Does Medicare Cover Mental Health Care?

Thriving and enjoying both physical and mental health: these are our goals for all our clients. Mental health challenges can interfere with overall wellness, so it’s important to address them head-on at any age.

Fortunately, if you’re on Medicare, CMS (the agency that runs the program) is attuned to the importance of both physical and mental health. Yes, Medicare does cover mental health care. And since we’re observing both Older Americans Month and Mental Health Awareness Month in May, we wanted to share some of the basics of that coverage.

Medicare Part B coverage

Here is a partial list of the outpatient mental health services that Medicare Part B (medical insurance) helps pay for:

  • One depression screening per year. This must be done in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals.
  • Individual and group psychotherapy with doctors (or with certain other licensed professionals, as allowed by the state where you get the services).
  • Psychiatric evaluation.
  • Medication management.
  • Partial hospitalization.
  • A one-time “Welcome to Medicare” preventive visit. This visit includes a review of your possible risk factors for depression.
  • yearly “Wellness” visit. Talk to your doctor or other health care provider about changes in your mental health since your last visit. 

Part B also covers outpatient mental health services for treatment of substance abuse. You can read more about what Part B covers on the Medicare website.

Upset senior man talks about issues with therapist

Original Medicare coverage

With original Medicare:

  • You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment.
  • After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for visits to your doctor or other healthcare provider to diagnose or treat your condition. 
  • If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance amount to the hospital.

Read more on the Medicare website.

Check other details

As with all things Medicare, there are rules about coverage that include what types of providers you can use for mental healthcare (including a requirement that you must use providers that accept “assignment,” or payment directly from Medicare). Be sure to check the Medicare website and review your program materials. Older adults who have an HMO or PPO Medicare Advantage plan (also called Medicare Part C plan) can check with their insurance provider to determine the specific mental health benefits that are offered.

Seek providers who understand aging-related issues

Experienced and licensed mental healthcare professionals will have experience working with people of all ages. However, you may want to look for someone who understands aging-related issues, including geropsychiatrists.

“With old age comes normal biological and psychological changes,” notes an article from Very Well Mind, “as well as the development of certain health and mental health conditions like chronic illnesses, physical disabilities, psychiatric syndromes, and comorbid diseases.” A geropsychiatrist will be well prepared to counsel clients through these changes. The American Psychiatric Association offers a searchable database to help you find one—use the “advanced search” option to focus on providers with a geriatric focus.

At Windward Life Care, we understand that mental health is a big part of our clients’ overall well-being. Our team of Aging Life Care Professionals is available to help you access your insurance benefits, and locate providers who can best meet your needs.