Medicare coverage for mental health

Mental health care can diagnose and treat mental illnesses or mental health conditions. A mental illness or mental health condition may affect your thinking, feeling or mood. Examples of mental health conditions include depression, anxiety and schizophrenia. Some also consider addiction, like opioid use disorder and alcoholism, to be mental health conditions.

Mental health conditions are typically not the result of any single event or circumstance. Rather, they are complicated conditions involving multiples factors. Treatment is intended to improve both the condition and your entire well-being.

Part B coverage

Medicare Part B covers outpatient mental health care, like individual and group therapy, activity therapies such as art therapy, partial hospitalization programs, and annual depression screenings. Medicare also covers outpatient substance use disorder treatment, such as services you receive from a clinic, hospital outpatient department, or opioid treatment program.

When choosing mental health care providers, make sure they accept assignment so that you avoid paying more. Accepting assignment means that a provider accepts Medicare’s approved amount as full payment for a service. If you see a non-medical doctor, like a psychologist or clinical social worker, it is additionally important that they be Medicare-certified. Medicare will only pay for the services of these types of providers if they are Medicare-certified and accept assignment.

If you have Original Medicare, you still owe 20% of the cost for most services after meeting your Part B deductible. For most preventive services, however, including annual depression screenings, you pay nothing and do not need to meet your Part B deductible.

Part A coverage

Medicare Part A covers inpatient mental health services. These are services you receive in a psychiatric hospital or general hospital, both for inpatient mental illness treatment and inpatient substance use disorder treatment. Your covered days in a psychiatric hospital have a lifetime limit, but your covered days in a general hospital do not. Medicare covers up to 190 days of inpatient care at a psychiatric hospital in your lifetime. If you have used your lifetime days at a psychiatric hospital but need additional inpatient mental health care, Medicare may cover your care at a general hospital.

General and psychiatric hospitals have the same out-of-pocket costs. After meeting your Part A deductible, Original Medicare pays in full for the first 60 days in your benefit period. A benefit period begins when you enter a hospital as an inpatient and it ends when you have been out of the hospital or a skilled nursing facility for 60 days in a row. After day 60, you owe a daily amount to the hospital.

Part D coverage

Medicare Part D Prescription Drug Plans (PDPs) are required to cover many drugs used to treat mental health conditions. If you have trouble accessing your prescriptions at the pharmacy, contact your doctor. Before signing up for a Part D Prescription Drug Plan, make sure that drugs you need are on that plan’s list of covered drugs (known as the plan’s formulary).

For any Medicare related questions, feel free to contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers Act (MIPPA) program.

If you are part of an agency or organization that assists seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.

Sean McPhilamy is a volunteer and Certified Medicare Counselor at the Alaska Medicare Information Office.

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