If you’re eligible for Medicare coverage, you might be wondering about the difference between Medicare Part A and Medicare Part B, as well as the mental health benefits of each.
Medicare is a federal government health insurance program for US adults over 65, some younger people with certain disabilities and conditions.
If you (or someone you care for) fall into these categories, it can be tricky to understand your benefits, including mental health services.
Here’s what you need to know about Medicare A vs. Medicare B for therapy and other mental health care coverage.
Overview of Medicare Part A and Medicare Part B
Medicare coverage consists of multiple parts. Each part has a unique purpose and covers different services.
- Medicare Part A (hospital insurance): Medicare Part A covers inpatient care in hospitals, hospices, skilled nursing facilities, and nursing homes. It also covers some at-home health care.
- Medicare Part B (medical insurance): Medicare Part B covers outpatient care. This includes medically necessary doctor visits, preventative services, medical supplies or equipment (such as wheelchairs), at-home health care, and mental health care.
See the chart below to learn about the differences between Medicare Part A & B for mental health.
| Medicare Part A | Medicare Part B | ||
| Types of services | Inpatient care: when you need round-the-clock care and are admitted overnight or for a certain extended period. | Outpatient care: when you have an appointment or treatment that you do not need to stay overnight for. | |
| Care setting | A general hospital or a psychiatric hospital | Outpatient settings (doctor’s offices, therapy offices, clinics, hospital outpatient departments, community mental health centers) | |
| Coverage | Mental health treatment while you’re admitted to a general hospital or psychiatric hospital |
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| Costs |
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Medicare eligibility and enrollment
Medicare is different from Medicaid, which provides insurance for people of all ages who generally fall under low-income requirements.
Generally, Medicare is for adults 65 years of age and older. Or, if you’re younger than 65, you might qualify earlier if you have:
- Received Social Security Disability Insurance (SSDI) for 24 months
- End-stage renal disease
- ALS (AKA Lou Gehrig’s disease)
If you’re under 65 and want to see if you qualify for early enrollment, contact Medicare directly (1-800-MEDICARE) or contact your local State Health Insurance Assistance Program (SHIP).
Additionally, it’s important to know when to enroll. There are three enrollment periods, including:
- Initial enrollment period: When you’re first turning 65, you can enroll a few months before or after your birthday. Use the calculator here to determine your Initial Enrollment Period.
- Special enrollment period: If you’re already over 65 but have been covered by an employer’s health insurance plan, you can still sign up at these times:
- While you are still working and have this insurance plan
- Within eight months of when you (or your insured spouse) stops working
- Within eight months of when the insurance plan stops, even if you (or your spouse) keep working
- General enrollment period: If you miss both periods, you can still sign up for Medicare. However, you will face a life-long penalty if you do so.
Medicare Part A and mental health coverage
Medicare Part A covers all inpatient care related to both mental health and physical health.
Inpatient mental health services
Inpatient mental health services are needed when you need intensive, round-the-clock care for your condition. These services are typically needed for people experiencing severe mental health crises, such as acute psychosis or suicidal ideation. In these cases, close monitoring, a structured environment, and 24/7 comprehensive care are crucial for stabilization and recovery.
Inpatient mental health services covered by Medicare Part A are:
- Inpatient mental health care in a general hospital
- Inpatient mental health care in a psychiatric hospital (note: there is a 190-day lifetime limit for coverage in a psychiatric hospital)
Additionally, your doctor will have to provide certification of necessity – meaning they must certify that the inpatient treatment is medically necessary.
Costs associated
There is a $1,632 deductible associated with Medicare Part A. Pricing is per day that you spend as an inpatient.
- First 60 days: $1,632 deductible
- Days 61 through 90: $408 per day
- Days 91 onwards: $816 per day
- After you use all lifetime “Reserve Days,” you pay full price
Medicare Part B and mental health coverage
If you need general outpatient mental health care, such as therapy or medication management, this is where Medicare Part B comes in handy.
Outpatient mental health services
There are many mental health services covered by medicare. Here are the specific outpatient mental health services that Medicare Part B covers:
- “Welcome to Medicare” preventive visit.
- Yearly Wellness visit
- Yearly depression screening
- Individual psychotherapy
- Group psychotherapy
- Family counseling
- Psychiatric evaluation
- Medication management
- Diagnostic tests
- Substance use disorder treatment
- Testing to ensure that your current treatment is effective
- Some prescription drugs that are not self-administered
- Partial hospitalization programs
- Intensive outpatient program (IOP) services
Costs associated
Everyone’s exact costs will be a bit different. However, these are the aspects of cost to consider:
- Monthly premiums: This is what you pay monthly to keep your insurance. It varies based on your income.
- Deductible: This is the amount you must pay before your insurance starts to help you pay for services. In 2024, the Part B deductible is $240.
- Coinsurance: This is the cost you’ll pay per service, which is 20% of the Medicare-approved amount. Make sure your provider is “accepting assignment” to pay this price.
Mental health providers and services covered
Part B of Medicare covers services with many types of mental health care providers with different licensures and specialties, including:
- Psychiatrists
- Physician assistants
- Nurse practitioners
- Clinical psychologists
- Clinical nurse specialists
- Clinical social workers
- Mental health counselors
- Marriage and family therapists
Frequency and duration of coverage
Depending on your specific plan, the frequency and total number of sessions may be limited. However, you may be able to get approval for extended care. Call Medicare customer service at 1-800-MEDICARE for more information about your specific plan.
Navigating coverage: practical steps for enrollees
It’s important to make sure you select the best coverage options for you to take care of both your physical and mental health.
On top of Medicare Part A and Medicare Part B, you might also consider adding additional coverage, such as:
- Medigap: This is Medicare Supplement Insurance meant to help cover the out-of-pocket costs that come with Medicare Part A and B. You buy it from a private health insurance company to get you even more coverage. You must already have Medicare Part A and Part B in order to buy a supplemental Medigap plan.
- Medicare Advantage: Medicare Advantage plans are often called “Medicare Part C.” This is a plan you get from Medicare-approved private insurance companies. There are specific rules for coverage ser by Medicare.
- Medicare Part D: This is a prescription drug plan that helps you pay for your prescription medications. If you have a Medicare Advantage plan, this typically includes Medicare Part D.
Contact your local State Health Insurance Assistance Program (SHIP) or a private insurance agent for help figuring out the best Medicare plan for you.
Finding a therapist who takes medicare
Are you looking for a therapist who accepts Medicare? Grow Therapy can help.
We know finding providers who take Medicare can be hard, so we’re making it easy for you! Grow Therapy can connect you to an in-person or online therapist who takes Medicare ASAP. Just use our Find a Therapist tool, choose your state of residence, and select Medicare as your insurance type.
Affordable mental health care is within reach. Get started today.
