Key Takeaways:
- Medicare Part B covers counseling for depression in both individual and group therapy sessions, making it a cost-effective option for those seeking optimal mental health support.
- Beneficiaries can access a wide range of mental health services under Medicare. Check if your preferred therapist or specialists accept Medicare to avoid unexpected out-of-pocket expenses.
- Understanding specific mental health benefits under different Medicare plans empowers individuals to make informed decisions about their care and optimize coverage at acceptable costs.
Roughly one in every four adults, or 26% of Americans aged 18 years and older, suffers from a diagnosable mental disorder in any given year.
The same percentage holds for Medicare beneficiaries as well, one in four of whom suffers from mental health conditions like anxiety, depression, schizophrenia, and bipolar disorder.
The issue, however, is that Medicare enrollees do not always have the same access to mental health services as the general population.
Between 2013 and 2019, the percentage of psychiatrists willing to see mental health patients under Medicare coverage fell from 60.7% to 55.1%.
Unfortunately, the lack of access to mental health providers is not the only issue plaguing Medicare enrollees.
What Mental Health Services Medicare Covers
Medicare covers inpatient and outpatient mental health care, including therapy, counseling, and hospital stays.
Medicare Part A (Hospital Insurance) – Inpatient Mental Health Coverage
Covers hospital-based mental health care, including:
- Inpatient stays at a general hospital, psychiatric hospital, or medical facility
- Room, meals, medications, and nursing care
- Coinsurance and deductible apply for each benefit period
Medicare Part B (Medical Insurance) – Outpatient Mental Health Coverage
Covers outpatient mental health services, such as:
- Therapy & Counseling: Individual and group therapy with a state-licensed mental health expert
- Mental Health Specialists: Services from psychiatrists, clinical social workers, or nurse practitioners
- Partial Medication & Equipment Costs: Covers some medical equipment and medications related to mental health treatment
Does Medicare Cover Counseling for Depression?
Yes!
Original Medicare provides counseling for depression in both inpatient and outpatient settings, as do some Medicare Advantage plans with mental health benefits.
There may be some out-of-pocket costs involved in both cases.
What Medicare Does Not Cover
Original Medicare does not cover alternative therapies like yoga and acupuncture or long-term custodial care for people with chronic mental health conditions.
It also doesn’t cover support groups or transportation to or from service providers.
Learn More: Outpatient Mental Health Care Under Medicare.
Get Personalized Medicare Advice for Your Mental Health Needs
Understanding mental health coverage under Medicare can seem complicated, but it doesn’t have to be.
At CoverRight, we provide concierge Medicare services to help you compare plans, understand benefits, and make confident decisions.
Reach out to us today to improve your Medicare experience.
Costs and Coverage for Mental Health Services
Coverage for mental health services under Original Medicare comes with numerous out-of-pocket costs like copayments, coinsurance, and deductibles.
Let’s break down the costs involved in different Medicare plans.
Costs Under Part A
- Premium: $0 for those who qualify for premium-free coverage; $285 or $518 per month for others.
- Deductible: $1,676 per benefit period.
- Coinsurance: For hospital stays –
-
- Days 1 to 60 – $O per day.
- Days 61 to 90 – $419 per day.
- Days 91 to 150 – $838 per day.
- Skilled nursing facility daily coinsurance: Days 21 to 100 – $209.50 per day.
- Out-of-pocket maximum: None.
Costs Under Part B
- Premium: $185 per month or higher, depending on income.
- Deductible: $257 annually.
- Coinsurance: 20% of service costs once you’ve met the annual deductible.
- Out-of-pocket maximum: None
Medicare Part B covers some mental health preventive services in full.
Additional Mental Health Benefits Under Medicare Part C
Some Medicare Advantage of Part C plans provide mental health services in addition to those covered by Original Medicare.
For instance:
- Expanded behavioral health support, in the form of therapy sessions and flexible mental health counseling.
- Prescription drug coverage for antidepressants, anti-anxiety medications, and antipsychotics.
- Telehealth services, virtual therapy, and virtual counseling sessions.
Benefits such as these apply only to specific Plan C providers and plans. Compare available plans and coverage options carefully.
Learn More: Cost-Sharing in Healthcare.
Comparing Mental Health Coverage: Original Medicare vs Medicare Advantage
Medicare Advantage plans can be cheaper for mental health services than Original Medicare, but they restrict access to specialists and providers who are not in-network.
Original Medicare, on the other hand, has higher out-of-pocket costs but offers more flexibility in choosing mental health providers.
Here’s a break down the costs of different mental health services under Original Medicare and Medicare Advantage:
| Mental Health Service | Cost Under Original Medicare (Part A and Part B) | Cost Under Medicare Advantage or Part C |
| Inpatient Mental Health Care | $1,676 deductible per benefit period. Part A covers the cost of hospital stays in full for up to 60 days. Copay is $483 after 60 days, and $838 after 90 days. |
Costs vary by the provider and plan type. Includes some copayments and deductibles. |
| Outpatient Mental Health Care (Therapy, counseling, Diagnostic Services) | $257 annual deductible.
