Does Medicare Cover Mental Health?
Medicare covers both inpatient and outpatient mental health services. However, there are some restrictions on the types and amounts of mental health care it covers.
Read on to learn what Medicare covers—and what it doesn’t. We’ll also explain some of its limitations and how to overcome them so you can get the affordable therapy you need.
Who Is Eligible For Medicare?
People who work pay into Medicare during their working years through a payroll tax, then are eligible to enroll when they turn 65 years old. You’re eligible for premium-free Medicare Part A if you worked and paid into Medicare for at least ten years.
It’s possible to get Medicare Part A at age 65 even if you haven’t worked, but you’ll probably have to pay out of pocket to cover your premium. The exception is if you are married to someone who paid into Medicare for ten years or more. In that case, you should still be able to get Part A without paying a premium. (Everyone who gets Medicare Part B has to pay the monthly premium for it.)
How Long Have We Had Medicare?
Medicare was passed in 1965 to increase access to healthcare for America’s senior citizens. Most people in America enroll in Medicare when it becomes available to them at retirement age. Before Medicare was passed, 54 percent of elders aged 65 and over had health insurance. Now, 98.4 percent of elders in America have health insurance through Medicare.
Medicare also covers people who are younger than 65 when they have disabilities. People with end-stage renal disease or Lou Gehrig’s disease can enroll in Medicare before they turn 65 years old.
People who qualify for Social Security Disability Income (SSDI) for any reason are eligible for Medicare 24 months after they start receiving SSDI.
You can inquire about your Medicare eligibility at your local Social Security office.
What Are the Different Parts of Medicare?
Medicare Part A covers inpatient treatment and Medicare Part B covers outpatient treatment. These two components of Medicare are often called “Original Medicare.”
You can also sign up for a Medicare Advantage Plan, also called Medicare Part C, when you want additional or different coverage. These plans are offered through private insurance companies.
Medicare Part D covers prescription drugs. It is administered by private insurance companies and is an optional part of Medicare that was created by the 2003 Medicare Modernization Act.
Does Medicare Cover Inpatient Mental Health?
Medicare Part A covers inpatient mental health care including the following services:
- Lab tests
- Medications
- Nursing care
- Room fees and meals
- Other related services and supplies
- Therapy and other mental health treatment
If you have Medicare, a benefit period is triggered every time you’re admitted to the hospital. That benefit period ends after you have gone without inpatient care for 60 days in a row.
There is a deductible for each benefit period. The deductible amount for 2022 is $1556. There is no coinsurance for the first 60 days of inpatient care, but after that period, you must pay increasing amounts of coinsurance for each day you remain in care.
There is no limit to the number of benefit periods you can receive for inpatient care. This includes inpatient medical care and inpatient mental health care received in the psychiatric unit of a general hospital.
Limits on Medicare Coverage of Inpatient Mental Health Care
However, Medicare places a strict limit on care received in a psychiatric facility. Medicare imposes a lifetime limit of 190 days for inpatient treatment in a psychiatric hospital.
Mental health advocacy groups like the National Alliance on Mental Illness (NAMI) are actively lobbying to change this policy that unfairly limits mental health care.
Does Medicare Cover Counseling ?
Medicare Part B covers outpatient mental health care including the following services:
- Diagnostic testing
- Psychiatric evaluation
- Medication management
- Electroconvulsive therapy (ECT)
- Partial hospitalization programs
- Substance use disorder treatment
- Group and individual psychotherapy
- Activity therapies like art, dance, and music therapy
- Family counseling to address a mental health condition
- Drugs that usually aren’t self-administered (like injections)
- An annual depression screening with a primary care physician
- An annual alcohol misuse screening with a primary care physician
Medicare Part B has an annual deductible that changes over time. It was $183 in 2018 and is $233 in 2022. After the deductible, Medicare covers 80% of outpatient services and you have to pay 20% coinsurance on the Medicare-approved amount for the service you are receiving.
The standard monthly premium for Medicare Part B in 2022 is $170.10. This amount is usually deducted from your Social Security check.
Medicare Mental Health Provider List
To see a list of mental health providers near you who accept Medicare, you can visit Medicare’s Physician Compare page or call 1-800-MEDICARE.
Medicare does cover therapy, but coverage is restricted to specific types of therapy providers. Covered provider types include:
- Psychiatrists
- Other doctors
- Nurse practitioners
- Physician assistants
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
However, while Medicare covers all of these provider types in general, professionals in any of these categories can choose to opt out of Medicare reimbursement. (Psychiatrists often choose to opt out of Medicare.) If you want to see a professional who has opted out, you’ll need to use a supplemental plan or pay out of pocket for their services.
