Mental health is an important part of your overall health and well-being. But sometimes it can be hard to talk about – especially for older adults. In fact, the Centers for Disease Control and Prevention (CDC) estimates that nearly 20% of people over age 55 experience some type of mental health concern. This can include things like depression, anxiety, grief, other mood disorders and cognitive behavioral mental illness.
But you’re not alone. There are many different forms of mental health services that can meet you where you’re at and help you to live a happier, healthier life.
Original Medicare provides some mental health coverage, both inpatient and outpatient depending on your needs. Let’s walk through this together, including what parts of Medicare cover which services, what you can expect with out-of-pocket costs and coverage benefits and limitations.
Medicare Part A covers inpatient mental health care
Sometimes, managing mental health conditions needs more psychiatric care than outpatient services can provide. That’s OK – the important thing is getting the help you need, and this is where inpatient care comes in. Original Medicare, specifically Part A (also known as hospital insurance), will help cover the mental health services you receive when admitted to a general or psychiatric hospital.
This includes things like:
- Semi-private hospital rooms and meals
- Nursing care
- Therapy or other treatment for your condition
- Lab tests
- Medicines
How long does Medicare Part A cover inpatient services?
In general, Medicare groups your Part A services into what they call “benefit periods.” A benefit period starts the day you’re admitted as an inpatient – whether that’s at a skilled nursing facility or general or psychiatric hospital – and it ends after you’ve gone 60 days without receiving inpatient care.
It's important to consider the type of hospital you’re being treated at. For instance, a general hospital doesn’t have a limit on the number of benefit periods you can have. Coverage and cost sharing will most likely be the same as other types of inpatient hospital stays.
However, with a psychiatric hospital, a benefit period doesn’t apply – you’ll receive coverage for up to 190 days. This is a lifetime limit. If you hit that 190-day limitation, you’ll need to begin receiving mental health services at a general hospital to be covered.
The costs of Part A inpatient services
Medicare coverage amounts, like premiums, deductibles, copays and more, change each year. For 2023, here’s what you can expect to pay:
- 20% of all Medicare-approved costs for the mental health services you get from providers during your stay
- $1,600 deductible per benefit period
- $0 copay for your first 60 days of inpatient treatment
- $400 daily copayment for days 61–90 of inpatient treatment
- $800 daily copayment (while using your 60 lifetime reserve days) for days 91 and beyond of inpatient treatment
- All costs after day 150 of inpatient treatment
If you have Medicare Supplement insurance or a Medicare Advantage plan, you may pay less and/or receive more hospitalization days or extra coverage depending on their benefits.
Medicare Part B covers outpatient mental health services
Medicare Part B (medical insurance) covers the outpatient mental health services you receive outside of a hospital. These are typically provided at a doctor’s office or clinic by mental health care professionals like psychologists, psychiatrists or clinical counselors and social workers.
Outpatient mental health care services may be:
- Depression screenings
- Individual and group psychotherapy
- Psychiatric evaluations and testing
- Medicine management
- Treatment for substance abuse disorders
- Intensive Outpatient Programs (IOPs)
Part B also covers partial hospitalization, which is a mental health treatment program you can commute to that is provided in a hospital outpatient setting or by a community mental health center.
How long does Medicare Part B cover outpatient services?
Unlike Part A inpatient services, Part B coverage isn’t limited to benefit periods and days. Think of it more like a routine medical service: Once you meet your deductible, you’ll pay coinsurance out of pocket for therapy sessions. Your mental health care provider must accept Medicare and also consent to the Medicare-approved amount in terms of coverage.
In addition to these services, Original Medicare will also provide one depression screening each year. This is considered a preventive service, and you won’t have to pay a deductible or coinsurance if you go to your primary care doctor. However, any additional treatment or follow-up after your screening will not be free.
The costs of Part B outpatient services
In general, Part B outpatient services should cost similarly to what you pay for routine office visits with your primary care doctor. First, you must meet your Part B deductible, which can change each year. In 2023, your deductible is $226. Then, once you’ve met this deductible, you’ll pay a coinsurance of 20% for the cost of services.
Coverage for antidepressants and other medicines
Much like other doctor-prescribed medicines, Original Medicare does not cover antidepressants. However, that doesn’t mean you’re out of luck. You can choose to buy a Medicare Part D prescription drug plan or a Medicare Advantage plan as an alternative to Original Medicare.
A majority of Part D and Medicare Advantage plans cover most antidepressants and mental health medicines. You may just have to adjust your choices between brand-name and generic medicines.
Does Medicare cover online therapy?
Yes, Medicare covers online therapy and counseling – a great option for those who may not be able to get to a counselor’s office regularly. Original Medicare began covering telehealth and over-the-phone visits between mental health professionals and clients during the COVID-19 pandemic. In general, your regular copayment and coinsurance rates will apply to these online appointments, so you can know what to expect for out-of-pocket costs.
Does Medicare cover marriage or family counseling?
Original Medicare will sometimes cover marriage or family counseling, but it depends on each situation. Both individual and group counseling is covered under Part B, but it must be considered medically necessary. This means that marriage or family counseling must be a part of your doctor-prescribed mental health treatment as someone with a diagnosed mental health concern.
Another important detail is where you receive your counseling services. Medicare Part B covers 80% of the cost of therapy if it’s provided by a behavioral health care professional. However, Medicare won’t provide coverage for family or couple counseling if it’s with a licensed Marriage and Family Therapist (MFT) – unless they are employees of clinics that accept Medicare.
Get started with your Welcome to Medicare preventive visit
Want to talk about mental health with your doctor? Your Welcome to Medicare visit is a great time to discuss any mental health concerns, screen for possible conditions and come up with a comprehensive course of treatment with your doctor.