20% of Medicare-approved costs in copay for all services after meeting the annual deductible. |
Deductibles vary by the specific plan and provider.
Copays can range from $10 to $50 per session and higher, depending on the plan. |
| Visit to Psychiatrist or Clinical Psychologist | 20% of Medicare-approved costs in copay for all services after meeting the annual deductible. | Copays vary according to the plan but are generally lower than Original Medicare. |
| Psychiatric Prescription Drugs | Not covered by Original Medicare.
Beneficiaries must have a stand-alone Part D plan to pay for costs. |
Most Medicare Advantage plans provide prescription drug coverage.
Coverage of specific drugs and their costs depend on plan formulary. |
| Emergency Mental Health Care | Part A covers emergency services in hospitals.
Under Part B, Coinsurance is 20% for crisis care visits. |
Covered, usually with copays that vary with the plan. |
| Alternative Therapies Like Yoga, Acupuncture, Hypnotherapy, Biofeedback. | Not covered. | Specific alternative therapies are covered by select Medicare Advantage plans. |
Note: Data sourced from Medicare.gov, and MedicareWire.
Options Beyond Medicare for Mental Health Support
If Medicare’s mental health coverage isn’t enough, beneficiaries can explore these options for additional support:
- Medigap (Medicare Supplement Plans) – Helps reduce out-of-pocket costs for Medicare-covered services, such as deductibles and coinsurance, but does not add extra mental health benefits.
- Medicaid – Provides low-cost or free mental health services for those who qualify based on income. Coverage varies by state.
- Employer & Community Resources – Many organizations offer mental health support programs, including:
- Employer Assistance and Resource Network (EARN) – Provides mental health toolkits for employees.
- National Alliance on Mental Illness (NAMI) – Offers advocacy, education, and support groups.
- Substance Abuse and Mental Health Services Administration (SAMHSA) – Connects individuals with treatment options.
How to Access Medicare Mental Health Services
Here’s a step-by-step guide to finding Medicare-approved mental health providers near you:
- Access Medicare Website: Go to the Medicare website and navigate to the ‘care compare’ section.
- Specify Service Type: Select ‘mental health’ as the type of service you need.
- Specify Your Location: Enter your city or zip code to find relevant providers near you.
- Check Provider Details: Review the search results and ensure the provider is in-network with your plan.
Enrolment Process for Mental Health Services Under Medicare
Here’s what you must do to enroll for mental health services under Medicare:
- Get screened in a primary care doctor’s office or clinic that can provide follow-up mental health treatment and referrals under Medicare Part B.
- Sign up for individual therapy, group therapy, or family counseling through Medicare-enrolled licensed professionals according to state guidelines.
Tips for Maximizing Benefits and Ensuring Continuity of Care
There are several ways to maximize mental health benefits under Medicare and ensure continuity of care.
- Get a free annual depression screening under Part B from your primary care doctor or clinic. They will schedule follow-up care as necessary.
- Check with your mental health service provider if they accept Medicare assignments, which means they are willing to accept Medicare-approved payments.
- Consider psychotherapy for conditions like depression, anxiety, schizophrenia, bipolar disorder, and PTSD, among others.
- Ask your provider if medication management can help in your particular situation. The right medications can be key to mitigating your condition.
Learn More: Maximizing Medicare Benefits and Cost Savings.
Planning Your Mental Health Care With Medicare
There are multiple key factors to consider when selecting a Medicare plan for mental health coverage.
- Provider Network: Your preferred therapists or specialists are within the plan network.
- Service Coverage: Verify the type of services covered, be it therapy, counseling, or medication management.
- Benefit Limits: Check for limitations on the number of therapy sessions per year, or lifetime caps on benefits.
- Cost Sharing: Compare out-of-pocket costs for different plans, especially copays for mental health visits.
- Plan Reputation: Research customer feedback and the plan’s overall history and reputation.
You can improve your Medicare mental health coverage with proactive planning. Here’s how:
- Having a thorough understanding of different Medicare plans, the extent of their coverage, and their costs.
- Leveraging Medicare Advantage plans that offer the widest additional mental health benefits.
- Ensuring necessary prescription drugs are covered at the lowest available cost-sharing structure.
- Understanding the meaning and consequence of terms like benefit periods and excess charges.
- Availing annual checkups and screenings for various mental health conditions.
- Considering supplemental insurance to cover out-of-pocket costs.
Learn More: Additional Medicare Costs.
Get Help with Medicare Mental Health Coverage
At CoverRight, our specialists deeply understand the Medicare system and healthcare market. We’ll help guide you to coverage that fits your life and budget.
Sources
- Johns Hopkins Medicine
- Mental Health Disorder Statistics. Available at: hopkinsmedicine.org. Last Accessed January 30, 2025.
- Commonwealth Fund
- Medicare Mental Health Coverage: What’s Included, What’s Changed, and What Gaps Remain. Published March 2, 2023. Available at: commonwealthfund.org. Last Accessed January 30, 2025.
- JAMA Network
- Trends in Psychiatrist Participation in Medicare. Published July 29, 2022. Available at: jamanetwork.com. Last Accessed January 30, 2025.
