How Does Medicare Cover Mental Health?

How Does Medicare Cover Mental Health?

A person’s mental health is all about his psychological and emotional state. A mental disorder can affect all aspects of life, including communicating with others, making decisions, and managing stress. Although maintaining good mental health is essential at all ages, it is especially important later in life.

Some of the most common forms of mental disorders in seniors are dementia, depression, and anxiety. Medicare covers mental health services in the same way it covers other medical services. Medicare Part A, Part B, and Part D each play a role in covering mental health services.

Medicare Coverage for Mental Health Therapy and Counseling

Medicare Part B covers a few different forms of therapy and counseling when medically necessary to treat a mental disorder. Medicare covers individual psychotherapy, group psychotherapy, family counseling, and partial hospitalization.

Individual and Group Psychotherapy

Psychotherapy is a way to treat one or several mental disorders. Also known as talk therapy, psychotherapy is when someone talks over issues with a psychiatrist or other professional in the field. While there are several forms of psychotherapy, the psychiatrist will choose the best method for the patient’s situation.

Medicare Part B covers psychotherapy when medically necessary to treat or diagnose a mental disorder. Part B covers 80% of the cost of the sessions after the patient pays a $185 (2019) deductible. The patient is responsible for the other 20%.

For Part B to cover psychotherapy sessions, a doctor or other licensed professional allowed by the patient’s state must provide the services. The professional must also accept Medicare assignment.

Family Counseling

Family counseling is a form of psychotherapy that involves multiple people from the family. Medicare Part B only covers family counseling if the main purpose of the sessions is to treat the beneficiary’s mental disorder. Medicare does not cover family counseling for marriage or other family issues.

Partial Hospitalization

People with mental disorders that have progressed to a severe level may require a more focused treatment. Partial hospitalization is an outpatient treatment program covered by Medicare Part B when medically necessary. This program allows the patient to come and go from a mental health facility while receiving treatment.

If the doctor recommends inpatient hospitalization instead, Part B will cover the doctor and treatment services, while Part A will cover the inpatient stay. There is a $1,364 Part A deductible for inpatient stays. Part A will cover 60 days of an inpatient stay after the patient meets the deductible. If the visit extends past 60 days, the patient will owe a daily copay. Part A covers up to 190 days total for psychiatric inpatient stays for the lifetime of the beneficiary.

Other Part B Mental Health Services

Medicare Part B covers other medically necessary services to help treat or diagnose a mental health disorder. Part B mental health services include diagnostic testing, psychiatric evaluations, and depression screenings.

Part B covers diagnostic testing and psychiatric evaluations, just like the other Part B services mentioned above. However, for diagnostic testing to be covered, the doctor must provide Medicare all of the necessary medical codes on the claim.

Depression screenings are covered at 100% by Part B. Medicare beneficiaries can receive one depression screening each year. However, beneficiaries can also receive a cognitive impairment assessment during their annual wellness visit. These visits must be provided by a doctor who accepts Medicare assignment for Part B to cover them at 100%.

Medication Benefits for Mental Health

Prescription medications may be part of the beneficiary’s treatment plan. Medicare Part D is the primary way beneficiaries receive drug coverage. The beneficiary’s drug coverage depends on his Part D plan. Beneficiaries should ask their doctors to prescribe medications on their Part D plan formulary.

Part D covers prescription self-administered medications such as tablets and pills. Part B, however, covers medications administered by medical professionals. For example, if a beneficiary is in the partial hospitalization program and receives an injection by a medical professional while in the facility, Part B would cover the charge.

Part A, Part B, and Part D all provide some form of mental health coverage. In the end, if the mental health service is medically necessary, Medicare should help cover it.

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HealthStatus teams with authors from other organizations to share interesting ideas, products and new health information to our readers.These articles are independently written and do not necessarily agree with the opinions or positions of HealthStatus.
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HealthStatus teams with authors from other organizations to share interesting ideas, products and new health information to our readers. These articles are independently written and do not necessarily agree with the opinions or positions of HealthStatus.

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