Medicare is the biggest health insurance program in the US. It covers hospital care, and outpatient services, and has prescription drug benefits. This depends on which plan type you’re enrolled in. Enrollees can access these benefits at their discretion. This is as long as they pay anything that isn’t covered by their specific plan via out-of-pocket costs. Are you wondering if Medicare covers mental health services like therapy? Here’s what you need to know about this health coverage benefit.
Does Medicare Cover Therapy?
Medicare is a federal health insurance program. It covers people 65 and older and younger people with certain disabilities. Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), and Part D (prescription drug coverage). Medicare Part C plans can include additional benefits that aren’t covered by Parts A and B.
Part B medical insurance covers many services, including mental health care, but some Medicare Advantage plans offer extra coverage for mental health services.
Private insurance companies contract with Medicare to provide health care services to enrollees. Original Medicare is the traditional government-sponsored Medicare coverage. It’s available for people who qualify for it based on age or disability status.
Florida is one of the few states that offer coverage for mental health services under Medicare Advantage plans. The state also has one of the highest percentages of adults with mental health coverage through Medicaid and state employee health programs. If you’re considering applying for Medicare in Florida, ensure you do so in person at the Social Security office.
There are some exceptions to the rule that Medicare does not cover mental health services. For example, suppose you receive treatment for substance abuse or dependencies such as alcohol and drugs. Then these sessions can be covered by Medicare Part B. Let’s say you need individual counseling because of a permanent disability that limits your ability to function independently daily. These sessions can also be covered by Medicare Part B.
To qualify for coverage of mental health services under Part B, your doctor will need to provide documentation of the diagnosis. They should prove that the need to see a therapist or psychiatrist on an ongoing basis is necessary.
What Mental Health Services Does Medicare Cover?
The best Medicare plans cover some mental health services, but the coverage is not comprehensive.
Medicare Part B covers outpatient mental health services and counseling. Medicare needs that all Part B plans to cover these services to the same extent as other types of outpatient care. The only exception is for partial hospitalization treatment. This is a type of intensive treatment during which patients receive medication and therapy on an outpatient basis. Medicare doesn’t cover partial hospitalization because it’s more like inpatient care than outpatient mental health treatment.
Medicare doesn’t typically cover long-term residential care unless a doctor or other clinician orders it as part of your treatment plan. Your doctor may recommend this type of care if you need help managing your symptoms. This care can be offered if you’re recovering from an episode of serious depression or bipolar disorder.
You can only receive hospital care if you meet certain criteria. This includes being admitted as an inpatient and receiving residential treatment for at least three days.
The following is a list of some common mental health services covered by Medicare:
- Psychotherapy. This involves speaking with a therapist about problems or concerns. Psychotherapy can be done in person or over the phone. Medicare covers both types of therapy as long as a licensed psychologist provides them. It could be a qualified professional who Medicare has approved to provide these services.
- Group therapy. This is when people meet to talk about their problems, emotions, or thoughts in a group setting. Medicare may cover group therapy if provided by a licensed professional who Medicare has approved to provide these services. You must have a referral from your primary care doctor before you can get group therapy through Medicare.
- Counseling. Medicare covers counseling for depression or anxiety. It also covers counseling for alcohol or drug abuse and smoking cessation if a doctor writes the prescription. Depending on their income level and other factors, some people may be required to pay a copayment for these services.
- Crisis Intervention Services. Medicare will pay for crisis intervention services if you meet certain criteria, such as recently being discharged from a psychiatric hospital. You must also show evidence that you need the service and that there is no other payment source for those services. There may be copayment required for these types of visits.
- Drug and Alcohol Rehabilitation. Suppose you’re being treated at an inpatient facility for substance abuse, it may be covered by Medicare if it’s medically necessary and there’s no other way to pay for it. Otherwise, it would be considered an outpatient treatment center.
Does Medicare Part D Cover Prescriptions for Depression?
Medicare Part D covers prescriptions for depression if you meet certain eligibility requirements. The two main Medicare Part D plans are stand-alone prescription drug plans and Medicare Advantage plans.
In a stand-alone plan, you must have both medical and drug coverage to be eligible to enroll in a Medicare Part D plan. Medicare Advantage plans typically cover both medical and prescription drug benefits.
Some Medicare Advantage plans include mental health services as an optional benefit. These services may include counseling or psychotherapy sessions with a physician or other mental health professionals. If your plan includes mental health benefits, they’ll be listed in the plan booklet mailed to you. You’ll see the benefits when you join the plan or on your monthly member materials statement.
Most Medicare Advantage plans have limits on how much they’ll pay for mental health services each year. These limits are based on the type of service covered by the plan, for example, outpatient services. Besides, most plans need authorization before paying for any mental health service, including prescription drugs.
Can You Get a Separate Plan to Cover Mental Health Services?
If you’re interested in getting extra coverage for mental health services, you can purchase a supplemental policy to fill these gaps. Also known as Medigap insurance, these policies may have various names depending on where you live. They provide coverage for prescription drugs and medical equipment that Medicare doesn’t cover.
Suppose you have Medicare Parts A and B but decide not to enroll in Part D prescription drug coverage, you could also be eligible for Medigap insurance to fill those gaps in coverage.
The Medicare coverage for psychotherapy is limited and, for some, expensive. The good news is that some Medicare insurance plans do cover a small percentage of these costs. You’ll just have to check your policy before scheduling a session. But if it turns out that your plan doesn’t cover mental health, or if you’re hoping to supplement your coverage, there are still options for getting the care you need.