How Medicare Covers Outpatient Mental Health Services
Does Medicare cover outpatient counseling or therapy sessions for seniors? Since retiring, my husband has really struggled with depression and needs to get some help. What can you tell us?
Yes, Medicare recently upgraded its coverage of outpatient mental health services to help beneficiaries with depression and other needs. Here’s how it works.
If you have original Medicare, your Part B coverage will pay 80 percent (after you’ve met your $147 Part B deductible) for a variety of counseling and therapy services that are provided outside a hospital, like individual and group therapy, family counseling and more. They also cover services for treatment of beneficiaries who struggle with inappropriate alcohol and drug use.
You or your supplemental insurance is responsible for the remaining 20 percent coinsurance.
Medicare also gives your husband the option of getting treatment through a variety of mental health professionals such as psychiatrists, psychologists, clinical social workers and clinical nurse specialists.
It’s also important to understand that if your husband decides to see a non-medical doctor (such as psychologists or a clinical social worker), you’ll need to make sure that he or she is Medicare-certified and takes assignment, which means they accept Medicare’s approved amount as full payment. If they don’t, Medicare will not pay for the services.
Medicare will, however, pay for the services of Medicare-certified medical doctors (such as psychiatrists) who do not take assignment, but these doctors can charge you up to 15 percent above Medicare’s approved amount in addition to the 20 percent coinsurance, which you will be responsible for.
To locate a mental health care professional in your area that accepts Medicare assignment, use Medicare’s online Physician Compare tool. Just go to medicare.gov/physiciancompare and type in your zip code, or city and state, then type in the type of profession you want locate, like “psychiatry” or “clinical psychologist” in the “What are you searching for?” box. You can also get this information by calling Medicare at 800-633-4227.
If you and your husband get your Medicare benefits through a private Medicare Advantage plan, they too must cover the same services as original Medicare but they will likely require him to see an in-network provider. You’ll need to contact your plan directly for the details.
In addition to the outpatient mental health services, you should also know that Medicare covers yearly depression screenings that must be done in a primary care doctor’s office or primary care clinic that can assure appropriate diagnosis, treatment and follow-up. Annual depression screenings are covered 100 percent.
Medicare will also cover almost all medications used to treat mental health conditions under the Part D prescription drug benefit. If your husband is prescribed an antidepressant or some other medication for his condition, and he has a Part D plan, you should call his plan to confirm coverage or you can search the plans formulary (the list of medications they cover) on their website.
For more detailed information, see publication #10184 “Medicare & Your Mental Health Benefits ,” or call 800-633-4227 and request a copy be mailed to you.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.