Does Medicare Cover Depression Screenings?
Medicare beneficiaries can receive a depression screening in a primary care setting, such as a doctor's office, once a year. You pay nothing for this screening.
Depression in Older Adults
Depression is a common but serious mental condition that negatively affects your health, mood and behavior.
- Feeling sad.
- Loss of interest or enjoyment in activities.
- Feelings of worthlessness or guilt.
- Increased fatigue or lack of energy.
- Weight loss or weight gain unrelated to dieting.
- Sleep issues.
- Problems concentrating or making decisions.
- Thoughts of death or suicide.
To be diagnosed with depression, symptoms must last at least two weeks, according to the American Psychiatric Association.
Depression rates tend to be higher among people with other serious health conditions, including cancer, arthritis, chronic lung conditions and cardiovascular disease.
Older adults also have the highest risk of suicide among all age groups.
The United States Preventive Services Task Force found that screening for depression has at least a moderate net benefit for patients and the health care system.
What Is a Depression Screening?
There is no gold standard for the type of depression screening Medicare will cover.
Doctors can choose the test and method that works best for their practice and patients.
You will likely complete the standardized screening independently through a self-reporting questionnaire.
Clinicians commonly use a two-step process with screener tools called the Patient Health Questionnaire-2 (PHQ-2) and Patient Health Questionnaire-9 (PHQ-9).
- Over the past two weeks, have you felt down, depressed or hopeless?
- Over the past two weeks, have you felt little interest or pleasure in doing things?
If you answer that you’ve experienced these problems more often than not in the past two weeks, then the doctor would conduct the more in-depth PHQ-9 screening, which includes 10 questions in total.
Screening tests do not actually diagnose depression, but instead indicate how severe depression symptoms are within a given time period.
In its 2011 analysis, the Centers for Medicare & Medicaid Services noted: “That is, screening alone — without organizational enhancement of care — is not enough. Actual improvement in outcomes requires careful follow-up and monitoring.”
Medicare Coverage and Your Costs
In October 2011, Medicare began covering annual depression screenings conducted within a primary care setting.
The screening is free for all Medicare beneficiaries, whether you have Original Medicare or a Medicare Advantage plan.
To qualify, the depression screening must take place in a doctor’s office or other primary care setting.
A depression screening may not be covered by Medicare if it takes place somewhere else, such as in a hospital, independent diagnostic testing facility or skilled nursing facility.
Your doctor or their staff may provide follow-up mental health treatment or a referral, depending on your screening results.
Medicare Part B covers the cost of some other mental health services.
- Individual psychotherapy with doctors or licensed professionals.
- Psychiatric evaluations.
- Medication management.
- Visits with psychiatrists, clinical psychologists and clinical social workers.
You’ll pay 20 percent of the Medicare-approved cost for any mental health services used to treat your condition. The Part B deductible also applies.
6 Cited Research Articles
- Savoy, M. and O'Gurek, D. (2016, April). Screening Your Adult Patients for Depression. Retrieved from https://www.aafp.org/fpm/2016/0300/p16.html
- ACP Internist. (2012, March). Medicare pays for annual depression screening. Retrieved from https://acpinternist.org/archives/2012/03/tips.htm
- Centers for Medicare & Medicaid Services. (2011, October 14). Decision Memo for Screening for Depression in Adults (CAG-00425N). Retrieved from https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=251
- American Psychiatric Association. (n.d.). What is Depression? Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression
- Medicare.gov. (n.d.). Depression screenings. Retrieved from https://www.medicare.gov/coverage/depression-screenings
- Medicare.gov. (n.d.). Mental health care (outpatient). Retrieved from https://www.medicare.gov/coverage/mental-health-care-outpatient