Does Medicare Insurance Cover Mental Health?

Posted on September 6, 2018 By Jeff Snyder

Mental health is one of most important facets of our overall health that is far too often ignored. Recently, it has been cast into the limelight with the suicides of Anthony Bourdain and Kate Spade, both of which have forced the general public to have some uncomfortable conversations. Unfortunately, it can be expensive for sufferers of mental health issues to get necessary help if they lack coverage. If you’re a senior in need of mental health care, the Medicare program can help you find answers.

Recently, mental health has been cast into the limelight with the suicides of Anthony Bourdain and Kate Spade, both of which have forced the general public to have some uncomfortable conversations.

For the purposes of this post, we’ll be speaking about Original Medicare. If you have a Medicare Advantage plan, you’ll receive at least the same benefits through your plan and possibly additional benefits. Each plan is different, so check your individual plan for specifics. Similarly, a Medicare Part D plan may be necessary to cover any medications you may be prescribed as part of your mental health treatment if you have Original Medicare.

Inpatient Mental Health Services Covered by Medicare Insurance

Like most inpatient services, inpatient mental health services are covered by Medicare Part A. This is applicable to services rendered in a psychiatric hospital or for mental health care given at a general hospital. The one coverage difference between a general hospital and a psychiatric hospital is that Medicare insurance will only cover 190 days of inpatient care in a psychiatric hospital throughout your lifetime. Once these 190 days are used up, you’ll be responsible for the full costs at a psychiatric hospital.

Medicare insurance only covers a lifetime total of 190 days of inpatient care in a psychiatric hospital.

While you’re at an inpatient facility, most services will be covered by Medicare insurance in some way. Big things that Medicare insurance doesn’t cover at all are private duty nursing, a private phone or television in your room, personal items (toothpaste, socks, razors), or, usually, a private room. In some cases, Medicare insurance will cover a private room. If a private room is considered medically-necessary for your condition, Medicare insurance will cover it.

What Costs Will You Cover for Inpatient Care?

Luckily, the Medicare program treats mental health like any other health issue. Under Medicare Part A, your payments will be based around a benefit period schedule. For inpatient care, you’ll have a standard Part A deductible each benefit period ($1,632 in 2024). On top of that, you’ll have a coinsurance for each day of the benefit period that you’re at the inpatient facility. The costs and payment schedule are similar to standard inpatient costs.

Under Medicare Part A, your payments will be based around a benefit period schedule, with costs similar to standard inpatient costs.

For the first 60 days (days 1 to 60), there’s no coinsurance owed. The next 30 days (days 61 to 90) will cost $408 in 2024 for the coinsurance. After day 90, you’ll fall into the lifetime reserve days, which cost $816 in 2024. Once the 60 lifetime reserve days are up, you’ll cover the full costs previously covered by your coinsurance.

Outpatient Mental Health Services Covered by Medicare Insurance

Medicare Part B covers many outpatient mental health services, making it affordable to get the help you need. The services must be provided by a doctor or psychiatrist; a clinical psychologist, social worker, or nurse specialist; a nurse practitioner; or a physician assistant, and they must accept assignment from the Medicare program. These services can be given at qualifying outpatient facilities like a health care provider’s office, a hospital outpatient department, or a community mental health center.

The mental health care services covered by Part B are fairly wide-ranging.

The mental health care services covered by Part B are fairly wide-ranging. Your Welcome to Medicare and Annual Wellness visits both screen for mental health concerns, as does an annual depression screening that you’re entitled to. Outpatient alcohol or drug abuse treatments are included in coverage. Medicare insurance will also cover diagnostic tests or psychiatric evaluations, individual or group psychotherapy, or even family counseling. These are only a few of the outpatient services covered by Medicare Part B, though.

What Costs Will You Cover for Outpatient Care?

The Welcome to Medicare visit, Annual Wellness visit, and annual depression screening are all fully covered by Medicare insurance (as long as the health care provider accepts assignment). Other costs are similar to anything else covered by Medicare Part B. You’ll be expected to pay for 20 percent of the Medicare-approved amount for your visit, up to your Part B deductible ($240 in 2024).

Most mental health service costs are similar to anything else covered by Medicare Part B.

You should be aware that, depending on where you get your outpatient treatment, you may have additional costs. Some hospital outpatient departments or clinics may require a copayment or coinsurance along with the standard Part B deductible and cost.

Mental health is important to your overall quality of life, and it goes way beyond depression. Globally, 15 percent of adults aged 60 and over suffer from a mental disorder, which can include hoarding, dementia, addiction, or even eating disorders. That wide range of threats needs to be met with a wide range of solutions. Thankfully, your Medicare insurance coverage can help make these solutions affordable and available when you need them most.

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