So, if you want to pay for therapy using Medicare, check with the provider first to confirm that they have not opted out of accepting Medicare and are a participating or non-participating provider.
What Are Participating and Non-Participating Providers?
Participating providers accept Medicare and always accept Medicare’s approved amount for their services. They submit a bill to Medicare for your care and you are responsible for 20% of that amount.
Non-participating providers accept Medicare but choose whether to accept Medicare’s approved amount for services on a case-by-case basis. They can charge up to 15% more than Medicare approves. This means you need to pay as much as 35% coinsurance when you see a non-participating provider.
Some states limit how much non-participating providers can charge above the Medicare-approved amount. For example, New York limits that amount to 5%. Some Medicare supplement plans, including Medigap Plans F and G, cover these excess charges.
Medicare has only recently started covering services provided by licensed professional counselors (LPCs) and marriage and family therapists (MFTs), but Medicare still only covers their services for treatment of substance use disorders.
Due to provisions in the 2018 SUPPORT Act, LPCs and MFTs can be reimbursed by Medicare for therapy provided to people with a primary substance use disorder diagnosis. This includes treatment for co-occurring mental health conditions.
Professional advocates are lobbying for LPCs and MFTs to be covered for mental health services beyond this special case. In the meantime, if you want to use Medicare to see a therapist to address mental health concerns, you’ll need to see an LCSW, psychiatrist, psychologist, physician assistant, or nurse practitioner.
Does Medicare Cover Marriage Counseling?
Medicare generally only covers marriage or couples counseling in a very limited number of cases.
First, Medicare has only been reimbursing marriage and family therapists (MFTs) since 2019, and it currently only reimburses them for services provided to people with a primary substance use disorder diagnosis.
Second, Medicare only covers services linked to a primary psychiatric diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). So, it won’t cover any kind of marriage or family therapy from any kind of provider if it isn’t required to treat a mental health condition.
This means that if you want to see a social worker or psychologist to address communication or other relationship issues that aren’t directly related to a mental health diagnosis, Medicare won’t cover it.
Does Medicare Cover Online Counseling?
Medicare didn’t used to cover online therapy, but it does now. In 2020, Medicare removed many long-standing restrictions on its coverage of telemedicine.
In the past, Medicare only covered telehealth services provided in rural locations and other federally designated Professional Shortage Areas. It also covered telehealth services only when they were provided in a medical facility like a hospital or clinic. This ruled out in-home telehealth services like online counseling.
Thanks to the changes made to Medicare policy in 2020, Medicare no longer limits telehealth coverage to people in rural areas and now covers telehealth services provided in a person’s home.
For more information, you can go to Medicare’s telehealth coverage information page.
What Can You Do If Medicare Doesn't Cover the Care You Need?
Unfortunately, there are few options for getting Medicare to cover unauthorized services other than changing the federal policies that govern Medicare.
Medicare Policy Can Change
Advocacy can make a difference. For example, the 2008 Patients and Providers Act changed the unfair Medicare policy that made people pay 50% coinsurance for outpatient mental health services. It lowered the coinsurance rate over time until it came into parity with the 20% coinsurance rate for outpatient medical services in 2014.
If you want to get a service that isn’t covered by Medicare, like marriage counseling, or want to see a specific provider who doesn’t accept Medicare, you will probably have to pay out of pocket for these services. Or you may be able to find alternative services or providers that are covered by Medicare.
What About Psychiatrists?
Covering psychiatrist visits with Medicare can be especially tricky. Due to how frequently psychiatrists opt out of Medicare, you may have no choice but to see one who doesn’t accept Medicare and to pay out of pocket for it.
Sometimes, signing up for a Medicare Advantage plan (Medicare Part C) expands access to therapists and psychiatrists who don’t accept Medicare but who accept insurance from the private insurance company that governs the Medicare Advantage plan.
We encourage you to be creative, explore, and consider your different options. In many cases, you can make Medicare work for you, even if you have to jump through a few hoops first. If not, there are also other ways you can get the care you need for a price you can afford.
If you can’t find a local private practice provider who accepts Medicare, consider searching for a provider who offers free or low-cost counseling on OpenCounseling. You may be able to get affordable mental health care from the public mental health system, which generally accepts Medicare, from a community counseling agency, or from a therapist who offers sliding-scale rates.
You can also consider signing up for online counseling with BetterHelp (a sponsor). With the income-based discounts they offer, you may be able to get therapy from a BetterHelp therapist that fits your budget.
Whichever option seems right for you, please reach out—the care you need may be only a call or click away.