Commonly Used Mental Health Benefits by Medicare Beneficiaries

As people age, certain life events — such as losing a loved one, a severe illness, or loss of mobility — can affect their mental health. In some cases, these events may trigger emotions that can lead to depression or anxiety if they’re not properly addressed. Often, these age-related challenges can compound existing long-term mental health conditions, including schizophrenia or bipolar disorder.

Overall, about one-quarter of Medicare beneficiaries live with a mental illness. The most affected are those under 65 who are eligible due to disability and dual-eligibles, meaning those who are eligible for both Medicare and Medicaid. Coverage has improved in recent years, but around half are still not receiving treatment for their conditions.

The frequent question is: does Medicare cover mental health? Here we explain the resources available through the different parts of Medicare.

Medicare coverage is divided into distinct “parts.” Original Medicare comprises Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare Part C (also known as Medicare Advantage) is a private alternative to Original Medicare. Medicare Part D is optional prescription drug coverage that Original Medicare beneficiaries often buy, but most Medicare Advantage plans already include. Here’s a quick rundown of mental health care coverage under each part of Medicare:

• Medicare Part A helps cover the mental health services you receive in a hospital as an inpatient, including room, food, nursing care, and related supplies or services.

• Medicare Part B helps cover mental health services outside of a hospital, such as visits with psychiatrists, other doctors, clinical psychologists, or clinical social workers — plus doctor-administered medications and doctor-ordered lab tests.

• Medicare Part C offers services that can vary with each private insurer’s plans, so checking membership materials or calling your plan will define what mental health services are covered.

• Medicare Part D helps pay for drugs prescribed for a mental health condition in keeping with each private insurer’s list of covered drugs, also known as a formulary.

Medicare mental health benefits provided by Original Medicare include outpatient services, inpatient services, and screenings. Prescription drugs needed to treat mental conditions fall under optional Part D plans that Original Medicare beneficiaries can purchase. Beneficiaries with Medicare Advantage plans receive the same coverage as Original Medicare, plus prescription drug coverage on most plans. Coverage may extend to other services like grief counseling and special needs plans linked to mental illness.

The Medicare mental health benefits most commonly used by Medicare beneficiaries are discussed below.

Psychotherapy — often referred to as talk therapy — uses several techniques to help you improve your mental health by addressing emotional difficulties and problem behaviors. Your needs will determine the kind of therapy your health care provider recommends. This can include individual sessions or group sessions with other people close to you, such as your spouse or family.

Medications may be combined with your treatment to deal with some chronic symptoms as your therapy sessions progress. Testing may also be part of your treatment. Examples include tests to determine if neurological factors are affecting your mental illness or to measure the impact on your body of any medications.

One therapist may combine various techniques to bring you relief from symptoms and make your everyday functions better. Another might specialize in one or two types of therapy, each addressing a different mental need. These could include:

• Cognitive behavioral therapy
• Dialectical behavior therapy
• Interpersonal therapy
• Psychoanalysis and psychodynamic therapy
• Supportive therapy

Most mental health therapies are provided on an outpatient basis, such as in a professional’s office or a clinic. Patients may wonder, “Does Medicare cover therapy?” Under Original Medicare, therapies are covered by Medicare Part B as long as the professional meets your state’s licensing requirements. Suppose severe symptoms dictate that hospitalization is needed. In that case, inpatient treatment can be covered by Medicare Part A, although there may be yearly or lifetime limitations, so you’ll want to monitor eligibility and usage. You’ll be responsible for any applicable deductibles and copayments, although an optional Medigap plan may reduce your share, depending on your chosen Medigap plan.

Medicare Advantage beneficiaries will receive the same Medicare therapy coverage as Original Medicare beneficiaries but may also have additional coverage depending on the plan.

One of the challenges of prescription regimens is adherence, which can be influenced by personal or cultural beliefs or the side effects of the medications themselves. However, with older populations, adherence can also be affected by poor eyesight, mobility issues, memory challenges, or simply not understanding the instructions. The distraction of mental health issues can compound the adherence issue further.

The more issues one deals with — including the number of prescriptions and doctors — the greater the lack of adherence. The outcome can be adverse drug events (ADEs) which, in turn, can cause unnecessary hospital admissions.

As a result, plans with Medicare drug coverage must offer Medication Therapy Management (MTM) at no cost if you meet specific requirements. The service usually starts with a discussion with your pharmacist or health care provider to review your medications. You may receive a:

• Full review of the medications you take and why you take them
• Summary in writing of what resulted from your discussion with your pharmacist or provider
• Written medications list and suggested action plan to get the most out of your medicines

Your updated medications list should accompany you any time you talk with doctors, pharmacists, and other providers — whether in doctors’ offices, the hospital, or the emergency room.

Helpful reminder tools can range from simple compartmented pillboxes to sophisticated medication dispensers: whatever is required to help you take your medications in the correct dosages at the right times.

