Does Medicare Provide Mental Health Coverage?

Medicare covers certain mental health services, provided the healthcare professional accepts assignment. The Part B deductible applies to doctor visits, in addition to a 20% copay. If you go to a hospital outpatient clinic or department for mental health services, you may have to pay an additional copayment or coinsurance to the hospital. 

What Mental Health Services Does Medicare Cover

If your primary care doctor or clinic accepts assignment, you can have one depression screening per year at no cost. Medicare.gov lists other Medicare-covered mental health outpatient services, including:

• Psychiatric evaluation
• Individual or group psychotherapy provided by licensed professionals
• Family counseling, if it is designed to help with your treatment
• Diagnostic tests
• Testing to determine if current treatment is helping
• Medication management
• Certain prescription drugs that are not self-administered (such as injections)
• Partial hospitalization (a structured program of outpatient services), provided you meet certain requirements and your doctor certifies you would otherwise need inpatient care

As stated on Medicare.gov, your provider may recommend more treatment than Medicare covers or services not covered by Medicare. If this occurs, you may have to pay some or all of the costs out of your own pocket. 

What Types of Provider Visits Will Medicare Cover?

With a 20% copay, if the provider accepts assignment, Medicare covers counseling or therapy provided by:

• Clinical psychologists
• Clinical social workers
• Clinical nurse specialists
• Nurse practitioners
• Physician assistants
• Psychiatrists and other doctors

This includes outpatient services in settings such as a doctor’s office, a community mental health center, or a hospital outpatient department. 

How Much Do You Pay Out of Pocket for Mental Health Services With Medicare?

The amount you have to pay out of pocket can depend on several factors, including:

• Whether you have met your Part B deductible
• How much the provider charges
• Where you get the item, test, or service
• The type of facility where you receive treatment
• Whether your doctor accepts assignment

Does Medicare Cover Antidepressants?

Medicare Parts A and B do not cover prescription drugs. For that, you need Medicare Part D. If you have original Medicare, you might consider enrolling in a Prescription Drug Plan (PDP). These plans are approved by Medicare but sold by private insurance companies. If you do not enroll when you first become eligible for Medicare, you may have to pay a late enrollment penalty. Each PDP is different, with a different formulary (list of covered drugs). 

If you opted for a Medicare Advantage Plan (Medicare Part C) instead of Original Medicare, you may have some prescription drug coverage, depending on your plan. These plans also have different costs and formularies. In addition, you may be required to fill prescriptions within a specific network of pharmacies to have coverage. 

PDPs and Medicare Advantage Plans may have different pricing tiers based on name brand, generic, and mail-order prescriptions. You may qualify for extra help if you meet low-income criteria. Speak with our friendly agent if you have questions about Medicare mental health coverage.