What Mental Health Services Does Medicare Cover?

When most Americans think of Medicare, they imagine it as a program to help with medications and procedures intended to treat or maintain a person’s physical health. While these people are certainly right in that regard, it is also worth mentioning that Medicare will cover some aspects of mental health care. The rest of this article will dive into the specifics and limitations that are involved when you wish to apply your Medicare coverage toward mental wellness.

Where Medicare Part B Is Relevant

Medicare Part B is the medical insurance portion of Medicare that handles payment for outpatient services. Provided below is a general overview of what you can apply it toward.

One screening for depression a year. This screening must be performed in the office of either a primary care doctor or primary clinic that can also give follow-up treatments and referrals.
Psychotherapy with a doctor, either individual sessions or in groups. Other medically-licensed professionals may also be valid, depending on terms for the specific state you are receiving services in.
Family counseling sessions so long as the primary purpose of said counseling is to aid in treatment.
Tests to assess if you are getting needed mental health services and how effective your current treatments are in helping you.
Psychiatric evaluation.
Managing medications like antipsychotics, antidepressants, and stimulants.
Some prescription drugs that do not commonly see self-administered applications. For example, injections like Abilify Maintena, Haldol decanoate, Invega Trinza, fluphenazine decanoate, and Zyprexa Relprevv.
Diagnostic tests
Partial hospitalization, provided that both the doctor and program accept the assignment.
One single “Welcome to Medicare” preventive visit. In short, this is a review of all possible risk factors for depression.
An annual “Wellness” visit. This gives you time to discuss any changes in your mental health with your doctor or other health care provider since the last time you visited them.
Outpatient mental health services so far as they relate to substance use disorders.

But What Does It Cost?

The hospital insurance of Medicare Part A means that you will be paying the following amounts for inpatient treatment:

A deductible of $1,600, or $1,632.00 in 2024
While the first 60 days cost you nothing, there is a $400 ($408 in 2024) daily copay between the 61st and 90th days; after day 90, you will have an $800 ($816 in 2024) copay for every “lifetime reserve day” to a maximum of 60 reserve days over your lifetime).
Every day beyond the lifetime reserve days means that you will need to pay for all of your costs. This means that Medicare Part A will not cover any additional costs beyond your 190th day of receiving inpatient psychiatric health care services.
Original Medicare means that you pay nothing for your annual depression screening, so long as your doctor or health care provider accepts the assignment.
After meeting the Part B deductible, you pay 20% of the amount Medicare approves for visiting your doctor or provider to diagnose and/or treat your condition.
If you receive services through a hospital outpatient clinic or department, there may be an additional copay or coinsurance amount due to the hospital.

Mental Health Services as Defined by Medicare

Mental health services exist to diagnose and treat people who are suffering from mental health conditions, such as depression or anxiety. Visits for these services are usually referred to as counseling or psychotherapy. Such visits can be done on an individual basis, within your family, as a group, or even for crisis scenarios.

What You Need to Know

Part B is the relevant part of Medicare when it comes to covering your psychotherapy and when dealing with the following people.

Psychiatrists and other doctors
Clinical psychologists
Clinical nurse specialists
Clinical social workers
Nurse practitioners
Physician assistants

Note: Medicare will only cover the costs of these visits if you get them from a provider who is willing to be assigned to your case.

Part B also covers outpatient mental services, including those that are most often administered outside of a hospital, so far as they occur in these settings.