Does Medicare Cover Psychiatric Care?
Medicare Benefits Solutions
Nov 19, 2021
There are many reasons why you may reach out for psychiatric help. As described by the American Psychiatric Association (APA), you may have problems that are:
- Sudden: panic attack, scary hallucinations, suicidal thoughts or inner voices
- Chronic or long-term: hopelessness, sadness, or anxiety leading to an inability to function
Regardless of the reason, be assured that Medicare coverage includes extensive mental health care services. If you are experiencing any mental health concerns, please contact your doctor.
Medicare Part A inpatient psychiatric care
Part A covers inpatient services in hospitals, rehabilitation facilities, and psychiatric facilities. Mental health care can be provided in a general hospital or a hospital exclusive to people who have mental health conditions. Inpatient psychiatric care provided in a free-standing psychiatric hospital has a lifetime limitation of 190 days.
The following is an overview of what is and is not covered under Part A inpatient care.
- Semi-private room
- General nursing
- Private room, unless medically necessary
- Private-duty nurses
- Charges for in-room television or telephone
- Personal care products
- Part A deductible ($1,484 in 2021) for each benefit period
- Coinsurance if your stay exceeds 60 days
- 20% of the Medicare-approved amount for the health care providers (covered under Part B)
Unlike Medicare Part B, which has an annual deductible, the Part A deductible is due for each benefit period.
What are benefit period guidelines?:
- A benefit period begins on the day of your admittance
- Ends after you have gone at least 60 consecutive days without inpatient care
- Is unlimited and requires a deductible each time a new benefit period begins
Medicare Part B outpatient psychiatric care
Medicare Part B covers your doctor’s medically necessary services in and out of the hospital, outpatient care, mental health care and other medical services.
Outpatient mental health care under Medicare Part B helps to treat conditions like depression and anxiety. Outpatient settings include a doctor’s office and hospital outpatient center. Your health care visit can be with a psychiatrist, clinical psychologist, nurse practitioner, clinical nurse specialist, physician assistant or clinical social worker.
Medicare Part B mental health care benefits include:
- Psychotherapy (individual or group)
- Family counseling
- Testing to validate your treatment
- Psychiatric evaluation
- Medication management
- Prescription drugs covered under Medicare Part B (not self-administered drugs)
- Diagnostic tests
- Partial Hospitalization Program – an intense, structured outpatient psychiatric program delivered in a doctor’s practice or therapists’ office, not requiring an overnight stay
Your Medicare Part B costs:
- 20% of the Medicare-approved amount
- Part B deductible ($203 in 2021)
- Additional coinsurance or copayment to the hospital outpatient facility
If you have Medicare Part B benefits, you are also eligible for an annual depression screening. If your healthcare provider accepts assignment, you do not have to pay anything for this service. Be sure to use Medicare-participating doctors who accept direct payment from Medicare as payment in full.
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References for mental health services include:
- American Psychiatric Association (APA)
- National Suicide Prevention Lifeline: 1-800-273-8255 (TTY: 1-800-799-4889)
- Substance Abuse and Mental Health Services Administration (SAMHSA) national helpline: 1-800-662-4357
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