Medicare Mental Health Coverage

The short answer is yes. Medicare offers coverage for therapy and a variety of other mental health services. Depending on which part you use, some benefits of Medicare coverage include counseling or therapy, in-patient care, outpatient care, medication management, and certain preventive services.

Who Qualifies for Medicare Mental Health Coverage?

Medicare mental health coverage is only available for those who meet specific eligibility criteria. To qualify for mental health coverage under Medicare, you must meet one of the following conditions:

• Be 65 years of age or older.
• Have a qualifying disability (younger than 65).
• Have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)

If you fall into one of these categories, you may be eligible for Medicare benefits for mental health services including therapy services, counseling, and psychiatric care like prescription drugs for a mental health condition. 

Mental Health Coverage Under Medicare

Medicare therapy coverage and benefits will vary depending on which part of the program you’re using. “Original Medicare” — Parts A and B — is the foundation.

Medicare Part A: In-patient mental health care

You can think of Medicare Part A as “hospital insurance.” It helps pay for in-patient (meaning you’re admitted to the hospital) mental healthcare and covers things like your hospital room, meals, and nursing care. It also covers related services and supplies that might be necessary during your stay.

Part A can cover mental health needs like:

• In-patient room costs
• Meals
• Nursing care
• Labs
• Some medications
• Therapy

Medicare part B: Outpatient mental health services

Medicare Part B can be thought of as “medical insurance.” It helps pay for outpatient services related to mental health, including visits to mental health professionals like psychiatrists, doctors, clinical psychologists, or social workers. Treatments such as individual or group therapy sessions are covered under Part B.

Part B can cover mental health needs like:

• Wellness visits
• Individual therapy
• Group therapy
• Annual screenings for depression
• Psych evaluations
• Appointments with a clinical social worker
• Diagnostic labs and tests
• Some medications

Medicare Advantage Part C

Medicare Advantage Part C provides coverage on top of the benefits Parts A and B offer.

Medicare Advantage Part C can cover things like:

• Grief counseling
• More telehealth options

Medicare Part D: Prescription drug coverage

Medicare Part D is used to offset the costs of prescription drugs that are useful in managing mental health. For example, Part D of Medicare coverage helps you afford things like mood stabilizers and antidepressants.

Medigap

While not technically part of Medicare, Medigap is sold to help supplement gaps in coverage in the Original Medicare plan. Medigap policies help with mental healthcare costs like copayments, deductibles, or coinsurance.

Limitations in Medicare Mental Health Coverage

Medicare is a lifeline for many people seeking mental healthcare, but like most things, it does have some limitations. While it generally helps with the cost of the most common mental health treatments, not everything is paid for. Several factors are used to determine what will be covered.

Number of therapy sessions covered

While therapy is likely a benefit under your Medicare plan, there can be limitations to the number of sessions covered annually by the mental health care provider.

Types of treatments not covered

The type of treatment you receive is another area that can impact coverage and cost as a Medicare beneficiary. While some approaches to mental health — like holistic or experimental therapies — have gained popularity in recent years, they aren’t always covered by Medicare. You’ll likely be responsible for out-of-pocket costs if you use specific treatments. 

As an example, Original Medicare therapy coverage doesn’t include the cost of pastoral counseling or hemodialysis for schizophrenia. Other areas of care Medicare doesn’t cover might include:

• Private duty nursing
• Toiletries during in-patient stays
• Adult day health
• Transportation
• Private room costs (if not medically necessary)
• Outpatient meals
• Data interpretation
• Report preparation
• Recreational activities

How to Check Your Medicare Mental Health Coverage

To fully understand what Medicare will cover, review your current plan in detail. You can do so by accessing your online account.

1. Log in to your Medicare account

Log into your online Medicare account. The secure portal provides specific details about your plan and coverage. The information you find here will help you make healthcare decisions to avoid unexpected costs in the future. You’ll get a summary of your coverage and be able to add medication and pharmacies to compare costs for drugs.

If you haven’t created your account yet, the 3-step process is simple — make sure you have your Medicare card and then go to the Medicare website:

1. Click the button or link to “Create Account”
2. Enter your Medicare number
3. Enter your Part A coverage start date (just month and year); if you don’t have Part A, you can also enter Part B or immunosuppressive drug coverage information
4. Enter your information
5. Enter your last name, date of birth, zip code, and email address (if you don’t have email, information can be mailed to the address on file; just click the box “I don’t have an email address”
6. Click the box agreeing to the statement
7. Set up your account
8. Create your username
9. Create a password
10. Select and answer a “Secret Question”
11. Click the green “Create Account” button

2. Review your current plan details

Check what’s covered under your plan’s mental health benefits. Look for the limitations of each plan type — Original Medicare, Medicare Advantage, etc. — so you’re prepared for any financial responsibility. If you’re looking for guidance on how to find a therapist covered by insurance, it’s important to check with your current healthcare provider to understand which mental health professionals and services are included in your plan. 

3. Use the Medicare plan finder tool

Don’t be afraid to leverage the portal’s Medicare plan finder tool. This resource helps you compare different plans and understand your coverage options thoroughly to know which option caters best to your needs and financial situation.

4. Check annual notices for changes

Medicare benefits can change. It’s vital to review essential documents like the Annual Notice of Change (ANOC) and the Evidence of Coverage (EOC) you receive.
Read these documents thoroughly every year you’re enrolled in any Medicare plan. Stay informed about significant changes that may affect the type of coverage you have or what mental health services will cost you.

5. Contact Medicare for personalized assistance

Navigating any insurance coverage can be a complex and confusing journey. If you’re seeking answers to specific questions, don’t hesitate to reach out directly. Preparing your questions in advance is a good idea so the process is as efficient and effective as possible.

The Medicare website has valuable resources and contact information to help you connect with a customer service representative trained to answer your questions about plan benefits. You can reach someone by calling 1-800-MEDICARE or using the site’s convenient online live chat feature. Chat is available 24 hours a day, 7 days a week (except for certain holidays). 

Get Affordable Online Mental Health Treatment

Finding solutions for mental health treatment that you can afford might seem overwhelming, but online therapy — like Talkspace — is an accessible, convenient, and affordable option that makes therapy readily available, regardless of financial constraints. Talkspace has partnered with most major insurance providers to ensure affordable care options outside of Medicare’s current scope are also available to members.

Talkspace online therapy accepts Medicare in specific states (with more added continually) to bridge the gap between vital mental healthcare and affordable treatment. Medicare Advantage is not covered at this time, but should be coming soon. Other options include online therapy covered by various insurance providers. Reach out today to learn more about getting mental health assistance from licensed professionals at Talkspace.