Did you know that 30% of people enrolled in Medicare have a mental health condition? However, less than half of adults living with mental health conditions in the United States have received mental health services within the past year. Mental health services are widely available and may be covered by insurance, including Medicare.
Key takeaways:
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Medicare is a four-part federal government health insurance program that covers adults 65+, certain people with disabilities, and people with kidney failure.
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Depending on the plan, Medicare offers some mental health care coverage, including outpatient treatment and medication management.
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Under Medicare Part B, people typically pay 20% of the cost of service out-of-pocket.
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You can check your coverage online using your Medicare.gov account.
What is Medicare?
Medicare is a federal government health insurance program in the U.S. that provides coverage to several eligible groups, including individuals 65 or older, certain individuals with disabilities, and those with kidney failure. Medicare may cover more than physical health services, such as physical therapy. It may help cover mental health services as well. Medicare has three parts:
Medicare Part A
This hospital insurance covers inpatient care in hospitals, hospices, skilled nursing facilities, and nursing homes. It also covers some at-home health care. This means it covers inpatient care at general hospitals as well as mental health care in a psychiatric hospital. There is a 190-day lifetime limit for coverage in a psychiatric hospital under Medicare Part A. Additionally, your doctor will have to provide certification of necessity, meaning they have to certify that the inpatient treatment is medically necessary.
Medicare Part B
Part A and Part B have their differences. The primary one is that Part B covers some practitioner services outside hospitals, medical supplies, and preventive services. This could be therapy or medication management, including the Welcome to Medicare visit.
Medicare Part C
Part C, also called Medicare Advantage, includes plans offered by private insurers.As an alternative to original Medicare, Plan C has the same hospital and medical insurance as Parts A and B, and many plans also include prescription drug coverage, which are typically offered primarily by Part D.
Medicare Part D
Medicare Part D helps cover the cost of prescription drugs. Medicare Part D is optional, and available to everyone who qualifies for Medicare. It is provided through private insurance companies approved by the federal government.
Does Medicare cover mental health care?
If you have a mental health condition and are hospitalized for inpatient services or require prescription drugs, you may be covered under Medicare Parts A and D, respectively. The information below shows what Medicare covers for outpatient mental health services under Part B.
Types of therapy and mental health care Medicare covers
Medicare covers depression screenings, including a one-time Welcome to Medicare visit to assess your risk factors for depression within the first year of having Medicare Part B. Additionally, Medicare fully covers one depression screening per year if done with a primary care doctor or clinic that can provide follow-up treatment or refer you to someone who can. On top of this, Medicare covers one wellness visit per year to speak with your care provider about your mental health concerns.
One-on-one or group psychotherapy or mental health counseling visits are also covered by Medicare, including cognitive behavioral therapy (CBT) and family counseling. The doctor, psychiatrist, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, or physician assistant must be a licensed professional who accepts Medicare (see below).
Psychiatric evaluation is covered and includes assessment for mental health conditions such as depression, anxiety, bipolar, attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), schizophrenia and other psychotic disorders, and substance use disorders. Some coverage is offered for substance use disorder assessments, treatments, and counseling, such as alcohol, tobacco, and opioid use disorders.
Medicare also covers medication management, diagnostic tests, partial hospitalization services, and structured psychiatric services more intense than what you’d get at a doctor or therapist’s office. With this coverage, you don’t stay in the hospital overnight and must meet specific requirements.
What mental health care Medicare doesn’t cover
Medicare does not cover meals, transportation, or support groups (not including group psychotherapy, which Medicare does cover).
Therapy covered by Medicare
Therapy covered by Medicare
How to check your Medicare coverage
There are a few ways to check your Medicare coverage online using the Medicare.gov website, which we’ll outline below.
Use your Medicare.gov account to check mental health care coverage
- If you have a Medicare number, you can create a secure online Medicare.gov account.
- Log in to your account and click the button in the top right corner that displays your first name.
- Click the My Preventive Services link.
