Mental Health Services: Does Medicare Offer Coverage?

Why is Mental Health Important?

Mental health is essential to having a happy, productive lifestyle. Mental health awareness is growing, and an emphasis on senior mental health is occurring. Declining health and disease put seniors at risk for mental health conditions, including anxiety and depression. Medicare covers mental health care, including psychological counseling, preventative screenings, and outpatient treatment programs.

Mental health services are for the maintenance or improvement of mental health or treating behavioral disorders. Mental health services include interventions ranging from assessment, diagnosis, treatment, or counseling. Mental health services occur in private, public, inpatient, or outpatient care. Mental health services occur in an individual or group setting.

What is Medicare?

Medicare is a United States federal health insurance program. Medicare supplements health and medical costs for individuals 65+, disabled youth, Social Security Disability Insurance (SSDI) recipients, End-Stage Renal Disease (ESRD) patients, and amyotrophic lateral sclerosis (ALS) sufferers. Medicare operates through payroll taxes, beneficiary premiums, surtaxes beneficiaries, co-pays and deductibles, and U.S. Treasure revenue. The Centers for Medicare and Medicaid Services (CMC) manages Medicare services.

Original and Medicare Advantage

There are two types of Medicare: Original Medicare and Medicare Advantage. The federal government administers original Medicare (Traditional Medicare). Medicare Advantage involves purchasing private insurance. Original Medicare consists of Part A and Part B. Part D is additional coverage for prescription drugs. A Medicare Advantage plan (Part C) is administered by private insurance companies that contract with the federal government. With Medicare Advantage, a premium is paid for Medicare Part B, but all benefits are bundled under one plan from a private insurance company.

  • Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a nursing facility, hospice care, and some home care.
  • Medicare Part B (Medical Insurance) covers specific doctors’ services, outpatient care, medical supplies, and preventative services.
  • Medicare Part C (Medicare Advantage) covers Part A and Part B. Offers additional coverage, including vision, hearing, dental, and health/wellness plans. Sometimes covers Part D.
  • Medicare Part D (prescription drug coverage) helps cover prescription drugs (including many recommended shots and vaccines).

Medicare and Mental Health

Preventive care helps identify patients at risk for mental health problems so that they may receive treatment sooner. Medicare Part B covers preventative services, including screenings. Medicare covers the following preventive benefits:

  • Annual depression screening. Medicare offers one free evaluation for depression if the patient’s doctor accepts the Medicare assignment.
  • Alcohol misuse screening. Mental health problems can lead to alcohol and substance abuse. Medicare covers one alcohol misuse screening. Non-alcohol-dependent enrollees may qualify.
  • Welcome to Medicare visit. The welcome to Medicare visit is an introductory preventative visit those reviews risks of depression that must be done within the first year of Medicare.
  • Wellness visit. The doctor evaluates physical and mental health. Bring up and concerns with the physician. The doctor will make recommendations based on risk factors or refer them for additional treatment.

Medicare Part A covers general hospital and psychiatric hospital services. There is a cap on Medicare coverage for inpatient services if staying at a psychiatric hospital instead of a public hospital. Medicare Part A covers psychiatric hospital care up to 190 days in a lifetime. When admitted to the hospital as an inpatient, Medicare Part B covers doctor services received during the stay.

Medicare Part B covers mental health outpatient services through a clinic or therapist’s office. Medicare covers counseling services, including diagnostic assessments including:

  • Psychiatric evaluation and diagnostic test
  • Individual therapy
  • Group therapy
  • Family counseling
  • Alcohol abuse counseling

Medicare Part D covers prescription drug benefits. Medicare Part A and Part B do not include drug coverage. Medicare Part B covers some medications that cannot be self-administered. Beneficiaries with Original Medicare must enroll in Medicare Part D prescription drug plan. Medicare Advantage enrollees can get drug coverage through a Medicare Advantage Prescription Drug plan. A Medicare Advantage Prescription Drug plan includes Medicare Part A, Part B, and Part D benefits. Stand-alone Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans vary in cost and coverage. Check the plan’s drug formulary, listing the medications covered by the plan. The drug formulary is subject to change.

Final Word

Medicare does not cover all therapy. Marital counseling and pastor counseling are not covered. Coverage only extends to a clinical psychologist or another health professional that accepts Medicare assignments. Medicare covers outpatient treatment programs, allowing beneficiaries to get more in-depth care without being admitted for inpatient care. Outpatient treatment programs typically operate through the outpatient unit or community mental health facility.


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