Mental Health Coverage and Medicare

It doesn’t matter if you’re just watching a movie, venting, or celebrating a special occasion. It’s a fact — gathering with friends helps you stay happier.

But what if you’re having a tough time connecting with friends? You’re going through a difficult time that you don’t know how to talk about.

Medicare can help. Talking with a mental health provider can offer the support you need. Mental health services also help diagnose and treat people with mental health disorders like depression and anxiety.

Take Advantage of Your Annual Free Depression Screening

Medicare Part B covers one depression screening per year in a primary care setting (like a doctor’s office). The office can provide follow-up treatment and/or referrals if needed. You pay nothing for this screening if your doctor “accepts assignment.” This means they agree to accept the Medicare-approved amount as full payment for covered services.

If you or someone you know is struggling or in crisis and would like to talk to a trained crisis counselor, call or text 988. It’s a free, confidential Suicide & Crisis Lifeline. You can also connect with a counselor through web chat at 988lifeline.org

Outpatient Mental Health Services Under Original Medicare

Part B covers mental health care services to help with conditions like depression and anxiety. These visits are often called counseling or psychotherapy. They can be done individually, in group psychotherapy or family settings, and in crisis situations. Coverage includes services generally provided in an outpatient setting like a doctor’s or other health care provider’s office, or hospital outpatient department. Services include visits with a psychiatrist or other doctor, clinical psychologist, clinical nurse specialist, clinical social worker, nurse practitioner, or physician assist.

As of January 1, 2024, Medicare covers mental health care services provided by marriage and family therapist and mental health counselors.

Covered mental health care includes partial hospitalization services given by a community mental health center or by a hospital to outpatients. Partial hospitalization is a structured day program that offers outpatient psychiatric services as an alternative to inpatient psychiatric care.

Also as of January 1, 2024, Medicare covers intensive outpatient program services provided by hospitals, community mental health centers, federally qualified health centers, and Rural Health Clinics. Partial hospitalization and intensive outpatient services are more rigorous than care you’d receive in a doctor’s or therapist’s office. Visit https://Medicare.gov/coverage/mental-health-care-partial-hospitalization to learn more.

You usually pay 20% of the Medicare-approved amount. And the Part B deductible applies for mental health care services.

For more information, refer to the MLN Booklet published by the Centers for Medicare & Medicaid Services, www.cms.gov/files/document/mln1986542-medicare-mental-health.pdf.

Inpatient Mental Health Care Under Original Medicare

Medicare Part A helps with the below if you’re admitted to a hospital or a psychiatric hospital.

• A semi-private room (a private room may be covered if medically necessary)
• Meals
• General nursing
• Drugs (including methadone for opioid use disorder)
• Other services and supplies as part of inpatient treatment

The amount you pay during a hospital visit depends on how long you stay. For 2024, you pay a Part A deductible of $1,632 (per each benefit period) when your stay is 60 days or less. For more than 60 days, you’ll pay different coinsurance amounts.

You can only get inpatient psychiatric care in a freestanding psychiatric hospital up to 190 days during your lifetime under Part A.

Part B covers mental health services from doctors and other health care professionals while you’re an inpatient. You typically pay 20% of the Medicare-approved amount after paying your annual Part B deductible.

If you have a Medicare Advantage plan, other mental health benefits may be available. Talk with your plan representative for more information.

Time to Connect

When you’re ready to gather with friends — take it one moment at a time. You may feel awkward reaching out. But it’s important to remember that good friends have your back. Connecting with them can provide huge benefits for your mental health.

Our licensed insurance agents are here for you too. While we can’t set up that movie date, we can answer any of your Medicare questions. So, you’re sure to get the help you need.

MR655a 2/2024