- You may see a list of preventive visits that you are currently eligible for.
- You should be able to see Yearly depression screening and Yearly wellness visit from the list, for example.
You can also explore other mental health services you may be eligible for through your account.
What if I don’t have a Medicare.gov account?
The Get Started with Medicare page on Medicare.gov has information about coverage options, how to sign up, general costs, and more. You can check your mental health benefits with Medicare using the What Medicare covers link. You can also search for specific coverage using the Is my test, item, or service covered? link.
On the Medicare.gov website, you can converse with a representative to inquire specifically about the mental health benefits available to you.
How much does therapy cost with medicare?
There are several terms that you need to know to understand your coverage. If you’re ever in doubt, reach out to a Medicare representative who will be able to guide you on your plan.
In-network vs. out-of-network: Does your mental health care provider accept Medicare?
First, you need to know if your provider accepts Medicare, as this will affect how much you pay. Healthcare providers who accept Medicare are considered “in-network,” while those who don’t accept Medicare are “out-of-network.”
Next, there are a few factors to consider when deciding how much you’ll have to pay. Learn more about these terms here: Does insurance cover therapy?
Deductibles
The deductible is the amount you must pay out-of-pocket each year before your insurance will start to pay.
Coinsurance
Coinsurance is the percentage of the total cost of a treatment or service that Medicare doesn’t pay for. You must pay this amount out-of-pocket. For mental health care under Medicare Part B, this number is generally 20% of the Medicare-approved amount during your benefit period.
Example of Medicare’s cost
Let’s say you find a therapist who accepts Medicare. You have already met your deductible for the year (in 2023, this amount is $226) by paying for other treatments and services covered under Part B. The cost of the visit is $100 for a single counseling session. With a coinsurance of 20%, this means that you’ll pay $20 out-of-pocket, while Medicare will pay the remaining 80% ($80).
Other factors to consider regarding using Medicare for mental health services
These costs are on top of your monthly premium, the amount you pay for your Medicare insurance each month.
This article focuses on original Medicare plans. The coverage for other Medicare health plans, such as Medicare Advantage, may vary. If you have additional insurance coverage, it may help reduce your out-of-pocket costs.
Additionally, if you have limited income and resources, some programs may help cover costs, such as Extra Help, State Medical Assistance (Medicaid), or a State Health Insurance Assistance Program (SHIP).
How to maximize mental health care benefits with Medicare
Maximizing your mental health care benefits with Medicare involves understanding your coverage and knowing how to access the right services for you. Start by taking advantage of Medicare’s covered services like yearly wellness visits, depression screenings, and therapy sessions, which are often fully or partially covered under Part B.
If you’re on Medicare Advantage (Part C), explore the additional mental health benefits specific to your plan. Check for programs like Extra Help or Medicaid if you have limited income, as they can assist with covering costs. Finding a provider who accepts Medicare and discussing a care plan tailored to your needs can also help you make the most of your benefits.
How to find a healthcare provider who takes Medicare
At Grow Therapy, we help connect you with a wide range of mental health professionals who accept Medicare insurance.
Use our Find a Therapist tool and select Medicare as the insurance type. You can then find a therapist near you who specializes in your needs.
You can also check your healthcare provider’s website or mental health centers, or contact them directly to ask if they accept Medicare.
Final thoughts
Investing in your mental health is an investment in your well-being, growth, and healing. Insurance coverage like Medicare can help make mental health care affordable. In particular, Medicare Part B can cover depression screenings, wellness visits, psychotherapy, and psychiatric evaluations.
It’s easy to check your Medicare coverage online using the above mentioned steps. To figure out how much you’ll need to pay out of pocket for mental health services, make sure you’re familiar with whether your provider is in-network and what your Medicare plan’s deductibles and coinsurance amounts are.
Here at Grow Therapy, we make it easy to find a mental health provider who’s right for you. Check out our search tool to explore our network of providers who accept Medicare. Get started today with taking care of your mental well-being.
