Does Medicare Cover Mental Health Services?
Medicare covers inpatient and outpatient mental health services, but you may be responsible for your deductible, copay and coinsurance costs. Medicare Part A covers mental health services in a hospital setting and Part B covers outpatient visits to a doctor and other mental health providers.
About 15 percent of people 60 and older have some type of mental health condition, according to the World Health Organization. Mental health disorders are also responsible for almost 7 percent of all disabilities in people over 60.
- Mood disorders, including depression or bipolar disorder
- Severe cognitive impairment — trouble remembering, concentrating, learning new things or making decisions about everyday life
The rate of people with symptoms of depression increases with age, but it is not a normal part of aging. The U.S. Centers for Disease Control and Prevention estimates 80 percent of depression cases are treatable, but it often goes untreated or undertreated in older Americans because it isn’t widely recognized.
What Mental Health Services Does Medicare Part A Cover?
Medicare Part A (hospital insurance) will help pay for mental health services you receive in a hospital if you are admitted for inpatient treatment. This coverage applies whether you’re treated at a general hospital or a psychiatric hospital.
- Hospital room
- Lab tests
- Medications and other related services and supplies while hospitalized
- Nursing care
- Treatment or therapy for your mental health condition
Your share of the costs for inpatient mental health care is the same as for general hospital services and treatments covered by Medicare Part A.
Original Medicare at least partially covers long-term psychiatric hospitalization and other long-term mental health hospital care for up to 190 days over your lifetime. But the daily coinsurance costs you have to pay out of pocket can be several hundred dollars a day if you are hospitalized beyond 60 days in a single benefit period — periods that last until you’ve gone 60 days without any hospital inpatient care.
- $1,408 deductible for each benefit period
- You are responsible for 20 percent of the Medicare-approved amount for mental health services you receive from doctors and other health care providers while you’re a hospital inpatient.
- $0 coinsurance for days 1 to 60 of hospitalization for each benefit period
- $352 coinsurance per day for days 61 to 90
- $704 coinsurance per day for days 90 and beyond for each lifetime reserve day — you have 60 of these days over your lifetime
- You pay all costs when you run out of lifetime reserve days.
How Much Will Medicare Part B Pay for Mental Health Care?
Medicare Part B pays 80 percent of the Medicare-approved amount for outpatient mental health services as long as the doctor or other health care provider participates in Medicare.
You have to meet your Part B deductible — $203 in 2021 — and then you are also responsible for the remaining 20 percent.
If you receive outpatient treatment in a hospital setting, you may have to pay an additional coinsurance or copayment amount.
Medicare Part B will help pay for a wide range of mental health services. Many of these services may be included in one-time or routine doctor visits that cover your whole health in review. Be sure to bring up your mental health concerns during these sessions with your doctor.
- One-time “Welcome to Medicare” preventive visit, including a review of your risk factors for depression
- A yearly wellness visit that allows your doctor to track changes in your mental health
- One depression screening per year at a primary care doctor’s office or clinic that can provide follow-up treatments and referrals
- Diagnostic tests
- Family counseling in certain cases
- Individual and group psychotherapy with licensed doctors or other approved providers
- Medication management
- Partial hospitalization — if your doctor determines you need inpatient treatment
- Prescription drugs that have to be administered by a doctor or other provider
- Psychiatric evaluation
- Testing to determine if your treatment is working
Medicare Part D Prescription Drug Coverage and Mental Health Care
Medicare Part D prescription drug plans are not required to cover all drugs, but with limited exceptions, they are required to cover all antidepressant, anticonvulsant and antipsychotic medicines.
Part D plans are sold by private insurers and other companies that Medicare approves. Almost all plans have a formulary — a list of drugs the plan covers. This list can change each year, but the company has to notify you at least 30 days before the change takes effect.
It’s important to review your plan’s formulary changes when you receive this information.
8 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, November 6). 2021 Medicare Parts A and B Premiums and Deductibles. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2021-medicare-parts-b-premiums-and-deductibles
- U.S. Centers for Medicare & Medicaid Services. (2020, March). Medicare and Your Mental Health Benefits. https://www.medicare.gov/Pubs/pdf/10184-Medicare-and-Your-Mental-Health-Benefits.pdf
- U.S. Centers for Medicare & Medicaid Services. (2020, March). Medicare and Your Mental Health Benefits. Retrieved from https://www.medicare.gov/Pubs/pdf/11358-Medicare-Mental-Health-Getting-Started.pdf
- World Health Organization. (2017, December 12). Mental Health of Older Adults. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults
- U.S. Centers for Disease Control and Prevention. (2011, February). Cognitive Impairment: A Call for Action Now! Retrieved from https://www.cdc.gov/aging/pdf/cognitive_impairment/cogimp_poilicy_final.pdf
- U.S. Centers for Disease Control and Prevention. (2008). The State of Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? Retrieved from https://www.cdc.gov/aging/pdf/mental_health.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Mental Health Care (Inpatient). Retrieved from https://www.medicare.gov/coverage/mental-health-care-inpatient
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Mental Health Care (Outpatient). Retrieved from https://www.medicare.gov/coverage/mental-health-care-outpatient