If you or your loved one receive Medicare and are in need of mental health treatment, coverage is available. However, you should be aware of the various categories of coverage and what they entail before seeking help.
Medicare Part A Inpatient Care
Mental health services rendered to you or a loved one as an admitted hospital patient fall under Medicare Part A.
If you are hospitalized in a general facility, all costs associated with mental health treatment are covered. However, inpatient care in psychiatric hospitals, exclusively for mental health patients, is only covered for up to 190 days over the life of the patient.
The following expenses related to mental health treatment are not covered under Medicare Part A:
- Private rooms or nurses
- Toiletries and other personal items
- Televisions and phones in the hospital room
The deductible per benefit period is $1,288. In addition, the following coinsurance fees apply:
- Days 1-60: $0 per day
- Days 61-90: $322 per day
- Days 91 and beyond: $630 per "lifetime reserve days" (additional days of hospitalization--limited to 60--that can be used only once in a lifetime)
Once your lifetime reserve days have been exhausted, you are responsible for the total cost of of care.
Medicare Part A recipients must also pay 20 percent of the amount of Medicare-approved services rendered by physicians and other providers while receiving inpatient care.
Although inpatient care is limited to 190 days, there is no cap on the number of benefit periods you can receive care.
Medicare Part B Outpatient Care
Office visits for outpatient mental health services are covered under Medicare Part B. These services can be administered by a psychiatrist, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, or physician assistant.
As a Part B policyholder, you are eligible to receive the following outpatient care for mental health:
- Annual depression screening
- Diagnostic tests
- Psychiatric evaluation
- Medication management services
- Prescription drugs
- Preventative screenings
- Family counseling
- Individual and group psychotherapy
You may also qualify for partial hospitalization services under Medicare Part B.
The following costs associated with mental health care services are not covered:
- Meals and transportation
- Support groups outside of group psychotherapy
- Any form of testing or training for job skills that are not directly related to treatment for mental health issues
The fees for mental health treatment under Medicare Part B after the deductible is met are as follows:
- $0 for annual depression screening
- 20 percent of the Medicare-approved amount for diagnostic and treatment doctor visits
Copayment or coinsurance fees, between 20 and 40 percent of the amount approved by Medicare, may also apply to services rendered inside a hospital's outpatient facility.
The costs of partial hospitalization mental health care treatment include:
- Part B deductible
- A percentage of costs, approved by Medicare
- Coinsurance for hospital outpatient facility or community mental health center
How to Use Your Mental Health Benefits
To receive mental health services under Medicare, you will need to have a depression screening performed by your primary care physician. These are offered free of charge and will enable your physician to render treatment or write a referral for further treatment if necessary.
Selecting a Provider
Your primary care physician may provide you with a list of reputable providers to render your mental health services. Otherwise, you can use the database offered by Medicare.gov to locate mental health providers in your local area that accept Medicare patients.