Medicare Coverage Of Therapy And Mental Health Benefits

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Contributing expert: Kelly Blackwell, Certified Senior Advisor®

Medicare beneficiaries can access mental health care benefits through Original Medicare Part A (hospital insurance) for inpatient care and Part B (medical insurance) for outpatient services; or through a Medicare Advantage plan. Mental health coverage through Medicare supports optimal emotional, psychological, and social well-being.

Updated: July 30, 2021


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Kelly Blackwell
Certified Senior Advisor (CSA)
Kelly Blackwell
Certified Senior Advisor (CSA)

Kelly Blackwell is a Certified Senior Advisor (CSA)®. She has been a healthcare professional for over 30 years, with experience working as a bedside nurse and as a Clinical Manager. She has a passion for educating, assisting and advising seniors throughout the healthcare process.

Does Medicare Cover Mental Health Therapy?

Yes, Medicare covers mental health care, which includes counseling or therapy. Depending on your needs, mental health care can be provided in a variety of settings. The goal is that you get the right kind of support when you need it.

Mental health pertains to our emotional, psychological, and social well-being. Our mental health can impact how we think, feel, and act. From a holistic, whole-person perspective, mental health plays a big part in our general overall health. Just as Medicare helps cover physical ailments, it also offers various benefits to support emotional, psychological, and social health.

Mental health concerns include anxiety and depression, substance abuse, eating and stress disorders, schizophrenia, and attention-deficit/hyperactivity disorders. These concerns can range from mild to severe and can be addressed on an outpatient or inpatient basis.

You can access mental health benefits through Original Medicare or Medicare Advantage (MA) plans, an alternative to Original Medicare. MA plans offer the same services, follow the same Medicare rules as Original Medicare, and generally require in-network providers, referrals, and prior authorization to receive benefits.

How Much Will Medicare Pay for Mental Health Services?

Medicare will pay a portion of a designated Medicare-approved amount for mental health services provided by licensed professionals who accept Medicare assignments. You are responsible for copays, coinsurance, deductibles, and any amount charged for the service that is higher than the Medicare-approved amount.

Mental health services, such as individual counseling provided in an outpatient setting, will be covered at 80% of the approved charge with Medicare Part B after the annual deductible ($203 for 2021) is met. You pay the other 20%. If you have an MA plan, you will pay a copay, typically ranging from $20 to $40 per session, to see an in-network provider. Deductibles may apply, and your MA plan will cover the rest of the contracted in-network cost.

MA plans must provide mental health services as a Medicare-covered service. Any out-of-pocket expenses you incur in the form of copays count toward your maximum out-of-pocket limit set by your MA plan.

If you receive inpatient mental health services that require hospitalization under Part A, you will be responsible for the deductible ($1,484 per benefit period in 2021).

Alternatively, if you are in a MA plan, you pay a daily copay for days one – six for each admission. In 2021, for instance, if you have a UnitedHealthcare MA HMO plan, your daily copay is $225. If you have a similar type of plan with Humana, your daily copay is $190. And if you have a similar plan with BCBS/Anthem, your daily copay is $270. See each plan’s Evidence of Coverage (EOC) for more details.

All inpatient mental health care coverage in a Medicare plan, whether through Original Medicare Part A or a MA plan, includes a maximum lifetime limit of 190 days for inpatient services received in a psychiatric hospital.

Does Medicare Pay for Therapy Services?

As part of mental health care benefits that Medicare offers, therapy, or counseling, is typically covered under Part B as an outpatient service with Original Medicare. MA plans provide the same benefits as Part B does. Therapy generally can be for an individual or a group. Family therapy is covered if it is to support the Medicare beneficiary’s mental health treatment goals.

Like all mental health services, therapy must be received from a provider that accepts assignment for Original Medicare or is in-network for MA plans. The provider must be licensed in your state. Copay or coinsurance and deductibles apply.

In 2021, for instance, for outpatient mental health care through a UnitedHealthcare MA HMO plan, you pay $25 copay for each Medicare-covered individual therapy session and $15 copay for group therapy. For a similar type of plan with Humana, you pay a $20 copay for mental health services received from a specialist, an outpatient hospital, or intensive therapy that is part of the day program in a hospital. For a similar plan with BCBS/Anthem, you pay $40 for each Medicare-covered visit, group, or individual.

Your copays vary depending on your MA plan. To find out what your out-of-pocket costs will be and precisely what your plan will cover based on Medicare rules, talk with your plan’s administrator, review your EOC, and talk with your healthcare provider. Allow for the time it takes to get a referral and prior authorization.

Part of therapy includes ongoing evaluation of the benefits of that therapy and a periodic look at how well it meets your mental health goals. These evaluations should take place between you and your provider and support the need for continued services that can be billed to your Medicare insurance.

Medicare typically covers teletherapy for mental health care services at no cost to you.

What Part of Medicare Covers Mental Health Care?

Medicare Part A covers mental health care in an inpatient setting. Part A mental health care is in a general hospital or a psychiatric hospital only for people with mental health concerns. If you get inpatient care in a psychiatric hospital, Part A will cover up to 190 days in a lifetime. There is no limit to the number of benefit periods you can have for mental health care in a general hospital.

Part A covers your room (not typically a private room), meals, nursing care (not private duty nursing), therapy and treatment, lab tests, medications, and other services and supplies you need. Part A does not cover personal items or a phone or TV in your room.

Medicare Part B covers mental health care on an outpatient basis in these types of settings:

  • A doctor’s or other health care provider’s office
  • A hospital outpatient department (you may have to pay an additional copayment or coinsurance)
  • A community mental health center

And from these types of providers (who accept Medicare assignment):

  • Psychiatrist or another doctor
  • Clinical psychologist, social worker, or nurse specialist
  • Nurse practitioner
  • Physician assistant

Part B helps pay for these outpatient mental health services:

  • One depression screening per year is done in a primary care doctor’s office or clinic to provide follow-up treatment and referrals.
  • Individual and group psychotherapy by licensed professionals in the state where you get services.
  • Family counseling, if the main purpose is to support your mental health treatment.
  • Testing to assess whether or not you are getting the services you need and if they are helping you, including certain lab tests.
  • Diagnostic tests
  • Psychiatric evaluations
  • Medication management
  • Certain prescription drugs that aren’t self-administered, like some injections
  • Partial hospitalization. These are intensive outpatient services that you get during the day, but you don’t have to stay overnight. This is in lieu of hospitalization.
  • Your one-time “Welcome to Medicare” preventive visit that includes a review of your possible risk factors for depression.
  • Your yearly “Wellness” visit when you talk with your health care provider about changes in your mental health.
  • Medication, counseling, drug testing, and therapy services provided by opioid treatment programs
  • One alcohol misuse screen per year for adults who use alcohol but don’t meet the medical criteria for alcohol dependency

Part D (drug coverage) helps cover self-administered prescribed drugs.

Medicare Advantage plans cover all services offered through Original Medicare Part A, Part B, and usually Part D. Copays and coinsurance amounts vary, depending on your plan. Providers and services must be in-network and typically require referrals and prior authorizations before you can receive services.

See your MA plan’s Evidence of Coverage (EOC) for details about what is covered and what you pay. Mental health care services with MA plans are categorized as “Inpatient Mental Health Services” (which correlates to Original Medicare Part A) and “Outpatient Mental Health Services” (which correlates to Original Medicare Part B).

Experts

Kelly Blackwell, Certified Senior Advisor®

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