Will Medicare Cover Mental Health Treatment?
Approximately 51.5 million adults suffered from a mental health issue in 2019. According to the National Institute of Mental Health (NIMH), that equates to nearly one in five adults. Changes during all stages in life can push an individual’s limits. Specifically, as you age, you may deal with more traumatic experiences, such as the death of loved ones, medical conditions, or even the sense of loss that sometimes accompanies retirement.
According to NIMH, in 2019, about 74% of adults age 50+ with a serious mental illness received mental health treatment such as counseling or medications. Researching appropriate centers and providers to help with a mental illness can be difficult, and verifying that your insurance will cover the visits can add additional stress. If you have Medicare, however, you have peace of mind. Medicare covers mental health services in various ways.
Part A hospital coverage
Medicare Part A covers you if you are admitted as an inpatient in either a general hospital or psychiatric facility. Part A covers a semi-private room, three meals daily, nursing care, treatment, medications, lab tests, and other services related to your condition. However, if you are an inpatient in a psychiatric hospital, Medicare Part A will only cover 190 days during your lifetime.
Part A coverage is per benefit period. A benefit period starts the day you are admitted and ends when you have gone 60 full days without inpatient hospital or skilled nursing facility care. There is no limit on the number of benefit periods under Part A for mental health care.
Each admittance as an inpatient has a $1,484 deductible per benefit period. After the deductible is met, there is a daily coinsurance. For days 1-60, the coinsurance for a Medicare beneficiary is $0 per day. During days 61-90, the cost is $371, then $742 for the lifetime reserve days.
Part B medical outpatient coverage
Medicare Part B covers mental health-related services performed in an outpatient setting like a physician’s office or community health center. These services need to be provided by a licensed health care provider who accepts assignment for Medicare to cover them.
One depression screening per year is covered 100% by Part B. Diagnostic tests, psychiatric evaluation, medications that are typically not self-administered, individual and group therapy visits, and other related services would be covered with cost-sharing. Clinical social workers, psychologists, nurse specialists, psychiatrists, nurse practitioners, and physicians’ assistants are all approved to provide mental health services under Medicare guidelines.
Medicare pays 80% of Part B services after you meet the Part B deductible ($203 in 2021)
Part D coverage
Prescriptions you take at home are generally covered under Part D. All Medicare drug plans use a formulary to document covered medications. Plans are required to cover antidepressant, anticonvulsant, and antipsychotic prescriptions. The amount you pay for these prescriptions varies with each plan. You may or may not have a deductible with your Part D plan.
Additional Medicare coverage
Medigap plans typically pay the hospital costs that you are responsible for under Part A and your 20% coinsurance under Part B. You pay a separate monthly premium, but your out-of-pocket costs are more predictable with Medigap.
Medicare Advantage plans replace Original Medicare. They typically also include Part D coverage. When you have Medicare Advantage, your plan determines your cost-sharing for inpatient and outpatient mental health services. Keep in mind, however, that Medicare Advantage plans provide mental health coverage that is just as comprehensive as Original Medicare. You may even get additional mental health benefits not covered by Original Medicare with a Medicare Advantage plan.
Warning signs of mental stress can include feeling withdrawn for more than two weeks, a significant change in weight, difficulty concentrating, and changes in mood or sleeping habits. Treatments such as self-care, therapy, and medication may make a drastic impact on those who battle mental health illnesses. If you have Medicare coverage, you can get the help you need.