Medicare Mental Health Coverage (Including Medication)

Medicare Mental Health Coverage – Overview

Medicare is a health insurance program offered by the US federal government to citizens over 65 years. It is also available to individuals below 65 years who have specific medical conditions.

Medicare provides insurance coverage for mental health therapy and other mental healthcare needs.

Medicare Part A covers the cost of hospital stays, Medicare Part B covers the cost of doctor visits and hospital day programs, and Medicare Part D can help pay for medications.

In this article, we shall see the kind of Medicare mental health coverage you can expect and its out-of-pocket costs.

Mental Healthcare in the US

Mental health is the state of a person’s emotional, social, and mental well-being. These functions affect a person’s thoughts, feelings, and actions.

These may include the person’s social interaction skills and stress levels.

Mental well-being is essential at every point in life. At times, life events may trigger emotional and physical responses. Some of these triggers include:

Retiring from a job
Loss of job
Grief
Getting bullied
Experiencing violence
Isolation/loneliness

Other factors that can affect a person’s mental health include:

Sleeping habits
Family history
Biology
Nutrition
Overall physical health

According to the National Institute of Mental Health, in 2022, approximately 58.9 million adults (23.2% of all U.S. adults) experienced mental illness.

This could quickly increase the prevalence of mental conditions in America.

Some early signs that denote the development of mental health issues may include:

Low energy levels
Aggressive behavior (yelling, fighting, etc.)
Eating too much or too little
Mood swings
Feeling helpless or hopeless
Excessive or insufficient sleep
Thoughts of self-harm or violence
Smoking, drinking or using recreational drugs excessively
Unexplained pains and aches

Medicare and Mental Health Coverage

Medicare offers a Welcome to Medicare preventive visit to every new enrollee. During this visit, the doctor checks for signs of depression, among other things.

The Medicare annual wellness visits are excellent for discussing any changes in mental health since the last visit with the doctor.

Besides wellness visits, Medicare also covers the cost of several mental health services.

Medicare Part A and Mental Health Coverage

Medicare Part A covers the cost of inpatient care at a general or psychiatric hospital. In this situation, Medicare Part A covers up to 190 days of inpatient psychiatric hospital care in a lifetime. However, this limit doesn’t apply to mental health services in a general hospital’s psychiatric unit. Still, it does not cover all eligible costs, as deductibles and coinsurance may apply.

However, the number of benefit periods for mental health care at a general hospital is not restricted.

Medicare Part B and Mental Health Coverage

Medicare Part B covers annual depression screening in a primary care setting where follow-up care and referrals can be provided. This screening should be held at a primary care doctor’s office to ensure proper follow-up care.

Medicare Part B also covers the cost of individual or group therapy by a state-licensed expert. Family therapy is also covered if it helps with the patient’s treatment.

Medicare Part B covers these mental healthcare service costs when the services are provided by a:

Clinical social workers
Clinical psychologists
Psychiatrist
Nurse practitioner
Physician Assistant
Clinical nurse specialist

The different types of healthcare services covered under Medicare Part B include:

Diagnostic tests
Test to evaluate the effectiveness of the current treatment
Partial hospitalization
Prescribed medication from a doctor
Evaluation and prescription drug follow-up visits

Partial hospitalization is an organized day program and an alternative to inpatient care. The treatment during partial hospitalization is more intensive than a weekly visit.

Medicare might not cover the cost of partial hospitalization at a community health center unless the community center adheres to specific rules.

For instance, the community health center should offer round-the-clock emergency care and clinical evaluation.

Medicare covers partial hospitalization program services under Part B, but it does not cover meals, transportation, or services not directly related to treatment, such as job skills training.

Medicare Part D is required for coverage of most outpatient prescription drugs. Part B may cover certain medications administered in a doctor’s office or hospital outpatient setting. However, Medicare Part D covers the cost of such medicines.

Exclusions in Medicare for Mental Health Coverage

Some of the mental healthcare services which are not covered under Medicare include:

Marriage counseling
Biofeedback
Adult-day health programs
Environmental modifications
Pastoral counseling
Preparing reports
Schizophrenia hemodialysis
Explaining data or results
Phone application or service
Transport and meal expenses

Out-of-Pocket Costs for Mental Health Coverage Under Medicare

Some of the common out-of-pocket costs you should be ready to pay for mental health coverage under Medicare Part A include:

In 2024, the Medicare Part A deductible will be $1,632 for each benefit period, up from $1,600 in 2023.
20% coinsurance for approved costs
For mental health services under Part B, you pay 20% of the Medicare-approved amount and the Part B deductible ($240 in 2024) applies.

As of 2024, Medicare covers mental health services provided via telehealth, including individual and group psychotherapy and substance use disorder treatment. Medicare provides 60 lifetime reserve days for inpatient hospital stays, which can be used after the first 90 days of inpatient hospital care within a benefit period. Under Medicare Part B you will need to pay for diagnosis and treatment costs.

Once the Medicare Part B deductible is met, you must pay 20% of the Medicare-approved amount. This Medicare Part B deductible changes every year.

Medicare covers outpatient substance use disorder treatment, including opioid treatment programs (OTPs), structured assessment, and intervention services.

Conclusion

Medicare Part A covers the cost of hospitalization for mental healthcare. Medicare Part B pays for therapy and partial hospitalization costs.

Medicare also covers annual mental health screening from a Medicare-approved expert.

Original Medicare does not cover the cost of meals, transport, and several prescription drugs used in mental health treatments.

You should enroll in Medicare Part D to cover the cost of prescription drugs.

Grants for Medical

Medicare Mental Health Coverage | Examination and Prescription