In this article, you will learn Medicare Parts A and B cover mental health services. In particular, you will learn Medicare covers psychotherapy to treat mental health disorders like anxiety, depression, alcohol, and substance abuse. Furthermore, you will know how Medicare Part B covers alcohol misuse and substance abuse, including opioid use disorder. Moreover, you will better understand depression with the story of the two senior sisters and their COVID-19 experiences. Ultimately, you will discover that psychotherapy can improve the quality of your life.
Medicare Part A – Inpatient Mental Health Services
Medicare Part A covers inpatient mental health services in a general hospital or psychiatric hospital. For example, a psychiatrist may prescribe you medications and admit you to a psychiatric hospital that only cares for people with mental health conditions. If a psychiatrist admits you to a psychiatric hospital, Medicare Part A only pays for up to 190 days of inpatient services during your lifetime. So how much does Medicare pay?
How much will Medicare pay for inpatient mental health services?
Before Medicare pays for your inpatient mental health services, you must first pay Part A deductible for each 60 day benefit period. If you have a Medicare Supplement plan, you do not have to pay this hospital deductible. Medicare will cover the first 60 days in a hospital at no cost. However, between 61 and 90 days in a hospital, you pay $371 coinsurance per day unless you have a supplement plan.
Furthermore, between 91 days up to 60 days over your lifetime limit, you pay $742 coinsurance per day unless you have a supplement plan. The lifetime limit is 190 days. Beyond this lifetime limit, you pay all costs.
Moreover, Original Medicare only pays 80% of the medicare-approved amount for mental health services. Therefore, you are responsible for paying 20% coinsurance while a hospital inpatient unless you have a Medicare supplement plan. So what does Medicare outpatient mental health cover?
Medicare Part B – Outpatient Mental Health Services
Medicare Part B covers outpatient mental health services with a primary care doctor or other qualified health professionals. For example, Medicare covers cognitive assessment and care planning with your primary doctor. This evaluation includes your one-time “Welcome to Medicare” preventive visit, which screens for depression and other signs of cognitive impairment. Moreover, Medicare covers an annual wellness visit where you can speak to your primary care doctor about your mental health. As a result of the screening, your primary doctor may refer you to a psychiatrist for further evaluation or to a psychologist for counseling.
After your psychological evaluation, a clinical psychologist or psychiatrist could recommend partial hospitalization as an alternative to inpatient psychiatric care. Under partial hospitalization, you receive more intensive treatment than you get in a clinician’s office. Treatment requires you to stay in a hospital outpatient department during the day and go home overnight. So what does outpatient mental health coverage cost?
How much will Medicare pay for outpatient mental health services?
Your one-time “Welcome to Medicare” and annual wellness visits cost zero deductible and zero coinsurance. These visits are completely free and include a yearly depression screening. To diagnose or treat your mental health condition, you pay 20% coinsurance to your doctor or other qualified health professional. Moreover, you are also required to pay the annual Part B deductible of $203 in 2021. Furthermore, you may have a copay for mental health services in a hospital outpatient clinic or department.
However, most Medicare Supplement plans pay your 20% Part B coinsurance, so you have less out-of-pocket expenses for outpatient mental health services. The Medigap Plan G offers great value and is available for seniors new to Medicare. To shop and compare Plan G prices, call Senior Healthcare Direct at 1-855-368-4717 or get a quote. Now that you know what outpatient mental health services cost, what else do they cover?
What mental health services does Medicare cover?
The primary mental health service Medicare covers are psychotherapy sessions with a psychiatrist, clinical psychologist, or clinical social worker. During a psychotherapy session, you talk about your moods, feelings, thoughts, and behaviors. The Mayo Clinic says, “Psychotherapy helps you learn how to take control of your life and respond to challenging situations with healthy coping skills.” Anyone going through difficult times can benefit from psychotherapy by treating mental health disorders like anxiety.
Anxiety disorders originate from your thoughts and feelings. You feel anxiety when you think about or remember events that make you nervous. Anxiety becomes a disorder when it negatively affects the physical and emotional quality of your life.
For example, Memorial Day can be traumatic for veterans who saw combat and death. It is especially traumatic when veterans experience the loss of their military friends. This trauma can cause upsetting memories, feeling on edge, and trouble sleeping. If you experience these symptoms longer than a few weeks or months, you may have Post-traumatic Stress Disorder (PTSD). Moreover, treating PTSD can help with other mental health disorders.
Major Depressive Disorder
When a person’s outlook on life changes from mostly positive to negative, depression may be the problem. For example, seniors with neurodegenerative diseases such as Parkinson’s may become depressed. Moreover, people who view a situation as permanent are more likely to be depressed. To illustrate, let’s compare the COVID-19 experiences of two senior sisters Sue and Tammy.
Mental Health of Sue and Tammy
Before the Coronavirus, Sue goes shopping and buys new clothes. Then the governor issues a COVID-19 stay-at-home order. As the weeks go by, Sue stays home and stares at all the new clothes in her closet. Most of them still have tags because she never wore them. After a few weeks alone at home, Sue feels her life is not worth living.
