In a post-COVID world, mental health is critical for everyone…especially Medicare beneficiaries. Did you know Medicare provides mental health benefits? They can be provided on an outpatient or inpatient setting. See below…
Outpatient Mental Health Care
As outlined on medicare.gov, Medicare Part B covers:
One depression screening per year at a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals.
Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services.
Family counseling, if the main purpose is to help with your treatment.
Testing to find out if you’re getting the services you need and if your current treatment is helping you.
Psychiatric evaluation.
Medication management.
Certain prescription drugs that aren’t usually “self administered” (drugs you would normally take on your own), like some injections.
Diagnostic tests.
Partial hospitalization.
A one-time “Welcome to Medicare” preventive visit. This visit includes a review of your possible risk factors for depression.
A yearly “Wellness” visit. Talk to your doctor or other health care provider about changes in your mental health. They can evaluate your changes year to year.
Part B also covers outpatient mental health services for treatment of inappropriate alcohol and drug use.
These services help individuals work through mental health conditions through counseling or therapy. Your Part B Medicare Plan covers these services at visits with the following providers that accept the specific assignment:
Psychiatrists
Clinical psychologists
Clinical social workers
Clinical nurse specialists
Nurse practitioners
Physician assistants
These health care providers can support their patients’ well-being in a hospital setting, community mental health center, or the provider’s office. If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance amount to the hospital. In all other cases, no matter where you see your healthcare provider, with the help of Medicare, you can expect the following out-of-pocket costs:
You will pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment.
You will pay 20% of the Medicare-approved amount for visits to your doctor or other health care provider to diagnose or treat your condition. In this case, the Part B deductible applies.
Your health care provider may recommend you get services more often than Medicare covers or services that Medicare doesn’t cover. In this case, you may have to pay some or all of the costs. Talk with us at Medicare Mindset or your healthcare provider for guidance.
Inpatient Mental Health Care
Some mental health care requires individuals to be admitted to a hospital as an inpatient. These services are given either in a general or psychiatric hospital.
In this case, Medicare Part A will pay for up to 190 days of inpatient psychiatric hospital services over your entire lifetime in as many benefit periods as you need. Keep in mind, Medicare won’t cover:
Private duty nursing.
A phone or television in your room.
Personal items, like toothpaste, socks, or razors.
A private room, unless medically necessary.
Outside of these, Medicare will help cover the costs associated with inpatient mental health care. For additional services your healthcare provider recommends (beyond what Medicare covers), you will have to pay some or all of those costs. Talk with healthcare provider for guidance.
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). TTY: 1-800-799-4TTY (1-800-799-4889). You can call and speak with a counselor 24 hours a day, 7 days a week.
Call 911 if you're in immediate medical crisis.
Reference Links
www.medicare.gov
Mental Health Care (Outpatient)
Mental Health Care (Inpatient)
Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.
