Does Medicare Cover Mental Health Services Like Therapy?

Medicare Benefits Solutions
Aug 15, 2022

Mental fitness can play a key role in overall wellness. Thanks to an effort to increase awareness and remove the stigma of discussing mental health, people have been more likely to seek help when dealing with mental health issues.

Seniors are especially vulnerable to mental health concerns due to illness, isolation, depression, and anxiety. If you have Medicare, you have access to a wide range of mental health services if you need them.

Mental Health and Mental Illness

Though often referred to interchangeably, mental health and mental illness are different conditions. A mental illness has a beginning and an end. The duration may be short-term or long-lasting, or you may have ongoing episodes. The Centers for Disease Control and Prevention (CDC) says, “mental illnesses are the most common health conditions in the United States.”

Mental health refers to your emotional, social and psychological wellness. Mental health affects your thoughts, feelings and actions, determining how you manage stress, communicate with people, and choose healthy options. People with poor mental health do not necessarily have a mental illness, but mental health is critical to your overall well-being, equally as important as your physical condition.

Does Medicare Cover Preventive Mental Health Services?

Medicare Part B covers several preventive services:

  • The Welcome to Medicare visit is a one-time benefit you can take advantage of within 12 months of enrolling in Part B. The visit may include a review of your potential risk for depression. It’s a great opportunity to discuss any concerns you may have about your mental health, and build a rapport with your physician especially if you have a new doctor with your Medicare coverage.
  • The Annual Wellness Visit is initially scheduled after your first year of having Part B and annually after that. It is an opportunity to talk to your doctor about changes in your physical and mental health since the prior visit.
  • An annual depression screening takes place in a primary care setting that can follow through with treatment and referrals.

If your healthcare provider accepts assignment and participates in the Medicare program, you pay nothing for these services because participating providers have agreed to accept the Medicare-approved amount as payment in full.

Symptoms of Behavioral Health Issues

The National Institute of Health (NIH) recommends getting professional help if you have severe or distressing signs of depression for two or more weeks, but if you are in crisis, please contact your doctor immediately.

Symptoms may include:

  • Trouble sleeping
  • Changes in appetite that lead to undesired weight gain or loss
  • Mood changes that drag you down to the point where you can’t get out of bed
  • Inability to concentrate
  • Loss of interest in activities that used to bring you joy
  • Lack of capacity to go about your day and manage responsibilities as you did in the past

The NIH encourages people with symptoms to talk to someone, such as a primary care doctor, before these signs become overwhelming. Counseling and therapy may help, but is mental health therapy covered by Medicare?

Does Medicare Cover Therapy, Counseling, or Psychologists?

Beneficiaries with mental health disorders, such as depression or anxiety, are eligible for Medicare Part B mental health care benefits if received on an outpatient basis. Medicare covers outpatient counseling and therapy visits with clinical psychologists, clinical social workers, clinical nurse specialists, psychiatrists, nurse practitioners or physician assistants. If you are an inpatient in a hospital or skilled nursing facility, Medicare Part A may help cover mental health care services administered once you are formally admitted.

What do Mental Health Services Cover?

Mental health services include individual and group psychotherapy, family counseling, psychiatric evaluation, medication management, diagnostic testing and injectable medications. Coverage also includes partial hospitalization services, which are intensive outpatient services delivered during daytime hours.

These services are typically provided by a hospital or community mental health center. You may be able to request a telehealth visit if you live in a rural area. To get mental health services, you must meet the Part B deductible of $233 in 2022. Once the deductible is met, Medicare pays 80% of the Medicare-approved amount.

Now that you know the services covered, it’s time to find mental health therapists that take Medicare.

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Therapists Who Take Medicare Near Me

Using an online Plan Finder Tool is an excellent place to start your search for Medicare plans that include counseling services. If you have Medicare Advantage (MA), check your plan’s network provider directory. With MA plans, you will generally get a higher benefit level when you use a network practitioner.

Depending on the type of MA plan you’re enrolled in, staying within the network may be encouraged or required. For instance, if you have an HMO, you may have to use providers within the plan’s network or risk paying 100% out of pocket for your services.

Does Medicare Cover Prescription Drugs for Mental Health?

Medicare Part D is prescription drug coverage that covers FDA-approved, medically necessary medications prescribed by your doctor and purchased through a pharmacy to take at home. You can get Part D coverage by enrolling in a stand-alone Prescription Drug Plan (PDP) if you have Original Medicare, or you can choose to enroll in a Medicare Advantage Plan that includes prescription drug coverage (MA-PD).

Part D plans are sold by private insurance companies, and the drugs they cover may differ. You can check if your medication is covered by reviewing the plan’s approved drug list, or formulary, which every Part D plan must provide to its members. Each drug plan may have different tiers of pricing, so compare plans carefully if you already rely on specific medications to maintain or improve your health.

Taking Care of Yourself

The National Institutes of Health offers tips to care for your mental health:

  • Exercise regularly, and remember that small amounts of exercise count
  • Maintain a balanced diet, and drink water throughout the day
  • Develop and adhere to a sleeping schedule
    Practice relaxation techniques like meditation and breathing exercises
  • Set goals to help you stay mindful of what you’ve done during the day, not what you haven’t done
  • Write in a gratitude journal every day.
  • Surround yourself with people who support you

If you are thinking of changing your Medicare Advantage plan, we’ve got the perfect resource for you. Use our handy checklist to help you get more of the things you want, without losing any of the good things you already have!

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