On the other hand, Tammy loves to take photos outdoors. When the governor gives the stay-at-home order, Tammy takes her photography indoors. She stays home and shoots pictures of the meals she prepares. Then she shares these photos on social media. Tammy spends weeks sharing photos and looking at photography, especially on Instagram.
When the governor reopens, Sue feels no reason to leave her home, so she continues to stay home. Whereas, Tammy takes a trip to a county park and uses her telephoto lens to photograph birds. At the park, Tammy calls her sister Sue and finds out she is not leaving her home and asks her to call the doctor.
Tammy is suffering from depression. Her thoughts and behavior make Tammy feel hopeless about her life, and she believes she can do nothing to change it. A highly pessimistic outlook on life has led her to self-isolation. Hopefully, Tammy speaks with a clinical psychologist and gets the psychotherapy she needs.
Types of Psychotherapy covered by Medicare
Medicare covers the following types of psychotherapy:
- Individual – only one patient in the therapy session
- Family – with the patient present or without the patient present
- Group – more than one individual (such a couple) in a therapy session
During your psychotherapy session, you can expect the following. First, a clinical interview where you can sit down in the clinician’s office and talk for one or two hours about your life and personal history. The clinician will often ask you specific questions about various stages in your life. In subsequent visits, the clinical therapist may request you take specific psychological tests.
For example, the most commonly used personality test is the Minnesota Multiphasic Personality Inventory (MMPI-2). It’s a long 567 true/false test that measures dysfunction of personality. You usually take the test on a computer in the clinician’s office. The test helps the clinician better understand your personality and diagnose mental illness.
When a clinician discovers you misuse alcohol, he/she may refer you to your primary care doctor for alcohol misuse counseling. However, if the clinician finds you are physically or psychologically dependent upon alcohol, you could be diagnosed with alcohol dependence. As a result, treatment can include relapse prevention, support groups, psychotherapy, and setting short-term goals. Furthermore, the 4-point Smart Recovery Program can also help you recover from alcohol dependence as well as opioids and other addictive substances.
Medicare covers Alcohol Misuse and Substance Abuse
Alcohol Misuse Counseling
Medicare Part B covers alcohol misuse once per year. Any adult, including pregnant women who misuse alcohol, can get up to four brief face-to-face counseling sessions with your primary care doctor. Moreover, Medicare pays all costs, so you pay nothing. So exactly how many alcoholic drinks are too many?
Alcohol Consumption and Misuse
A standard alcoholic drink is 12 ounces of beer, 8-9 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces (one-shot) of distilled spirits. The National Institute of Alcohol Abuse and Alcoholism defines the following terms:
- Moderate alcohol consumption is up to one drink per day for women and up to two drinks per day for men.
- Low-Risk drinking for women is no more than three drinks per day and no more than seven drinks per week.
- Low-Risk drinking for men is no more than four drinks per day and no more than fourteen drinks per week.
When you drink more than these amounts, you are misusing alcohol and can cause harm to yourself or those around you. Furthermore, anyone under the age of 21 or pregnant women who use alcohol constitutes misuse. If you misuse alcohol, please call your doctor. In some cases, people who misuse alcohol also abuse other substances like opioids.
Medicare covers Opioid Use Disorder
January 1, 2020, CMS will pay certified Opioid Treatment Programs for opioid use disorder treatment services under Medicare Part B. You pay nothing for these treatment services. However, you must pay the $203 Part B deductible in 2021. Opioid treatment programs include counseling and therapy services in person and through Medicare Telehealth (real-time video or over the phone). You can find an Opioid Treatment Program Service provider in your area.
Opioid Risks and Safer Options
Opioid prescription pain medications are highly addictive substances and cause 70% of all drug overdose deaths in America. You can reduce your risk of opioid addiction and death by taking nonopioid medications such as acetaminophen (Tylenol) or ibuprofen (Advil). Moreover, ask your clinical psychologist about Cognitive Behavioral Therapy to help modify your physical, behavioral, and emotional triggers of pain and stress. Furthermore, Medicare covers acupuncture for chronic lower back pain.
Medicare Mental Health Takeaways
Medicare covers inpatient (Part A) and outpatient (Part B) mental health services. In conclusion, this article’s most important takeaways include:
- Medicare Part A pays up to 190 days in a psychiatric hospital.
- Annual mental health screenings are free with Medicare Part B.
- Most Medicare Supplement plans pay your 20% Part B coinsurance.
- Psychotherapy treats mental health disorders like anxiety, depression, alcohol, and substance abuse.
- Medicare Part B covers alcohol misuse and substance abuse, including opioid use disorder treatment.
Psychotherapy can improve the quality of your life. If you are facing challenging times, remember you are not alone. Medicare provides mental health service, so call a clinical psychologist and schedule your appointment.
We help seniors shop and save on Medicare coverage nationwide. You can shop for Medicare Advantage, Supplements, and Part D plans. Call Senior Healthcare Direct at 1-855-368-4717 and speak with a licensed agent or get a quote.
Last Updated on April 12, 2021 by Brian Kondas