Medicare and mental health benefits – What Medicare covers

As you grow older, life and tough circumstances can lead to issues such as depression, anxiety and more.

The human body is a complex and highly sophisticated system that has many delicate parts working in harmony. The command center for this entire system is, of course, the brain, which is why mental health is so crucial to overall well-being. As you grow older, life and tough circumstances can lead to issues such as depression, anxiety and more. The good news is that these ailments are treatable. Health sciences have already come a long way and continue to grow as doctors and scientists work hard to discover new ways to alleviate mental health issues. There is effective treatment already available for so many mental health issues, with more being developed as time goes on.

If you are on a Medicare health coverage plan you may be wondering, does Medicare cover mental health? The simple answer is yes. However, there are limitations and specific terms involved in the process. Here’s everything you need to know about what Original Medicare Parts A and B cover in terms of mental health treatments.

Medicare and mental health

Medicare mental health coverage is available and quite comprehensive as part of the offering from original Medicare, however, it isn’t all-encompassing. While there isn’t a specific Medicare mental health plan per se, you get a certain degree of both inpatient and outpatient coverage as part of Medicare’s mental health coverage.

Inpatient care

Inpatient care or treatment that requires admission into a medical facility for issues related to mental health is covered by Medicare Part A. This pertains to treatment in both general hospitals and specialist psychiatric hospitals as well. However, there are limitations; Part A will only pay for coverage for up to 190 days of inpatient care in a psychiatric hospital throughout your lifetime. Part B also contributes to inpatient treatment by helping cover part of the fees for doctors and other healthcare professionals when you are admitted into a hospital for inpatient care relating to mental illnesses. There are a few aspects of inpatient care that are not covered by Original Medicare though.

These include: 

• Charges incurred by a private duty nurse
• Costs of additional facilities in your hospital room such as a phone or television
• Personal items you acquire such as toothpaste, a razor, socks etc.
• The additional costs incurred by opting for a private room if it isn’t medically necessary

Outpatient care

Not all situations will require hospital stays, and Original Medicare does cover mental health in outpatient treatment situations as well. Medicare Part B covers the costs incurred through visits to mental health professionals such as psychiatrists or other doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician assistants. Any doctors or psychiatrists you visit must participate in Medicare for you to receive these benefits. Part B covers various visits to health professionals for mental health, be it in a hospital, clinic, or doctor’s office. This also includes treatments for alcohol and drug use. Here are the outpatient Medicare mental health treatments available through Part B.

• One depression screening each year
• Individual and group psychotherapy
• Family counseling, if specifically required as part of your treatment
• Tests measuring effectiveness of treatment
• Psychiatric evaluations
• Medication management
• Certain drugs that aren’t self-administered
• Diagnostic tests
• Partial hospitalization
• Depression check during initial Welcome to Medicare screening
• Yearly wellness visit

Drug coverage (Medicare Part D)

Drug coverage is not a part of Original Medicare, and you must obtain a Medicare Part D drug coverage plan in order to receive benefits pertaining to drugs required to treat mental health. If you do opt for a Medicare drug coverage plan, you will receive a formulary that you can consult in order to find out what drugs related to mental health are covered by the plan. Typically, all antidepressant, anticonvulsant, and antipsychotic medications are covered in Part D.

Costs associated with this care

Copayments, coinsurance and deductibles are all charged during mental health treatment under Medicare, just like with any other kind of treatment. If you have purchased Medigap or Medicare Supplement plans then these charges may change based on your choice of plan.

Medicare and mental health coverage are intrinsically linked. However, there are also limitations and drawbacks, especially if you only have original Medicare and no other form of coverage. This is where Medicare Advantage plans, such as Blue Shield of California Medicare Advantage Plans can be useful. All Medicare Advantage plans match the coverage offered in Original Medicare at the very least and typically offer more coverage. Usually, Medicare Advantage plans also come with a drug coverage component, which means you get additional coverage for your mental health needs. If you are looking for a more comprehensive Medicare mental health offering than what is offered through Original Medicare, then Medicare Advantage is well worth considering.