Medicare Coverage for Mental Health Services: What You Need to Know

May 28, 2022
Posted in Medicare
May 28, 2022 Jonathan Nolan

Medicare Coverage for Mental Health Services: What You Need to Know

At some point in life, many of us experience a need for mental health services. And in a lot of cases, those circumstances come after retirement. Once the kids have left home, you’ve left your career, and your social life changes, feeling like depression and anxiety can surface. Many Medicare beneficiaries are uncertain of their treatment options, and might wonder about Medicare coverage for these services. Here’s what you need to know.

Medicare coverage includes preventive services for mental health. We all know that preventing a health condition is often easier, and wiser, than attempting to treat one after the fact. So along with other types of preventive services, Medicare offers screenings for mental health conditions:

  • A “Welcome to Medicare” visit within your first year of coverage, which includes an assessment for your depression risk
  • Annual depression screening via your primary care doctor
  • Alcohol misuse screening (one per year)
  • Annual wellness exams, during which you can talk to your doctor about mental health symptoms or concerns, or ask for a referral if necessary

Medicare coverage includes treatment for mental health conditions. If prevention fails, Medicare does offer coverage for a variety of mental health treatment options. The following services are offered on an outpatient basis:

  • Psychiatric testing and diagnoses
  • Therapy -both individual and group, depending upon your needs and preferences
  • Family therapy in some situations
  • Up to 4 sessions of alcohol abuse counseling

Medicare coverage does extend to inpatient services. In some circumstances, a patient might need more intensive mental health care. Medicare Part A does cover hospitalization, up to 190 days in your lifetime. Medicare Part B will cover services that you receive during your stay in the hospital.

Medicare coverage can help pay for certain medications. Yes, antidepressants and other medications used for mental health conditions can be covered by your Medicare plan. However, because Part D and Medicare Advantage formularies (lists of covered drugs) do differ from one plan to another, it is wise to check your list of covered drugs each year during the enrollment period. Taking this step will help you to maintain a plan that covers the prescriptions you need for your condition.

The plan you have matters.  Advantage Plans and Supplement Plans will differ in the way you access mental health benefits.  If you have any Advantage Plan, contact your broker or insurance company for details on how to access care. If you have Original Medicare, you can see any provider that will accept it.

If you have any other questions about Medicare coverage for mental health services, please contact one of our helpful representatives. We can help you compare and shop for Medicare plans that best suit your needs.



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