Medicare Mental Health Services

Dec 24, 2022 By Triston Martin

Medicare covers a significant portion of the expenses associated with a diverse range of mental health services, regardless of whether they are administered on an outpatient basis or to patients hospitalized as inpatients in a general or psychiatric facility. However, you should be aware that these benefits come with restrictions, like as significant copayments and coinsurance, as well as a lifetime cap on coverage.

In a survey conducted in May 2022 by CVS Health and Morning Consult, respondents aged 65 and older reported that they had experienced mental health concerns for themselves, family members, or friends at some point in their lives. This statistic demonstrates the prevalence of mental health issues among older adults. A survey conducted by the University of Michigan in May 2021 found that almost one in five older persons between the ages of 50 and 80 said that their general mental health has deteriorated since the beginning of the epidemic.

Does Medicare Cover Outpatient Mental Health Services?

Many mental health services provided to patients who are not hospitalized are covered by Medicare Part B, the portion of Medicare that pays for medical bills and other associated medical expenditures. Among the expenditures that are covered are the following:

  • A first appointment to say "Welcome to Medicare" will also involve an assessment of the circumstances that put you at risk for depression.
  • One screening for depression per year should be carried out in the office of a primary care physician or at a primary care clinic that also offers subsequent therapy and referrals.
  • Psychiatric examination to identify the mental disease and establish a treatment plan.
  • Evaluation and diagnosis
  • Psychotherapy or counseling on an individual or group basis, delivered by medical doctors or certain other experts who are duly licensed to practice in your state.
  • Family therapy, in which the primary goal is to assist you in your treatment for mental illness.
  • Medication management involves the administration of some prescription medications that the patient cannot do.
  • Partial hospitalization is a kind of therapy that does not need the patient to be admitted to a hospital and often consists of many hours of treatment each week.
  • Evaluation to determine whether or not you are receiving the necessary services and whether or not the therapy you are receiving is beneficial to you.
  • A yearly checkup for wellness with a physician or other professional to review any changes in mental health that may have occurred.

The Cost of Receiving Mental Health Treatment for Outpatient

After you have paid the Medicare Part B deductible, which is $233 in 2022 and will drop to $226 in 2023, Part B will cover 80% of the eligible services for outpatient mental health treatment, and you will be responsible for paying the remaining 20% of the cost. It is essential that you be aware that the mental health specialists you consult with must accept assignments from Medicare; this indicates that they agree with Medicare's pricing schedule and will not charge you any more than that.

If you have Medicare Supplement Insurance, often known as Medigap, your plan may pay for your 20% portion of the cost. If you have a Medicare Advantage plan, you will need to verify the details of your particular plan to see the amount you will be responsible for paying. You may be responsible for paying extra costs to the hospital if you use the outpatient mental health services provided by the facility.

Does Medicare Cover Inpatient Mental Health Services?

Mental health services that need your admission to a general or psychiatric hospital are covered by your hospital insurance, known as Medicare Part A. You are only insured for a maximum of 190 days of inpatient services during your whole life if you are ever admitted to a mental institution. After that, you would need to get them in a regular hospital setting to be insured for mental health services.

The Cost of Receiving Mental Health Treatment for Inpatient

For each benefit period, inpatient psychiatric treatment is subject to a deductible of $1,556 (which will increase to $1,600 in 2023). If you have Original Medicare, you won't have to pay any coinsurance for the first sixty days of a hospital stay for mental health treatment, even if you have to remain longer than that. However, you are liable for copays equal to 20% of the Medicare-approved rate for mental health services you get from physicians and other providers while you are an inpatient. This applies to both inpatient and outpatient care. Either your Medigap plan, if you have one, or your resources, will be responsible for paying for this.

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