Are mental health services included in coverage from Medicare?

Medicare covers mental health services in several different settings.

Medicare Part A covers mental health care services you get in a hospital that require you to be admitted as an inpatient. Medicare Part B may provide partial hospitalization coverage if you meet specific requirements, and your doctor certifies that you would otherwise need inpatient treatment. Your costs in Original Medicare for this setting are as follows

  • $1,408 deductible for each benefit period
  • Days 1–60: $0 coinsurance per day of each benefit period.
  • Days 61–90: $352 coinsurance per day of each benefit period.
  • Days 91 and beyond: $704 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
  • Beyond lifetime reserve days: all costs.
  • You will have to pay 20% of the Medicare-approved amount for mental health services you get from doctors and other providers while you’re a hospital inpatient.

Medicare Part B covers mental health care services for these covered outpatient mental health services:

  • One depression screening per year. The screening must be done in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals.
  • Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services.
  • Family counseling, if the primary purpose is to help with your treatment.
  • Testing to determine 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” (drugs you would normally take on your own), like some injections.
  • Diagnostic tests.
  • Partial hospitalization.
  • A one-time “Welcome to Medicare” preventive visit. This visit includes a review of your possible risk factors for depression.
  • A yearly “Wellness” visit. Talk to your doctor or other health care provider about changes in your mental health. They can evaluate your changes from year to year.
  • Part B also covers outpatient mental health services for the treatment of inappropriate alcohol and drug use.

There is no cost for your yearly depression screening if your doctor or health care provider accepts Medicare assignment. You will have to pay 20% of the Medicare-approved amount for visits to your doctor or other health care provider to diagnose or treat your condition. The Part B deductible applies. If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance amount to the hospital.

If you are enrolled in a Medicare Supplement or Medicare Advantage, your deductible, copay, or coinsurance may be different or less depending on the plan you have chosen. Medicare Advantage plans may also offer additional mental health services. Please check your Medicare Advantage Summary of Benefits to see if your plan provides any supplemental benefits.

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