What mental health care does Medicare cover? I have anxiety and depression, and my primary care provider recommended I see a therapist or psychiatrist.
~ Josefina (Cleveland, OH)
Dear Josefina, Medicare covers both inpatient and outpatient mental health care. And Medicare prescription drug plans cover medications used to treat mental health conditions, but be sure to check the formulary to ensure the brands and dosages you take are included. Medicare Part B covers outpatient mental health care, including the following services:
Individual and group therapy
Tests to make sure you are getting the right care
Activity therapies, such as art, dance, or music therapy
Training and education (such as training on how to inject a needed medication or education about your condition)
Family counseling to help with your treatment
Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you
An annual depression screening
Be sure to ask any provider you see if they take your Medicare insurance before you begin receiving services. If they don’t, you will likely be responsible for the full cost of the care. Psychiatrists are more likely than any other type of physician to opt out of Medicare, meaning Medicare will not cover any of the cost of the care from those doctors. Additionally, not all non-medical providers (like psychologists or clinical social workers) are Medicare-certified. If you need a list of providers near you who accept Medicare, you can go to www.medicare.gov/care-compare. Medicare Part A covers inpatient mental health care that you receive in either a psychiatric hospital (a hospital that only treats mental health patients) or a general hospital. Your provider should determine which hospital setting you need. If you receive care in a psychiatric hospital, Medicare covers up to 190 days of inpatient care in your lifetime. If you have used your lifetime days but need additional mental health care, Medicare may cover your care at a general hospital. Medicare Part D covers most prescription drugs used to treat mental health conditions. You may have Part D coverage through a Medicare Advantage Plan or through a stand-alone Part D plan. All Part D plans must cover at least two drugs from most drug categories and must cover all drugs available in certain categories, including antidepressants and antipsychotic medications. I hope this helps! -Marci
Article Submitted by:
Stephanie Kirk, Owner JC Madison Inc.
18887 State Highway 305, Poulsbo, WA