Medicare Mental Health Coverage | Examination and Prescription

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. It also offers cover for other types of mental healthcare needs.

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

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

Mental Healthcare in the US

Mental health is defined as a person’s emotional, social and mental well-being. These are the functions that affect a person’s thoughts, feelings, and actions.

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

Mental well-being is important 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 studies, almost 80% of adults in the US suffer from at least one chronic mental condition. Around 50% of adults have two or more mental health problems in the US.

This could easily 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 Mental Health Coverage

Medicare Mental Health Coverage – Medicare and Mental Health Coverage

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

The annual wellness visits offered by Medicare are excellent to discuss 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 all eligible costs, for a maximum 190 day period in your lifetime.

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 the cost of one screening for depression per year. 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 a single person or group therapy by a state-licensed expert. Family therapy is also covered in case 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 meant 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 alternate 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 certain rules.

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

During partial hospitalization, Medicare may not cover the cost of:

  • Meals
  • Support groups (apart from group therapy)
  • Transport
  • Job skills testing or training if it is not part of a treatment

Remember, Medicare Part A and Part B do not cover the cost of prescription medication which is to be taken at home. However, Medicare Part D covers the cost of such medications.

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:

  • US$ 1,408 deductible for every benefit period
  • 20% coinsurance for approved costs
  • Copayments of US$ 0 for days 1-60, US$ 352 for days 61-90, US$ 704 for reserve days from day 91, and all costs after lifetime reserve days have been used completely

A Medicare policyholder gets 60 lifetime reserve days to use during their lifetime. Under Medicare Part B you will need to pay for diagnosis and treatment costs.

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


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.

See Also

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