How do you access prescribed prescription drugs? If you have Original Medicare, you may access your prescription drugs through an optional, standalone Medicare Part D plan. With Medicare Advantage, prescription drug coverage is likely part of your plan. In either case, the drugs available to you (and their cost) will depend on the plan you choose. However, for drugs related to mental health, plans must cover all or substantially all antidepressants, antipsychotics, and anticonvulsants (benzodiazepines) — three of the six “protected classes” plans must cover. They must also cover various psychotropic medications, such as anti-anxiety drugs.

You may receive inpatient psychiatric care in a psychiatric hospital, a psychiatric inpatient unit within a general hospital, or a psychiatric hospital acute care unit within a psychiatric institution. It entails 24/7 care in a structured, secure, and intensive environment for patients who can’t be treated safely or adequately in a less comprehensive situation.

To be admitted to inpatient psychiatric hospitalization, you must be under the care of a physician who knows you, since that physician must certify your need for admission. To meet state law, you or your legal guardian must also give written informed consent for your admission.

Beneficiaries needing mental health treatment in a general or psychiatric hospital have coverage under Medicare Part A. However, the coverage is limited to 190 days in your lifetime for psychiatric hospitals. Original Medicare beneficiaries pay a deductible and coinsurance for each benefit period, which is defined as beginning on the first day of admission and ending when the beneficiary has gone for 60 consecutive days with no inpatient care. There can be more than one benefit period per year, which restarts a cycle of deductibles and coinsurance. All or part of such costs will be covered for those with optional Medicare Supplement Insurance (Medigap). Medicare Advantage plans will vary their cost-sharing requirements.

The services covered in inpatient psychiatric care under Medicare Part A might combine intensive nursing with medical intervention, psychotherapy, occupational, and activity therapy.

For beneficiaries seeking mental health services, besides the screening services described below, Medicare Part B covers individual and group therapy with psychiatrists, clinical psychologists, clinical social workers, and other qualified support staff, according to your state’s rules.

Mental health services can include psychiatric evaluation, diagnostic tests, individual and group therapy, medication management, and certain prescription drugs administered by doctors in their offices or facilities. Other services include telehealth and possibly family counseling if the goal is to help with treatment.

Suppose a Medicare beneficiary requires a program of individualized and multidisciplinary outpatient treatments beyond what’s available in a therapist’s or doctor’s office. In that case, partial hospitalization is an alternative to an inpatient stay. Treatment is received during the day — without overnight stays — either in a hospital outpatient department or a community mental health center. Original Medicare beneficiaries will meet their annual deductible, then pay 20% of the Medicare-approved amount for covered services. Again, a Medigap plan may pay part or all of those out-of-pocket costs. Medicare Advantage plans will vary in their cost-sharing of outpatient services.

The Centers for Medicare & Medicaid Services (CMS) found good evidence to support screenings for depression in adults to prevent or provide early detection of an illness or disability. Depression is a mental disorder that can be recurrent, life-threatening, and cause morbidity. It can greatly benefit from early diagnosis and intervention. Its origin is believed to include psychological, social, and biological factors, and its diagnosis depends on a highly variable set of symptoms.

One in six persons older than 65 suffers from depression. As a result, Medicare covers an annual screening for depression at no cost. It only requires the screening to occur in a primary care setting with clinical staff to help guarantee accurate diagnosis, effective treatment, and appropriate referrals to mental health treatment. Primary care settings include doctors’ offices or clinics but do not include emergency departments, skilled nursing facilities, testing labs, rehab facilities, or hospices.

Medicare Part B, whether received under Original Medicare or Medicare Advantage, covers the following:

• An annual depression screening that includes a questionnaire that identifies any risk of depression
• A one-time “Welcome to Medicare” preventive visit, when a review of possible risk factors for depression is conducted
• An annual wellness visit to discuss any changes in your mental health with your doctor or other health care provider

A depression screening is required during a beneficiary’s first annual preventive visit under Medicare. Screenings should also be included in subsequent years to catch any signs before they can disrupt your daily living.

With Original Medicare, you pay nothing for your annual depression screening if your health care provider accepts Medicare assignment. Regardless, screenings aren’t done often enough: The percentage of Medicare beneficiaries screened for depression only increased from 8% in 2016 to 23% in 2022.

For further visits to your doctor to diagnose or treat your condition, you’ll first meet the Part B deductible. Next, you’ll pay 20% of the Medicare-approved amount unless you have an optional Medigap plan that helps pay your cost-sharing. Medicare Advantage will meet — or exceed — the coverage offered by Original Medicare when you use an in-network provider.

Medicare’s starting age of 65 is a time of transition for many and change can disrupt your feeling of well-being. Whether it’s the loss of the social structure you enjoyed at work or something else — and you now feel isolated and lonely — your mental health must be a top priority.

For example, something as seemingly simple as loneliness can lead to several physical and mental health conditions. Among them are:

• Anxiety
• Depression
• High blood pressure
• A compromised immune system
• Cognitive decline

Whether you’re approaching the Medicare age or are already there, call OpenMedicare at (844) 910-2061 to be sure you have the right plan for all your needs, including access to solid Medicare mental health coverage and support should you ever need it.

Please note that we do not always offer every available plan in your area. As a result, any information we provide is limited to the plans we do offer. Please contact Medicare.gov or 1–800–MEDICARE for information on your options.