Medicare and Mental Health

Everyone is susceptible to mental health issues, including depression and anxiety. But older adults can be at a higher risk due to circumstances such as limited mobility, isolation and loss of companionship, as well as physiological factors like decreased levels of certain brain chemicals.

The American Association for Geriatric Psychiatry estimates that 20 percent of people age 55 years or older experience some type of mental health concern, with the most common conditions being anxiety, severe cognitive impairment, and mood disorders such as depression or bipolar disorder.

Because mental health is essential to overall health and wellness, Medicare helps cover many mental health care costs, including both inpatient and outpatient care.

Below is an overview of mental health services covered by Medicare.

NOTE:
The following information applies to those who have Original Medicare with or without a Medicare Supplement policy. If you get your Medicare benefits through a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, call your plan administrator for specific details about mental health coverage.

Outpatient mental health care: types of health professionals

Original Medicare Part B (medical insurance) helps cover mental health services and visits with these types of health professionals:

• Psychiatrist or other doctor
• Clinical psychologist
• Clinical social worker
• Clinical nurse specialist
• Nurse practitioner
• Physician assistant

Outpatient mental health care: types of services

Original Medicare Part B (medical insurance) helps pay for these covered outpatient services:

• One depression screening per year
• Individual and group psychotherapy
• Family counseling
• Testing to find out if you’re getting the services you need and if your current treatment is helping you
• Psychiatric evaluation
• Medication management
• Certain prescription drugs that aren’t usually self-administered, like some injections.
• Diagnostic tests
• Partial hospitalization
• A one-time “Welcome to Medicare” preventive visit that includes a review of your
  potential risk factors for depression
• A yearly “wellness” visit, which is a good time to talk to your doctor or other health care
  provider about changes in your mental health so they can evaluate your changes year to
  year
• Treatment of inappropriate alcohol and drug use

Inpatient mental health care

• Medicare Part A (hospital insurance) helps pay for mental health services that require inpatient admission to a hospital
• You can get these services either in a general hospital or in a psychiatric hospital that only cares for people with mental health conditions

Medicare may cover partial hospitalization

• Medicare Part B covers partial hospitalization in some cases
• This type of treatment is provided during the day and doesn’t require an overnight stay

Prescription drug coverage

• To get Medicare prescription drug coverage, you must join a Medicare Prescription Drug Plan. Medicare drug plans are managed by insurance companies and other private companies approved by Medicare.
• Each Medicare drug plan can vary in cost and in the specific drugs it covers. It’s important to know your plan’s coverage rules and your rights.
• If you take prescription drugs for a mental health condition, find out whether a plan covers your drugs before you enroll. Visit Medicare.gov/find-a-plan to find out which plans cover your drugs.

For more details on Medicare coverage of mental health treatment, go to Medicare.gov.

Any of the conditions listed below may indicate a mental health issue.* Help is available — talk to your doctor or other health care provider if you think any of these exist:

• Thoughts of ending your life (like a fixation on death or suicidal thoughts or attempts). More information is available from the National Suicide Prevention Lifeline.
• Sad, empty, or hopeless feelings
• Loss of self-worth (like worries about being a burden, feelings of worthlessness, or self-
  loathing)
• Social withdrawal and isolation (like you don’t want to be with friends, engage in
  activities or leave home)
• Little interest in things you used to enjoy
• A lack of energy
• Trouble concentrating
• Trouble sleeping (difficulty falling asleep or staying asleep, oversleeping, or daytime
  sleepiness)
• Weight loss or loss of appetite
• Increased use of alcohol or other drugs

* From “Medicare and Your Mental Health Benefits,” a booklet published by the Department of Health and Human Services, July 2019.