Medicare covers nearly all common mental health services, including psychiatric visits, medications, counseling, and hospitalization. Outpatient mental health care is covered under Part B, and inpatient mental health care is covered by Part A. In this article, we’ll go over what types of mental health services Medicare covers, how much they cost, and who is eligible.
What is covered?
Medicare covers a wide variety of outpatient mental health services under Part B:
- One depression screening each year from a primary care doctor or clinic that can provide follow-up treatment or referrals
- Individual and group therapy, as well as family counseling
- Psychiatric evaluations and testing
- Medication management
- Diagnostic testing
- Partial hospitalization
- Substance abuse treatment
You can get these services from psychiatrists, clinical social workers, nurse practitioners, and clinical psychologists.
Inpatient hospitalization is covered under Part A. Patients are eligible for up to 190 days of inpatient hospitalization for mental health services over the course of their lifetime.1 Medications are covered under Part D prescription drug coverage.
What are the costs?
Part B pays 80% of the Medicare-approved amount for care from psychiatrists and other outpatient mental health professionals.2 If you have Medicare Advantage, which combines the benefits of Parts A and B and sometimes D, the costs depend on your specific plan.
Part B plans and many Part D and Advantage plans typically require beneficiaries to meet an annual deductible before the plan pays their portion of service costs. In 2020, the Part B deductible is $198 (up from $185 in 2019).3 The deductibles—as well as medication costs—for Part D and Advantage plans can vary between private insurers.
As mentioned before, inpatient care is covered under Part A, but Part A requires a different kind of deductible. At the start of every inpatient hospitalization benefit period in 2020, there is a $1,408 deductible (up from $1,364 in 2019) that must be met before Medicare will pay its portion.4
The Part A deductible doesn’t reset annually. Instead, it will reset if you’re admitted into the hospital again after being out of the hospital for 60 or more consecutive days.
Other than this deductible, you’ll pay nothing for the first 60 days of each benefit period. After 60 days, there is a set coinsurance payment that increases the longer you are hospitalized in 2020:
- Days 1–60: $0 coinsurance
- Days 61–90: $352 coinsurance per day
- Days 91+ (lifetime reserve days): $704 coinsurance per day for up to 60 reserve days over your lifetime5
Every day after day 90 of each benefit period is considered a lifetime reserve day. Once you’ve exhausted all 60 of your lifetime reserve days, you’ll be expected to pay the full cost of hospitalization for days 91 and up of each benefit period.
Patients are also responsible for 20% of the cost for any mental health services provided by doctors or other providers while hospitalized.6
What are the limitations?
Like all care covered by Medicare, mental health services must be determined medically necessary to be covered. A service is considered medically necessary when a doctor certifies that it is required to treat, prevent, or diagnose an illness.
You’ll have to make sure the provider you choose for your mental health care accepts Medicare patients—not all do, and if they don’t, you’ll have to pay 100% of the costs.
During inpatient hospitalization, Medicare does not cover the following services:
- Private nursing
- Private rooms, unless it is determined to be medically necessary
- Phones or televisions in the hospital room
- Personal items like toothpaste or razors
Who is eligible?
Anyone who is covered under Medicare Parts A and B is eligible for mental health coverage. To enroll in a Part D prescription drug plan, you need to have either Part A or Part B.
To get Original Medicare, you must meet one of several requirements:
- You are age 65 or older.
- You have a disability and receive benefits for it.
- You have been diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).
We hope this information has been helpful. If you have additional Medicare questions, check out our other FAQ pages.
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