could pay little or nothing out of pocket for Medicare-covered mental health services.

Part D Prescription Drug Coverage for Mental Health

Medicare Part D plans must cover antipsychotic and antidepressant medicines. All Medicare prescription drug plans must include at least one option of all therapeutic classes. This ensures that mental health drugs have coverage, and healthcare providers cannot discriminate against them.

What if My Mental Health Medication Is Not On My Plan Formulary?

Medicare covers all therapeutic classes of prescriptions, which doesn’t mean there is coverage for all prescription drugs. If you’re on an uncovered medication, you have a few options.

  • Ask your provider to prescribe another medication that can help provide the same results
  • Ask for a Formulary Exception

FAQs

How does Medicare cover mental health counseling?

Medicare Part B will help cover outpatient psychiatric care when you visit a doctor — such as your primary care physician — to diagnose and treat a mental illness.

Does Medicare cover partial hospitalization?

Part A may also help cover hospitalization in a psychiatric hospital. This hospitalization is like an inpatient stay in a psychiatric hospital, but you go home at night.

Is a psychiatrist covered by Medicare?

Part A of Medicare will help cover inpatient psychiatric care when admitted to a hospital for psychiatric care.

Do Medicare Advantage plans cover mental health?

Medicare Advantage plans take care of mental health services and must cover all of Medicare’s benefits, including mental health services.

Can I get mental health services from any provider?

Yes, you can visit clinical psychologists, psychiatrists, clinical social workers, counselors, and other medical specialists under Medicare Part B.

Can my Medicare Supplement plan cover my mental health services?

Medigap plans also cover mental health services. Medigap plans must cover all of Medicare’s benefits, including mental health services. Depending on the supplement you choose, you could pay little or nothing out of pocket for Medicare-covered mental health services.

Do Medicare Advantage and Part D prescription drug plans cover mental health drugs?

Yes, Medicare Advantage and Medicare Supplement plans must cover antipsychotic and antidepressant medicines. Medicare Advantage and Part D prescription plans must cover all therapeutic classes of prescriptions, meaning that all mental health drugs must have coverage.

What if I can’t afford my mental health medication?

If you cannot afford your mental health medication, ask your doctor for a cheaper alternative.

You can also check with a licensed insurance broker to see if you qualify for the extra help program.

What is the Medicare-approved amount for mental health services?

Medicare will pay for 80% of approved mental health services. This is after you meet your deductible and coinsurance responsibilities.

Does Medicare cover psychiatrists?

Medicare does cover psychiatrists as long as they’re medically necessary. Medicare covers it at an 80-percent clip, with patients responsible for the remaining 20%. This includes initial psychiatric evaluations.

How much does Medicare pay for psychology?

Medicare pays $4 out of every $5 — or 80 percent — toward the cost of psychology services rendered. The rest is your out-of-pocket costs.

Is depression covered by Medicare?

Medicare beneficiaries receive one free annual depression screening as a diagnostic test initially, then a follow-up appointment each year. Other health services related to depression receive 80-percent coverage from Medicare as coinsurance.

Does Medicare take care of mental health?

Yes. Medicare will take care of any medically necessary mental health services. This extends to mental health benefits like family counseling, group psychotherapy, group therapy, medication management, and mental disabilities.

Does Medicare cover stress?

Medicare will want to treat the symptoms of any stress-related illness — like high blood pressure — so it stands to reason they’d cover mental health services until you’re back in good physical health.

What is the Medicare co-pay for mental health?

You are required to cover 20 percent of the out-of-pocket costs, plus a $233 Part B deductible during your benefit period.

Need Help Getting Coverage for Mental Health?

Your mental health is just as important as your physical health, so make sure you have the coverage to face anything. Our licensed insurance agents can help you find Medicare Supplement coverage to patch the holes in your regular Medicare plan.

Our agents are extremely knowledgeable, friendly, and patient to guide you to the health insurance plan that best suits your needs. Best of all, their time is free for you.

So give us a call today. Or fill out our quick and easy online rate form to be connected with the best rates in your area.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.