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Does Medicare Cover Mental Health?

It is estimated that one in every five seniors in the United States experiences some type of mental health concern, the most common of which is depression. That number is expected to double by the year 2030. Senior citizens face unique challenges that can impact their mental health, such as losing loved ones, chronic illness, physical disabilities, and social isolation, which can contribute to mental health problems.

Maintaining and promoting strong mental health in senior citizens can significantly impact their quality of life. Good mental health contributes to maintaining independence, coping with stress and changing conditions, and maintaining social connections. 

In this article, we will outline Medicare’s mental health coverage. 

Does Medicare Cover Mental Health Services? 

Medicare covers in and outpatient mental health treatment, along with prescription coverage. Let’s outline what kind of coverage you can expect from each part of Medicare.

Medicare Part A

Medicare Part A covers inpatient mental health services in general and psychiatric hospitals. However, you are limited to 190 total days as an in-patient at a psychiatric hospital throughout your lifetime. 

For hospital services, your coverage begins on the day of admission and concludes after 60 consecutive days without inpatient care. 

You may be wondering, how much will I pay for my hospital stay? First, you will have to pay a $1,600 deductible (for 2023) for each benefit period. Once you pay the deductible, there is no co-insurance for the first 60 days. (Read our article here for more information about hospital stays under Medicare.)

Medicare Part B

Medicare Part B covers outpatient mental health services delivered by various professionals (such as psychiatrists, psychologists, social workers, and others) and includes psychiatric evaluations, individual and group therapy, and medication management. 

Additionally, Medicare covers a “Welcome to Medicare” preventative visit scheduled during your first 12 months. Part B also covers an annual depression screening and an annual Wellness visit where your doctor will ask you about any changes to your mental health.

Seniors in rural areas can sometimes find it hard to access mental health care. Medicare covers telehealth coverage for evaluating and treating mental health and substance abuse disorders. 

Medicare covers 80% of the Medicare-approved amount for these outpatient services. You are responsible for the Part B deductible ($226 in 2023) and 20% of the Medicare-approved amount and co-insurance costs.

Medicare Advantage

Im here for you whenever you need me. Shot of a woman supporting her elderly mother through a difficult time.

Depending on the plan, Medicare Advantage plans will differ in their coverage but must cover the same benefits as traditional Medicare. Most also cover prescription drugs.

Part D Plans 

Mental health treatment can be costly, and many senior citizens rely on Medicare Part D to cover the cost of prescription medications for mental health conditions. Medicare Part D is a program that provides prescription drug coverage to seniors, and it covers many medicines used to treat mental health conditions such as depression and anxiety. The specific drugs covered and the cost-sharing requirements vary depending on the plan, so it is essential to review the plan’s specifics to determine which medications are covered and what the out-of-pocket costs will be.

For senior citizens with limited income and resources, the Extra Help program (also known as the Low-Income Subsidy program) is available to assist with prescription drug costs. The program covers most out-of-pocket expenses for prescription drugs covered under Medicare Part D, including deductibles, premiums, and coinsurance. 

Medicaid 

All Medicaid programs cover certain mental health and substance use disorder services, but the specifics vary depending on where you live.

The Mental Health Parity and Addiction Equity Act of 2008 require all healthcare plans to offer mental health benefits equal to their medical and surgical coverage. This means that your treatment for a mental illness must be on par with what you would receive for a physical ailment. 

Opioid and Alcohol Abuse Treatment

Medicare covers opioid use disorder treatment, including medication (such as methadone), counseling, drug testing, therapy, and assessments. It also protects one alcohol misuse screening annually for adults who drink alcohol but don’t meet the medical criteria for

alcohol dependency. If your healthcare provider determines you’re misusing alcohol, you can receive up to four brief face-to-face counseling sessions annually. 

Managing your Mental Mental Health

Taking care of your mental health is just as important as your physical health, especially as you get older. There are several things you can do to help manage your mental health and improve your overall well-being. 

For example, make sure you’re getting enough restful sleep each night. Sleep plays a vital role in our mental health, which can lead to mood swings, irritability, and a lack of focus. 

Another way to manage your mental health is to stay active and social. Exercise releases endorphins, which can help boost your mood and reduce stress levels. It doesn’t have to be too strenuous – a brisk walk around the block, gardening, or even some light stretching can make a big difference. 

Similarly, spending time with friends and loved ones can help alleviate loneliness and isolation. Make an effort to stay connected with others, whether it’s through regular phone calls, online video chats, or in-person meetups.

Selecting the Right Medicare Coverage For You

Selecting mental health coverage is an important decision, as it can significantly impact your access to care and overall well-being. When selecting Medicare coverage, it is crucial to consider factors such as the scope of coverage, cost, and network of providers. 

For over 40 years, The Medicare Family has specialized in helping seniors navigate the complexities of Medicare. We help seniors select a plan that meets their needs, including mental health coverage. Book a call today to get started!

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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