Does Medicare Cover Psychiatric Care?
Medicare covers up to 80 percent of the cost of a psychiatrist visit. Medicare may cover some other costs if you visit a psychiatrist in a different setting, such as a psychiatric hospital. The online Physician Finder tool lets you locate a Medicare psychiatrist in your area.
What Is a Psychiatrist?
A psychiatrist is a medical doctor who specializes in psychiatry.
These physicians have been trained to diagnose mental health conditions.
After you undergo a mental evaluation, psychiatrists can prescribe medications to treat mental disorders.
- Private practices
- Nursing homes
- Courts and prisons
- Rehabilitation programs
- Both general and psychiatric hospitals
- Community agencies
About half of all psychiatrists in the United States operate private practices, according to the American Psychiatric Association.
People seek mental health services for many reasons.
It’s easier to find the right provider once you understand the difference between psychiatrists and other mental health professionals.
- Psychologists hold doctoral degrees in clinical psychology or another specialty such as counseling or philosophy. However, they are not medical doctors and cannot prescribe medication. They can conduct testing, clinical interviews and psychological evaluations. They can also diagnose your condition and conduct individual or group therapy.
- Clinical Social Worker
- Clinical social workers can evaluate your mental health and use therapeutic techniques based on certain training programs. They’re also trained in case management and advocacy services.
- Clinical Nurse Specialist
- A psychiatric and mental health clinical nurse specialist is a registered nurse with a master’s degree and clinical experience in mental health conditions such as stress, anxiety, depression or grief. They can diagnose conditions, develop and implement treatment plans, administer psychotherapy and, in some cases, prescribe medication.
Medicare Psychiatrist Costs and Coverage
Psychiatrists practice in various settings, such as private practices or psychiatric hospitals.
How much you pay for a psychiatrist’s services and how much Medicare covers depends on where you receive mental health services.
Medicare Part B covers 80 percent of approved costs for visits to a psychiatrist or other mental health professional in an outpatient setting.
This includes services received at a private practice, a clinic or similar location.
The psychiatrist must accept assignment from Medicare, and your Part B deductible applies.
- Psychiatric evaluations
- Medication management
- Diagnostic tests
Partial hospitalization is a structured program of outpatient psychiatric care that is more intense than what you’d receive in a doctor’s office.
Treatment is usually provided during the day, and you aren’t required to stay overnight.
Partial hospitalization can take place at a hospital outpatient department or a community mental health center.
You will pay a percentage of the approved cost for each service you receive from a psychiatrist in this kind of setting. The health care professional must accept assignment from Medicare.
You may also owe a coinsurance payment for each day of care.
Your cost for partial hospitalization depends on the treatment provided, but under Medicare rules, it cannot cost more than 40 percent of the Medicare-approved amount.
Medicare Part A covers mental health care services you get in a general hospital or a psychiatric hospital.
In some situations, such as after a suicide attempt, you may be admitted as an inpatient to a general hospital. You may then be released to a psychiatric hospital for further observation and additional services.
Medicare Part A covers only 190 days for inpatient care in a psychiatric hospital over your entire lifetime.
Any days you spend in a general hospital do not count toward the 190-day lifetime limit — even if you were admitted for mental health reasons or are receiving treatment for a mental health condition.
Out-of-pocket costs are the same for both general and psychiatric hospitals.
This includes the Part A deductible ($1,484 in 2021), a per-day coinsurance payment for each benefit period for hospitalization of more than 60 days and less than 91 days, and 20 percent of Medicare-approved amounts for services from psychiatrists and other providers inside the hospital.
For more Information about inpatient mental health care costs and coverage, visit Medicare.gov.
How to Find Care
The Medicare online Physician Compare tool is the easiest way to find a Medicare psychiatrist near you.
Enter your city or zip code and type “psychiatry” into the keyword box.
Hit “Search,” and a list of psychiatrists who accept Medicare will appear. You can click a doctor’s name for contact information, driving directions and other details.
If you are covered under a Medicare Advantage plan, you may need to check your plan’s website or call your provider to find psychiatrists who accept your specific Medicare Advantage insurance.
Medicare Advantage plans are an all-in-one alternative to Original Medicare.
These plans must cover the same services as Original Medicare, but often restrict beneficiaries to specific networks of doctors and providers.
In some cases, you may need a referral to see a specialist.
If you have trouble accessing the Physician Compare website, you can call 1-800-633-4227 and speak with a Medicare representative. This representative can also send you a printed version of the psychiatrist search results.
10 Cited Research Articles
- National Alliance on Mental Illness. (2020, April). Types of Mental Health Professionals. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Types-of-Mental-Health-Professionals
- Centers for Medicare & Medicaid Services. (2020, January). Medicare Mental Health. Retrieved from https://www.cms.gov/files/document/medicare-mental-health-mln1986542.pdf
- Medicare.gov. (2020). Medicare & Your Mental Health Benefits. Retrieved from https://www.medicare.gov/Pubs/pdf/10184-Medicare-and-Your-Mental-Health-Benefits.pdf
- U.S. Department of Health and Human Services. (2015, September 10). Where can I find a doctor that accepts Medicare and Medicaid? Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/where-can-i-find-a-doctor-that-accepts-medicare-medicaid/index.html
- Barry, P. (2014, May). Medicare Coverage for Mental Health Services. Retrieved from https://www.aarp.org/health/medicare-insurance/info-02-2009/ask_ms_medicare_question_45.html
- American Psychiatric Association. (n.d.). Providing Care to Patients With Medicare Advantage Plans. Retrieved from https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/medicare/medicare-advantage
- American Psychiatric Association. (n.d.). What Is Psychiatry? Retrieved from https://www.psychiatry.org/patients-families/what-is-psychiatry-menu
- Medicare.gov. (n.d.). Mental health care (inpatient). Retrieved from https://www.medicare.gov/coverage/mental-health-care-inpatient
- Medicare.gov. (n.d.). Mental health care (outpatient). Retrieved from https://www.medicare.gov/coverage/mental-health-care-outpatient
- Medicare.gov. (n.d.). Mental health care (partial hospitalization). Retrieved from https://www.medicare.gov/coverage/mental-health-care-partial-hospitalization