Does Medicare Cover Talk Therapy Services?
Dear Savvy Senior,
What types of mental health services does Medicare cover? I struggle with anxiety and depression, and my primary care provider recommended I see a therapist or psychiatrist.
—Anxious Annie
Dear Annie,
Medicare actually covers both outpatient and inpatient mental health care services and programs to help beneficiaries with anxiety, depression and many other mental health needs. Here what you should know.
Outpatient Coverage
If you’re enrolled in original Medicare, your Part B coverage will pay 80 percent (after you’ve met your annual $257 Part B deductible) for a variety of counseling and mental health care services that are provided outside a hospital, such as in a doctor or therapist’s office, hospital outpatient department or community health center. These services can also be received via telehealth.
You, or your Medicare supplemental (Medigap) policy, is responsible for the remaining 20 percent coinsurance.
Medicare also gives you the expanded option of getting treatment through a variety of health professionals such as psychiatrists, psychologists, clinical nurse specialists, clinical social workers, nurse practitioners, physician assistants, marriage and family therapists and mental health counselors.
To get this coverage, you’ll need to choose a participating provider that accepts Medicare assignment, which means they accept Medicare’s approved amount as full payment for a service.
If you choose a nonparticipating provider who accepts Medicare but does not agree to Medicare’s payment rate, you may have to pay more. And if you choose an opt-out provider that does not accept Medicare payments at all, you will be responsible for the entire cost.
To locate a mental health care professional in your area that accepts Medicare, go to Medicare.gov/care-compare, click on “doctors & clinicians” and type in your location, followed by “clinical psychologist” or “psychiatry” in the Name & Keyword box. You can also get this information by calling Medicare at 800-633-4227.
Inpatient Coverage
If you happen to need mental health services in either a general or psychiatric hospital, original Medicare Part A covers this too, after you’ve met your $1,676 Part A deductible. Your doctor should determine which hospital setting you need. If you receive care in a psychiatric hospital, Medicare covers up to 190 days of inpatient care for your lifetime. And if you use your lifetime days but need additional care, Medicare may cover additional inpatient care at a general hospital.
Additional Coverage
In addition to the outpatient and inpatient mental health services, Medicare also covers yearly depression screenings that must be done in a primary care doctor’s office or clinic. Annual depression screenings are covered 100 percent.
And if you have a Medicare prescription drug plan, most medications used to treat mental health conditions are covered too.
Medicare Advantage Coverage
If you get your Medicare benefits through a private Medicare Advantage plan, they too provide the same coverage as original Medicare does, but may impose different rules and will likely require you to see an in-network provider. You’ll need to contact your plan directly for details.
For more information, call Medicare at 800-633-4227 and request a copy of publication #10184 “Medicare & Your Mental Health Benefits,” or you can read it online at Medicare.gov.