Does Medicare Cover Mental Health Care?

Read about mental health in-patient and out-patient care through Medicare

by Katie Banks+ on Aug 24, 2015 | 3 Comments

Mental health care is for those who need need either out-patient care such as in office counseling and therapy sessions, or for those who need to be admitted to an in-patient facility for more intensive mental health care. Many people find that these services are necessary over a lifetime to help with loss, divorce, and other personal issues, as well as some people have mental health diagnoses that require more significant care. As people turn 65, they wonder how will mental health care be covered by Medicare. Let us explain.

Does Medicare Cover Mental Health Care?

Medicare does cover mental health care for both out-patient and in-patient services. Below are the costs you are responsible for, and the limitations placed by Original Medicare on mental health services.

Out-Patient Mental Health Care
Out-patient Mental Health Care for counseling and therapy is covered by Medicare Part B. Here are the basics of what is covered and your costs:

  • For all services besides screenings you are responsible for your Part B deductible: $185
  • Individual, group, and family counseling you pay 20% for doctor’s visits
  • For out-patient facility care you can pay an additional copay usually 20-40%
  • Diagnostic Tests: 20%
  • One depression screening per year: $0

In-Patient Mental Health Care
In-patient Mental Health Care that requires you to be hospitalized is covered by Medicare Part A. Here are the basics of what is covered, your costs, and the limitations of coverage:

  • For all mental health services in a hospital you must pay your Part A deductible: $1,364.
  • Hospital coinsurance days 1-60: $0
  • Hospital coinsurance days 61-90: $335 per day
  • Hospital coinsurance days 91-150 (lifetime reserve days): $670 per day
  • Over a lifetime you can only receive 190 days of mental health hospitalization
  • Beyond Lifetime care and/or lifetime reserve days: 100%
  • Doctors’ costs for mental services in the hospital: 20%

Does Medigap Cover Mental Health Care?

Medigap plans can cover some or all of the costs of mental health care, dependent on the Medigap plan you choose. For instance, while many Medigap plans will cover part of your costs, only Medigap plan C and F will cover all mental health service costs by a Medicare approved provider. Medigap C and F will cover your Part A and B deductibles, copays, and coinsurance.

If you were to have one of these plans, you should not have any out of pocket expenses besides your monthly premium -unless you were to go beyond your lifetime care days (then you would pay 100% out of pocket for all services).

Learn More about Medigap Get a Medigap Quote

Does Medicare Advantage Cover Mental Health Care?

Medicare Advantage does cover mental health care. While Medicare Advantage plans “replace” Original Medicare with a smaller, local network, they must cover what Medicare covers; however, the costs for each service may vary. You will want to check with each plan to see how much Medicare Advantage will cost you for mental health services.

Learn More about Medicare AdvantageGet a MA Quote

To learn more call a Senior65 agent at 800-930-7956.

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Reader Comments and Questions

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By Jodi on May 23, 2017

For many years Medicare has reimbursed me for out of network, out patient therapy. Suddenly Medicare has refused reimbursement. I filed an appeal and am waiting. I cannot afford this necessary therapy without the reimbursement. Why did Medicare stop reimbursing g me? My symptoms are getting worse without therapy and I fear hospitalization without my therapy treatment.

Jodi,
Medicare is only required to pay doctors and healthcare providers that accept Medicare assignment. In the past, there may have been a health reason your provider was covered by Medicare, but now there isn't. You will need to contact Medicare directly to see what the reason is. However, even if they do partially cover it, you'll have Part B expenses, and possibly excess charges (charges when you see a doctor that doesn't accept assignment (usually 15% above the Medicare approved amount)).

Remember if you have Medigap F or G, your Part B excess charges are covered at 100%. So if you did see a provider that did not accept assignment, but Medicare and the provider agreed to treat you, you'd be covered!

If you don't currently have a Medicare Supplement or are looking to switch give one of our Senior65 licensed independent insurance agents a call at 800-930-7956.
-Amy from https://www.senior65.com/


By Rosemary on March 12, 2016

Have been in psychotherapy for some time for depression but have had to discontinue the treatment because I cannot find a psychiatrist or a psychologist who will take a medicare recipient ( I have supplemental) in Seattle

Rosemary,
If you have Original Medicare there should be several psychologists and psychiatrists in your area that accept Medicare assignment. If you have Medigap Plan F or G which cover "excess charges" (charges by providers that don't accept assignment), you should be able to see just about any counselor or therapist. If for some reason, you meant you have Medicare Advantage, not Medicare Supplement, you will want to contact your Med Adv provider to find out which therapists accept your insurance.
-Chris from https://www.senior65.com/


By Rita on August 31, 2015

I'm turning 65 in November, and I have bi-polar disorder. I was hospitalized about two years ago and it cost a lot. I'm worried about the out of pocket costs for hospitalization and for seeing my psychiatrist. Do you think Medigap or Medicare Advantage would be better for me? I don't want to switch my psychiatrist. I spent a long time finding her. I don't mind spending a few extra hundred dollars a month to save tens of thousands a year. I just want the best plan.

Rita,
Great question! If you are able to afford it, we suggest getting Medigap C or F to supplement Original Medicare. Most of our clients find with either plan that after they pay their monthly premium they have no out of pocket costs for mental health care (as long as it is approved by Medicare, and administered by a Medicare-approved provider). Hope this helps!
-Michelle from https://www.senior65.com/



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