Medicare and Mental Health: Coverage and Costs

what medicare covers for mental health, woman looking anguished

Did you know that more than 40 million American adults suffer from mental illness such as depression, bipolar disorder, anxiety disorder, and schizophrenia? Sadly, less than half of those Americans receive the treatment they need to treat their mental illness. This is partially due to the stigma surrounding mental illness, but it’s also due to lack of resources, lack of insurance, or just not knowing where to start. Around 20 percent of older Americans live with some form of mental illness, so it’s important to know what Medicare will cover and how much treatment will cost.

Part A coverage

Medicare Part A covers hospital inpatient mental health care, including rooms, meals, nursing, and other related services and items. While this covers both general hospital and psychiatric hospitals, Part A only covers 190 days of inpatient psychiatric hospital services during your lifetime. Part A does not cover non-essentials like a private nurse, a private room (unless medically necessary), and a phone or television in your room.

Part A costs

Part A costs included in mental health services include:

  • Part A deductible ($1,364 in 2019, applied for each benefit period)
  • No coinsurance for days 1-60
  • $355 coinsurance for days 61-90
  • $670 coinsurance per lifetime reserve day after 90 days. Lifetime reserve days are the days in which you remain an inpatient beyond the 90 days that Medicare covers. Medicare will pay for your covered costs and charge you a daily coinsurance for up to 60 of lifetime reserve days.

You will be responsible for all costs once all of your lifetime reserve days are used up.

Part B coverage

Medicare Part B covers the following for mental health care:

  • Annual depression screening
  • Psychiatric evaluation
  • Certain diagnostic tests
  • Partial hospitalization (like a structured outpatient program)
  • Individual psychotherapy
  • Group psychotherapy
  • Family counseling
  • Medication management

infographic showing what medicare part b covers for mental health

Please note, Part B will only cover counseling and psychotherapy as administered by a professional licensed in the state in which care is provided. For example, counseling received from a pastor would not be covered, but care received from a licensed psychologist or licensed social worker would be covered. The healthcare professional must also accept Medicare-assignment in order for the services to be covered.

Part B costs

Part B costs included in mental health services include:

  • Medicare Part B deductible ($185 in 2019)
  • 20% of the Medicare-approved amount of services after the deductible has been met
  • A possible copayment or coinsurance, usually between 20-40% of the Medicare-approved amount of service

Part D coverage and costs

By law, Medicare must cover some drugs, including antidepressants and antipsychotic medications.

The cost of your medications depends on if the drug is brand-name or generic, what drug plan you have, and what coverage period you’re in. For more information on drug pricing, call you drug plan or pharmacy directly.

Mental health resources

If you or someone you know is at risk of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). You can speak to a trained crisis counselor 24/7.

You can also text the Suicide Prevention Lifeline at 741741 to talk to a trained crisis counselor 24/7 for free.

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