Question: Does Medicare cover mental health services?
Answer: Yes, Medicare does cover mental health care services. Mental health care includes services and programs to help diagnose and treat mental health conditions. These services and programs may be provided in outpatient and inpatient settings. Medicare helps cover outpatient and inpatient mental health care, as well as prescription drugs you may need to treat a mental health condition.
What mental health services does Medicare Part B cover?
Medicare Part B helps cover mental health services you generally get outside of a hospital (like in a clinic, doctor’s office or therapist’s office) and services a hospital provides in its outpatient department. Part B also covers visits with these providers:
- Psychiatrist or other doctor
- Clinical psychologist
- Clinical social worker
- Clinical nurse specialist
- Nurse practitioner
- Physician assistant
Doctors or other health care providers who participate in Part B must accept assignment. An assignment is an agreement by your doctor, provider or other supplier to be paid directly by Medicare and not to bill you for any more than the Medicare deductible and coinsurance. You will need to ask your doctor or other health care provider if they accept assignment before you schedule an appointment. Some health professionals, like clinical social workers and clinical nurse specialists, must always accept assignment. Deductibles and coinsurance may apply.
Assignment is an agreement by your doctor, provider or other supplier to be paid directly by Medicare and not to bill you for any more than the Medicare deductible and coinsurance.
What mental health services does Medicare Part A cover?
Medicare Part A (hospital insurance) helps cover mental health services you get in a hospital that require you to be admitted as an inpatient. You can get these services either in a general hospital or in a psychiatric hospital that only cares for people with mental health conditions. No matter which type of hospital you choose, Part A will help cover inpatient mental health services.
Part A covers:
- Semi-private rooms
- General nursing
- Drugs (including methadone to treat an opioid use disorder)
- Other hospital services and supplies as part of your inpatient treatment
What mental health services does a Medicare Advantage Plan cover?
If you have a Medicare Advantage Plan, it may offer extra benefits, like certain types of mental health counseling not covered by Original Medicare. Contact your plan for details. If you have a Medicare Supplement Insurance (Medigap) policy or other health coverage, tell your doctor or other health care provider so your bills get paid correctly.
What mental health prescriptions does Medicare cover?
For Medicare to cover your mental health prescriptions, you must enroll into a Medicare-approved plan that offers drug coverage, like a Medicare prescription drug plan. Medicare prescription drug plans are run by private insurance companies that follow rules set by Medicare. Each plan can vary in cost and in the specific drugs it covers. However, nearly all antidepressants and antipsychotics are required on drug formularies of every Medicare prescription drug plan. It’s important to know your plan’s coverage rules and your rights.
It’s important to know your plan’s coverage rules and your rights.