Does Medicare Cover Mental Health Therapy?

Susanna Marsiglia - Mental Health Therapy

If you are wondering whether Medicare covers mental health therapy, the answer is yes. Medicare offers coverage for inpatient mental health services under Medicare Part A. It also offers coverage for outpatient mental health services under Part B. Some of the outpatient mental health services Medicare offers are evaluations and visits to a mental healthcare provider.

Medicare Part B provides coverage for mental health services you get as an outpatient. You can get these mental health services through the office of a therapist or from a clinic. Medicare offers coverage for counseling services, which include the following:

• Alcohol abuse counseling

• Psychiatric evaluation and diagnostic tests

• Family counseling

• Individual therapy

• Group therapy

It is important to note that alcohol abuse counseling is offered for up to four sessions. You should also note that the goal of a family counseling is to help improve your condition. Furthermore, additional eligibility requirements may be needed to qualify for the above benefits. Another important piece of information is that Medicare does not cover all types of therapy. For example, the program does not offer coverage for counseling with a pastor or marital counseling.

It only covers mental health services you get through a clinical psychologist, licensed psychiatrist, or other healthcare professional who approves the Medicare program.

There are instances where some individuals with mental health conditions may need more rigorous treatment than a therapist or doctor can offer. Having said that, it is worth noting that the program also offers coverage for outpatient treatment sessions where beneficiaries can enjoy structured or rigorous mental health services without being admitted for inpatient care.

Referred to as partial hospitalization programs, these programs are run through the outpatient unit of a hospital. They can also be run through a community mental health facility, and you may be eligible for them if your doctor provides verification that you are better off hospitalized as an inpatient.

Does Medicare Offers Coverage for Inpatient Mental Healthcare?

Sometimes your condition may require an inpatient stay, and if this turns out to be the case, you can rely on Medicare Part A for general hospital as well as psychiatric hospital services. You should, however, know that there is a cap on coverage for the inpatient services you receive if you choose to stay at a psychiatric hospital versus if you are in a general hospital. In other words, Part A will only offer coverage for psychiatric hospital care for up to 190 days in your lifetime.

Does Medicare Offer Coverage for Preventative Mental Health?

Preventative care is very crucial since it helps identify patients at risk of facing mental health issues. In so doing, preventative care ensures these patients get the necessary treatment sooner. Part B offers coverage for several preventative services, including screenings, to assess a patient’s risk for some mental health conditions.

Medicare offers coverage for the following benefits:

1. Wellness Visit

A wellness visit is an annual visit that allows your doctor to carry out an evaluation both on your physical and mental health. Also, during this type of visit, you get the opportunity to talk about any mental health concerns with your doctor. Plus, the wellness visit gives your doctor a chance to make recommendations on your risk factors or refer you for extra treatment.

2. Annual Depression Screening

Everyone with Medicare is eligible for one free evaluation for depression every year, provided your physician approves Medicare assignment.

3. “Welcome to Medicare” Visit

The ‘Welcome to Medicare’ visit is an introductory preventive visit that includes a review of a patient’s risk for depression. A patient should have the exam within year one of getting Medicare.

4. Alcohol Misuse Screening

Patients with mental health problems may find themselves dealing with alcohol abuse. Medicare offers coverage for one alcohol misuse screening every year. If you have enrolled in Medicare and you are not alcohol dependent, you may qualify. However, if a patient is not alcohol dependent, they may qualify for counseling.

Does Medicare Offers Coverage for Mental Health Prescription Drugs?

Medicare Part D offers coverage for prescription drug benefits you may require for treatment of your condition. It is crucial to note that Original Medicare, which includes Parts A and B, does not cover drug benefits. Part B, however, covers some medications, which cannot be self-administered. These medications include drugs that are given by injection. But if you are looking for prescription coverage and already have Original Medicare, then you will have to enroll in a Part D prescription drug plan.

Original Medicare covers mental health therapy services such as individual therapy, group therapy, and alcohol abuse counseling, among others. Additionally, Part D covers prescription drug benefits you may need to treat your condition. Overall, it is highly recommended that you consult with your physician regarding diagnosis and/or treatment for a mental health condition.


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