Medicare coverage for Mental Health is a topic that is often misunderstood. Many people are not sure what is covered and what is not. In this blog post, we will discuss the basics of Medicare coverage for mental health services. We will also talk about how to get the most out of your mental benefits.
What Mental Health is Covered?
Yes, Medicare covers mental health care, which includes counseling or therapy. Depending on your needs, mental health care can be provided in a variety of settings. The goal is to get the right kind of support when you need it.
Mental health pertains to our emotional, psychological, and social well-being. Our mental health can impact how we think, feel, and act. From a holistic, whole-person perspective, mental health plays a big part in our general overall health. Just as Medicare helps cover physical ailments, it also offers various benefits to support emotional, psychological, and social health.
Mental health concerns include anxiety and depression, substance abuse, eating and stress disorders, schizophrenia, and attention-deficit/hyperactivity disorders. These concerns can range from mild to severe and can be addressed on an outpatient or inpatient basis.
You can access mental health benefits through Original Medicare or Medicare Advantage (MA) plans, an alternative to Original Medicare. MA plans offer the same services, follow the same Medicare rules as Original Medicare, and generally require in-network providers, referrals, and prior authorization to receive benefits.
How Much Does Medicare Pay Towards Mental Health?
Medicare will pay a portion of a designated Medicare-approved amount for mental health services provided by licensed professionals who accept Medicare assignments. You are responsible for copays, coinsurance, deductibles, and any amount charged for the service that is higher than the Medicare-approved amount.
Mental health services, such as individual counseling provided in an outpatient setting will be covered at 80% of the approved charge with Medicare Part B after the annual deductible ($233 for 2022) is met. You pay the other 20%. If you have an MA plan, copay to see an in-network provider typically ranges from $20 to $40 per session. Deductibles may apply, and your MA plan will cover the rest of the contracted in-network cost.
What Additional Services are Covered?
MA plans must provide mental health services as a Medicare-covered service. Any out-of-pocket expenses you incur in the form of copays count toward your maximum out-of-pocket limit set by your MA plan.
Also, If you receive inpatient mental services that require hospitalization under Part A, you will be responsible for the deductible ($1,556 per benefit period in 2022). Alternatively, if you are in an MA plan, you pay a daily copay for the first five or six days of each admission. In 2022, for instance, if you have a UnitedHealthcare MA HMO plan, your daily copay for days one – six is $225. If you have a similar type of plan with Humana, your daily copay for days one – six is $225. And if you have a similar plan with BCBS/Anthem, your daily copay for days one – five is $355. See each plan’s Evidence of Coverage (EOC) for more details.
All inpatient mental health care coverage in a Medicare plan, whether through Original Medicare Part A or a MA plan, includes a maximum lifetime limit of 190 days for inpatient services received in a psychiatric hospital.
Is There Help for Therapy?
As part of Medicare’s mental care benefits, therapy, or counseling is typically covered under Part B as an outpatient service with Original Medicare. MA plans provide the same benefits as Part B does. Therapy generally can be for an individual or a group. Family therapy is covered if it is to support the Medicare beneficiary’s mental treatment goals.
As with all mental health services, you must receive therapy from a provider that accepts assignment for Original Medicare or is in-network with your MA plan. The provider must be licensed in your state. Copay or coinsurance and deductibles apply.
In 2022, for instance, for outpatient mental health care through a UnitedHealthcare MA HMO plan, you pay a $25 copay for each Medicare-covered individual therapy session and a $15 copay for group therapy. For a similar type of plan with Humana, you pay a $20 copay for mental health services received from a specialist, an outpatient hospital, or intensive therapy that is part of the day program in a hospital. For a similar plan with BCBS/Anthem, you pay $40 for each Medicare-covered visit, group, or individual.
What Part of Medicare Covers Mental Treatments?
Medicare Part A generally covers inpatient mental health care provided in a psychiatric hospital. Part B typically covers outpatient mental services, such as individual counseling and therapy. Part D may cover some drugs used to treat mental conditions. Some MA plans provide all three types of coverage – inpatient, outpatient, and prescription drugs – for mental health.
If you looking for a plan with great mental health coverage. Please give us a call if you need help.