Medicare pays much of the cost of a wide range of mental health services, whether provided on an outpatient basis or for inpatients in a psychiatric or general hospital. But you need to be aware of limits on these benefits, including substantial copays, coinsurance and a lifetime maximum.
Mental health issues are common among older adults: Thirty-one percent of Original Medicare beneficiaries are living with mental illness, according to a July 2020 report by the Commonwealth Fund, a private foundation focused on health care. And in a July 2020 survey by the Kaiser Family Foundation, 46% of Americans ages 65 and up said that pandemic-related stress and worry were detrimental to their mental health.
What Medicare covers for outpatient mental health services
Medicare Part B, which pays doctor bills and related health care expenses, covers many mental health services rendered to patients not admitted to a hospital. Covered costs include:
A “Welcome to Medicare” visit that includes a review of your risk factors for depression.
One depression screening per year, performed in the office of a primary care doctor or in a primary care clinic that provides follow-up treatment and referrals.
Psychiatric evaluation to diagnose mental illness and prepare a care plan.
Individual and group psychotherapy or counseling provided by physicians or certain other professionals licensed to do so in your state. Covered providers may include psychiatrists or other doctors, clinical psychologists or social workers, nurse practitioners and physician assistants.
Family counseling that aids in your mental health treatment.
Medication management and some prescription drugs that are not self-administered.
Partial hospitalization, which typically includes many hours of treatment per week without admission to a hospital.
Testing to find out if you’re getting the services you need and if your current treatment is helping you.
An annual wellness visit with a doctor or other provider to discuss any mental health changes.
What you’ll pay for outpatient mental health care
For outpatient mental health care, after you meet the Medicare Part B deductible, which is $203 in 2021, there are typically copayments of 20% for additional services. If you receive additional mental health services in hospital outpatient facilities, you may owe more.
To get information on your out-of-pocket costs, talk to your health care provider. Your bottom line will depend upon providers’ charges, the facility type, whether your doctor accepts Medicare assignment and any other insurance you may have.
What Medicare covers for inpatient mental health services
Medicare Part A, your hospital insurance, covers mental health services that require your admission to a psychiatric or general hospital. If you’re in a psychiatric hospital, you’re covered for only up to 190 days of inpatient services over your lifetime. After that, you’d need to receive mental health services in a general hospital to be covered.
Your costs will also be substantial: For long hospital stays, they could amount to $10,000 or more in total charges.
What you’ll pay for inpatient mental health care
A deductible of $1,484 applies to inpatient psychiatric care for each benefit period. You will owe no coinsurance for the first 60 days of a hospital stay for psychiatric treatment. But you will owe copays of 20% of the Medicare-approved amount for mental health services you receive from doctors and other providers while you’re an inpatient.
For days 61 through 90 of a psychiatric hospital stay, you’ll owe $371 per day in coinsurance. Your daily coinsurance jumps to $742 per each “lifetime reserve day” after day 90. (In Original Medicare, lifetime reserve days are a set number of days that are covered by Medicare when you’re in the hospital for more than 90 days; you have up to 60 days in your lifetime.) After that, you pay all costs.
What Original Medicare doesn’t cover
Your health care provider may recommend you receive services more frequently than Medicare covers, or services that Medicare doesn’t cover, and you may end up paying some or all of these costs. Ask your provider why they are recommending such services and whether Medicare will cover them.
You will have to pay for private duty nursing or a private room, unless it’s medically necessary. Other limits may apply.
Other coverage options
Some Medicare Advantage plans offer enhanced coverage of mental health services. If these Medicare Advantage plans are available in your area, you may want to consider them, especially if you have chronic mental illness. All Medicare Advantage plans are required to cover everything that Original Medicare covers, at a minimum.
Medicaid may cover some costs of long-term psychiatric hospitalization that are not paid by Medicare. But to qualify for Medicaid, you may have to exhaust your financial resources. Benefits vary by state; contact your state’s Medicaid office for coverage details.
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