Medicare Mental Health Coverage

Medicare offers various coverage options to address widespread mental health needs. While the program’s complexity can be daunting initially, getting the most out of this resource means learning what services are available and what restrictions you should be aware of as a Medicare beneficiary. 

Keep reading to learn everything you need to know about Medicare coverage for therapy and other mental health services.

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 with 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

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:

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.

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

Click the button or link to “Create Account”
Enter your Medicare number  

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
Enter your information 
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”

Click the box agreeing to the statement
Set up your account
Create your username

Create a password

Select and answer a “Secret Question”

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.

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. 

Get Affordable Online Mental Health Treatment

Talkspace will soon accept Medicare in some states to bridge the gap between vital mental healthcare and affordable treatment. In the meantime, we offer online therapy covered by various insurance providers. Reach out today to learn more about getting mental health assistance from licensed professionals at Talkspace.