While Medicare does provide coverage for various mental health services, it’s essential to familiarize yourself with each part’s specific benefits and limitations. This knowledge will help you to make informed decisions about your mental health care and the necessary steps to receive the appropriate support.

Original Medicare consists of parts A and B and each part provides different coverage for mental health services. 

Medicare Part A covers inpatient mental health care, including costs associated with hospitalization. 

Medicare Part B deals with outpatient mental health services, such as appointments with a mental health provider, as well as annual depression screenings.

What mental health services does Medicare cover?

There are various mental health services available to Medicare beneficiaries depending on their needs. In this section, we’ll take a look at some of the key aspects such as residential treatment, as well as psychologist, and psychiatrist coverage.

Does Medicare cover residential treatment for mental health?

Medicare Part A provides inpatient mental health care coverage, including hospitalization in a general hospital or a psychiatric hospital. If you require residential treatment, your stay and services in these facilities will be covered. However, be aware of the costs involved, such as the $1,632 deductible (in 2024), daily copayments, and limited lifetime reserve days available for extended hospital stays. For more information on these costs, click here.

Does Medicare cover psychologists?

Medicare Part B covers outpatient mental health services, including therapy sessions with clinical Medicare psychologists, clinical social workers, and other licensed mental health professionals. After meeting the Medicare Part B deductible ($240 in 2024), Medicare typically covers 80% of the approved costs, leaving you responsible for the remaining 20%. You can also receive covered services such as family counseling and psychiatric evaluations as needed.

Does Medicare cover psychiatrists?

Medicare also covers psychiatrist services under Part B, including outpatient treatment for various mental health conditions like depression and anxiety. This coverage includes services from psychiatrists, nurse practitioners, and physician assistants. 

Besides therapy and consultations, private Medicare Part D plans cover prescription medications needed for your mental health treatment. There are also private Medicare Advantage plans that offer a more comprehensive approach to mental health care. Such plans include the same benefits as Original Medicare but may offer plenty of additional things like gym or fitness classes.

Medicare Part B mental health coverage

Medicare Part B helps with the costs of outpatient mental health services. 

• To access these services, you’ll first need to meet the annual Part B deductible, which is $240 in 2024. 
• Once the deductible is met, Part B covers various outpatient mental health services, including individual and group psychotherapy, diagnostic tests, medication management, and more. 
• Medicare pays 80% of the Medicare-approved amount for therapy services, but you’re responsible for the 20% co-payment. Keep in mind that these services must be provided by a qualified healthcare professional.

Apart from therapy, Medicare Part B also covers one depression screening per year, which must be conducted in a primary care setting. This is important because early detection and intervention can significantly improve mental health conditions.

Medicare Part A mental health coverage

For inpatient mental health care, the coverage is slightly different. 

• Under Medicare Part A, a $1,632 deductible is applied for each benefit period. 
• After that, specific copayments apply depending on the duration of your hospital stay.
• Days 1-60 have a $0 copayment per day, days 61-90 have a $408 copayment per day, and days 91 and beyond have an $816 copayment per “lifetime reserve day.”

Medicare telehealth and mental health

Telehealth refers to medical and health services provided by your doctor or other healthcare provider using audio and video communications technology, such as your phone or computer.

Telehealth has become increasingly popular, especially given the convenience of receiving mental health services from the comfort of your home. During the Covid-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) finalized their rule on in-person exam requirements for Medicare coverage of telehealth-based mental health services when the patient is at home. This means you can access these services much easier than before. Even though the Public Health Emergency due to Covid19 is now over, access to telehealth has not been stopped and Medicare beneficiaries can take advantage of it until the end of 2024.

What is the Medicare-approved amount for mental health services?

The Medicare-approved amount refers to the maximum price that Medicare has agreed to pay for specific services from a healthcare provider. This amount will vary depending on:

• Any other insurance you may have
• How much your health service provider charge
• If your doctor accepts assignment
• The type of facility
• Where you get your test/item/service

To find out how much your test, item, or service will cost, you need to speak to your doctor or health care provider. This is a link to a Medicare Mental Providers list, so you can find a suitable provider near you.

Remember to always check with your healthcare provider to ensure they accept assignment and work within Medicare’s limits to avoid unexpected costs. By understanding these Medicare-approved amounts and cost-sharing structures, you can take full advantage of your mental health benefits and manage your out-of-pocket expenses effectively.

Who can bill Medicare for mental health services?

When it comes to receiving mental health services under Medicare, you have access to various healthcare providers. It can be tricky working out exactly what it does and doesn’t cover. For example, does Medicare cover mental health counseling? 

Let’s explore which professionals are authorized to bill Medicare for their services.

Psychiatrists can diagnose and treat mental health conditions. As medical doctors, they may also prescribe medication to manage your symptoms. Medicare covers outpatient mental health services provided by psychiatrists, ensuring you receive comprehensive care from these experts.

Clinical psychologists play a pivotal role in addressing mental health issues’ emotional, social, and cognitive aspects. They offer psychotherapy and may collaborate with other healthcare professionals in providing a holistic treatment approach. Rest assured, their services are also covered under Medicare!

Clinical social workers offer counseling and address various aspects of your life that may contribute to mental health challenges. They can help you develop strategies to improve your well-being and successfully bill Medicare for their services.

Nurse practitioners and physician assistants are essential healthcare team members, delivering medical and mental healthcare services such as assessments, diagnoses, and medication management. They can also provide psychotherapy and coordinate care with other healthcare professionals. They will cater to your needs as long as they accept Medicare assignments.

Remember, good mental health is not a destination, it is a process. We hope this guide has given you all the information you need to make the most informed and appropriate choices for you and yours.

Article updated on January 16, 2024.