Medicare Coverage for Elderly Mental Health
Medicare Coverage for Elderly Mental Health
Lindsay Malzone, Medicare Expert Staff

Mental health is a growing concern when it comes to the health of many Americans. With Medicare beneficiaries, this can be increasingly challenging as feelings can be escalated by feeling isolated or alone. While Medicare does cover mental health, it doesn’t cover everything.

Today we’re going to discuss how Medicare covers mental health services. Next, we’ll cover who qualifies for mental health services through Medicare. Then we’ll talk about what mental health services are covered. After that, we’ll go over additional insurance options available.

Medicare Coverage for Mental Health

The services you need will dictate whether it is covered under Medicare Part A or B. Medicare Parts A and B will cover mental healthcare services after an inpatient hospital admission. These services include a depression screening, family counseling, psychotherapy, and management of medications.

Medicare Part A Mental Health Coverage

Medicare Part A covers mental health services when you are admitted as an inpatient at a hospital. These services help treat and diagnose beneficiaries with mental health disorders such as depression and anxiety.

If admitted to a general hospital the coverage is the same as your typical part A services. Your benefit period begins once your Part A deductible is paid, you’ll no additional costs from days 0 to 60 for hospital services. From days 60 and beyond you’ll be required to pay a per-day copay.

There is no limit on the number of benefit periods and you can receive mental health care from a general hospital or a psychiatric hospital. Medicare only covers 190 days for a lifetime for psychiatric hospitals. The deductible and costs are the same as in a general hospital.

Medicare doesn’t cover private duty nursing, a phone or television in your room, or personal items like toothpaste, razors, or socks.

Medicare Part A covers your:

  • Lab tests
  • Meals
  • Medications
  • Nursing care
  • Other related services and supplies
  • Room
  • Therapy or other treatment for your condition

Medicare Part B Mental Health Coverage

Medicare Part B covers outpatient mental health services. If your doctor accepts Medicare assignment, you’ll pay nothing for your annual depression screening. After you meet the Medicare Part B deductible, you’re responsible for 20% of the cost of diagnoses and treatment from your healthcare provider and any excess charges.

If you’re receiving services at an outpatient hospital or clinic, you may be responsible for additional copays or coinsurance.

If your healthcare provider recommends services that aren’t covered by Medicare, you may be responsible for the entire cost.

Medicare Part B includes:

  • Annual wellness visit
  • Diagnostic tests
  • Family counseling, to help with treatment
  • Individual and group psychotherapy
  • Medication Management
  • Mental health services for the treatment of substance abuse
  • One annual depression screening in a primary care doctor’s office or clinic that can provide referrals for follow-up
  • Partial hospitalization
  • Psychiatric evaluation
  • Specific prescription drugs that aren’t generally self-administers such as injections
  • Testing to determine if the services and treatments are needed and to discover if the treatments you’re receiving are helping your condition


Who qualifies for mental health services through Medicare?

Anyone that is participating in Medicare is eligible for mental health services. If you have any of the below thoughts, symptoms, or feelings you should speak with your healthcare provider.

  • A lack of energy
  • Increased use of alcohol or other drugs
  • Little interest in things you used to enjoy
  • Loss of self-worth (like worries about being a burden, feelings of worthlessness, or self-loathing)
  • Sad, empty, or hopeless feelings
  • Social withdrawal and isolation (like you don’t want to be with friends, engage in activities, or leave home)
  • Thoughts of ending your life (like a fixation on death or suicidal thoughts or attempts)
  • Trouble concentrating
  • Trouble sleeping (like difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
  • Weight loss or loss of appetite

What mental health services are covered and not covered by Medicare?

Mental Health Services covered by Medicare:

  • A one-time “Welcome to Medicare” preventive visit. This visit includes a review of your potential risk factors for depression.
  • An annual Wellness visit. Medicare covers a yearly “Wellness” visit once every 12 months.
  • Certain prescription drugs that you’ll generally not self-administer.
  • Diagnostic tests.
  • Family counseling if the main purpose is to help with your treatment.
  • Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services.
  • Medication management.
  • One depression screening per year. The screening must be done in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals.
  • Partial hospitalization.
  • Psychiatric evaluation.
  • Testing to find out if you’re getting the services you need and if your current treatment is helping you.

Mental Health Services not covered by Medicare:

  • Activity therapy that’s for recreation or to divert attention from other issues.
  • Meals.
  • Support groups that bring people together to talk and socialize.
  • Testing or training for job skills that aren’t part of your mental health treatment.
  • Transportation to or from mental health care services.

Additional Insurance to help cover costs.

As you can see, with Original Medicare there can be quite a few additional costs left for you to cover. A few options that can help offset these costs are a Medicare Supplement or a Medicare Advantage plan.

Medicare Supplements help you pay what’s left over after Medicare pays its portion. Depending on the plan letter you choose, the Medigap plan could pay all or most of your portion of the costs.

Medicare Advantage plans are another way to receive your Medicare benefits. On these plans, you’ll have a limit on what your total costs for the year can be. In addition, they have smaller fixed copays for most items that make your care more predictable and manageable.

Consult with a licensed insurance broker to get assistance determining which additional coverage types is best for you.

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