Does Medicare Cover Mental Health Services?
Medicare covers inpatient and outpatient mental health services, but you may be responsible for your deductible, copay and coinsurance costs. Medicare Part A covers mental health services in a hospital setting and Part B covers outpatient visits to a doctor and other mental health providers.
- Written by Terry Turner
Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).
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Matt Mauney
Matt Mauney
Financial Editor
Matt Mauney is an award-winning journalist, editor, writer and content strategist with more than 15 years of professional experience working for nationally recognized newspapers and digital brands. He has contributed content for ChicagoTribune.com, LATimes.com, The Hill and the American Cancer Society, and he was part of the Orlando Sentinel digital staff that was named a Pulitzer Prize finalist in 2017.
Read More- Published: August 31, 2020
- Updated: October 23, 2023
- 4 min read time
- This page features 10 Cited Research Articles
- Edited By
According to the National Council on Aging, 25% to 30% of older adults have reported experiencing mental health disorders such as anxiety or depression in the years following the COVID-19 pandemic.
- Anxiety
- Mood disorders, including depression or bipolar disorder
- Severe cognitive impairment — trouble remembering, concentrating, learning new things or making decisions about everyday life
The rate of people with symptoms of depression increases with age, but it is not a normal part of aging. The U.S. Centers for Disease Control and Prevention estimates 80% of depression cases are treatable, but it often goes untreated or undertreated in older Americans because it isn’t widely recognized.
What Mental Health Services Does Medicare Part A Cover?
Medicare Part A (hospital insurance) will help pay for mental health services you receive in a hospital if you are admitted for inpatient treatment. This coverage applies whether you’re treated at a general hospital or a psychiatric hospital.
- Hospital room
- Lab tests
- Meals
- Medications and other related services and supplies while hospitalized
- Nursing care
- Treatment or therapy for your mental health condition
Your share of the costs for inpatient mental health care is the same as for general hospital services and treatments covered by Medicare Part A.
Original Medicare at least partially covers long-term psychiatric hospitalization and other long-term mental health hospital care for up to 190 days over your lifetime. But the daily coinsurance costs you have to pay out of pocket can be several hundred dollars a day if you are hospitalized beyond 60 days in a single benefit period — periods that last until you’ve gone 60 days without any hospital inpatient care.
- $1,632 deductible for each benefit period
- You are responsible for 20% of the Medicare-approved amount for mental health services you receive from doctors and other health care providers while you’re a hospital inpatient.
- $0 coinsurance for days 1 to 60 of hospitalization for each benefit period
- $408 coinsurance per day for days 61 to 90
- $816 coinsurance per day for days 90 and beyond for each lifetime reserve day — you have 60 of these days over your lifetime
- You pay all costs when you run out of lifetime reserve days.
How Much Will Medicare Part B Pay for Mental Health Care?
Medicare Part B pays 80% of the Medicare-approved amount for outpatient mental health services as long as the doctor or other health care provider participates in Medicare.
You have to meet your Part B deductible — $240 in 2024 — and then you are also responsible for the remaining 20%.
If you receive outpatient treatment in a hospital setting, you may have to pay an additional coinsurance or copayment amount.
Medicare Part B will help pay for a wide range of mental health services. Many of these services may be included in one-time or routine doctor visits that cover your whole health in review. Be sure to bring up your mental health concerns during these sessions with your doctor.
- One-time “Welcome to Medicare” preventive visit, including a review of your risk factors for depression
- A yearly wellness visit that allows your doctor to track changes in your mental health
- One depression screening per year at a primary care doctor’s office or clinic that can provide follow-up treatments and referrals
- Diagnostic tests
- Family counseling in certain cases
- Individual and group psychotherapy with licensed doctors or other approved providers
- Medication management
- Partial hospitalization — if your doctor determines you need inpatient treatment
- Prescription drugs that have to be administered by a doctor or other provider
- Psychiatric evaluation
- Testing to determine if your treatment is working
Medicare Part D Prescription Drug Coverage and Mental Health Care
Medicare Part D prescription drug plans are not required to cover all drugs, but with limited exceptions, they are required to cover all antidepressant, anticonvulsant and antipsychotic medicines.
Part D plans are sold by private insurers and other companies that Medicare approves. Almost all plans have a formulary — a list of drugs the plan covers. This list can change each year, but the company has to notify you at least 30 days before the change takes effect.
It’s important to review your plan’s formulary changes when you receive this information.
- Association for Financial Counseling & Planning Education (AFCPE®) member
- Holds six Health Literacy certificates from the CDC
- Emmy® Award winner
10 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022, September 27). 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2023-medicare-parts-b-premiums-and-deductibles-2023-medicare-part-d-income-related-monthly
- National Council on Aging. (2022, May 18). How to Improve Access to Mental Health and Substance Use Care for Older Adults. Retrieved from https://www.ncoa.org/article/how-to-improve-access-to-mental-health-and-substance-use-care-for-older-adults
- U.S. Centers for Medicare & Medicaid Services. (2020, November 6). 2021 Medicare Parts A and B Premiums and Deductibles. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2021-medicare-parts-b-premiums-and-deductibles
- U.S. Centers for Medicare & Medicaid Services. (2020, March). Medicare and Your Mental Health Benefits. https://web.archive.org/web/20211022112459/https://www.medicare.gov/blog/medicare-mental-health-coverage-2020
- U.S. Centers for Medicare & Medicaid Services. (2021, September). Medicare and Your Mental Health Benefits. Retrieved from https://www.medicare.gov/Pubs/pdf/10184-Medicare-and-Your-Mental-Health-Benefits.pdf
- World Health Organization. (2017, December 12). Mental Health of Older Adults. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults
- U.S. Centers for Disease Control and Prevention. (2011, February). Cognitive Impairment: A Call for Action Now! Retrieved from https://www.cdc.gov/aging/pdf/cognitive_impairment/cogimp_poilicy_final.pdf
- U.S. Centers for Disease Control and Prevention. (2008). The State of Mental Health and Aging in America Issue Brief 1: What Do the Data Tell Us? Retrieved from https://www.cdc.gov/aging/pdf/mental_health.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Mental Health Care (Inpatient). Retrieved from https://www.medicare.gov/coverage/mental-health-care-inpatient
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Mental Health Care (Outpatient). Retrieved from https://www.medicare.gov/coverage/mental-health-care-outpatient
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