The government has expanded Medicare coverage for mental health services as the nation continues evolving its understanding of mental health conditions, especially after the COVID crisis and subsequent lockdowns. There have been relaxations in rules and changes in range. In short, yes, Medicare does cover mental health services, but there are important nuances to consider. Different parts of Medicare cover various conditions, medications, and treatments, and specific rules govern what is covered and how.
The Fundamentals
Most mental health and dual diagnosis (substance abuse) services are primarily managed by Medicare Part B, often called “original Medicare.” Part B does not cover inpatient services, but we’ll delve into that shortly. If you require mental health treatment, it’s crucial to understand that the government specifies the types of providers eligible for coverage. These include medical doctors, physician assistants, psychiatrists, clinical practitioners, clinical social workers, nurse practitioners, family therapists, and mental health counselors.
If you prefer to seek mental health treatment from a provider not listed as an approved option, you can choose a provider who accepts assignments. This is just the basic information regarding how Medicare addresses mental health treatments. Let’s explore it in more detail.
Inpatient Care
Similar to other medical treatments and services, inpatient mental health care falls under the purview of Medicare Part A. This coverage can be used at psychiatric and general hospitals, subject to certain conditions. For instance, under Medicare Part A, a patient is allowed a maximum of 190 inpatient mental health treatment days over their lifetime. In other words, if you require more than 190 days of mental health treatment, even if they are separated by time, you will be responsible for all expenses starting from day 191.
Medicare Part A does not cover certain inpatient mental health costs, such as private nursing, in-room entertainment (phone and television), private rooms, and personal items you may need during your stay.
Outpatient Services
Medicare Part B or original Medicare covers outpatient mental health services. Coverage is particular, including the “Welcome to Medicare” visit and depression screening, which are covered. The “Welcome to Medicare” visit assesses your risk factors for depression, and Medicare Part B covers one depression screening annually.
Medicare Part B also covers individual and group psychotherapy, mental health testing and evaluations, family counseling (with the Medicare patient as the primary recipient), some medications and medication management, and intensive outpatient dual diagnosis programs.
However, Medicare Part B does not cover certain services, such as transportation to mental health facilities, support groups, and job skills training.
Costs
The costs associated with mental health treatment align with the standard rules for various parts of Medicare, which can be somewhat confusing. Here’s a cost breakdown:
- The “Welcome to Medicare” visit, annual wellness visits, and yearly depression screenings are fully covered by Medicare Part B at no cost.
- Hospitalizations and other inpatient treatments covered by Medicare Part A are subject to a deductible and daily copay.
- Screening and treatment for opioid abuse and tobacco cessation are fully covered, but any necessary medical supplies may be subject to deductibles.
- Other forms of mental health treatments, like regular counseling, typically entail standard copays and deductibles, resulting in patients paying 20% of the treatment cost.
Telehealth
One significant change to Medicare’s approach to mental health treatments is the approval of telehealth for therapies and screenings. Due to the isolation brought about by COVID-19, many individuals have turned to telehealth for continued treatment. The federal government has temporarily allowed telehealth to facilitate access during this time. It’s essential to remember that copays and deductibles may still apply, occasional in-person visits may be required, and telehealth coverage could change in the future, necessitating awareness of evolving rules and regulations.
Medicare Advantage
So far, we’ve focused on original Medicare, but what about individuals with private Medicare Advantage plans? Since private insurers must offer the same minimums as original Medicare, Medicare Advantage does indeed cover mental health treatments. Depending on the policy, insurers may extend coverage to therapies not included in original Medicare. If you’re considering Medicare Advantage and mental health is a priority, it’s crucial to explore various insurers to find the coverage that suits your needs.
Medicare Part D
Prescription drug coverage for mental health medications operates similarly to other medicines. Approved medications will be either partially or fully covered.
Whether Medicare already covers you and you are seeking mental health treatment or shopping for Medicare with anticipated mental health care needs, understanding what is and isn’t covered is paramount. Knowing your costs is essential for budgeting. While the intricacies of coverage can be somewhat perplexing, the principles of inpatient and outpatient treatments align closely with standard Medicare Parts A and B care.
