How to Choose the Right Mental Health Provider With Medicare

Mental health issues affect people of all ages, including seniors. In February 2023, the Kaiser Family Foundation (KFF) reported that 20% of those age 65 and older cited having symptoms such as anxiety and depression. Original Medicare and Medicare Advantage cover many mental health services, but finding a mental health provider isn't always easy.

First, if you exclude pediatricians, the percentage of physicians accepting new Medicare patients has been around 90%. Alternatively, the percentage of psychiatrists doing the same has hovered around 60%, ultimately creating a general shortage of mental health providers.

But more importantly, finding the right provider calls for understanding the role of each type of provider, identifying various potential candidates, then going through the selection process.

Medicare covers many types of mental health services, but not all. For example, you’re covered for marital counseling with a licensed professional as long as it influences your mental health issues, but that counseling cannot come from your pastor.

Treatment may occur in venues ranging from a doctor's office and community mental health facilities to psychiatric hospitals. But the key to successful treatment is finding the provider you relate to and who makes you feel safe enough to take the treatment journey.

Good mental health has no price — it affects every aspect of our lives, but it does have a cost. So what is the Medicare-approved amount for mental health services? In the case of mental health treatment, the coverage of costs is virtually the same as any other service that Medicare covers, depending on the type of Medicare coverage you have, its deductibles, copayments, and coinsurance.

Medicare helps cover mental health services through the following providers:

• Psychiatrists or other doctors
• Clinical psychologists
• Licensed clinical social workers
• Clinical nurse specialists
• Nurse practitioners
• Physician assistants

The condition of coverage is that all those health care providers must accept assignment, meaning they agree to accept the payment amount that Medicare approves for the service.

Treatment for mental health conditions can be divided broadly into medication and counseling, also known as therapy or psychotherapy. Some providers may only prescribe medication, while some may offer counseling, and others may provide both. Let's look at the different mental health service providers within this framework.

Psychiatrists are trained Doctors of Medicine (MD) or Doctors of Osteopathic Medicine (DO) who have chosen to specialize in mental health. Their primary function is identifying and treating mental health conditions, including complex and severe mental illness. These physicians can all prescribe and monitor medication. Some will also provide counseling through talk therapy or psychotherapy. Medicare Part B (Medical Insurance) covers psychiatrist visits and psychotherapy.

A psychiatrist might specialize in specific age groups, such as children or seniors, or fields such as addiction psychiatry.

Clinical psychologists have doctoral degrees in psychology. As such, they can identify and treat many mental health conditions through talk therapy but are rarely licensed to prescribe medications. They may coordinate with a doctor to ensure their patients have access to prescription medications and monitoring if required. Another role of psychologists is to administer psychological tests and evaluations. Regulations vary from state to state, and some allow clinical psychologists to issue prescriptions. Medicare Part B (Medical Insurance) covers psychologist visits and psychotherapy.

Under the large umbrella of psychologists, other therapists who take Medicare can include licensed professional counselors (LPC), licensed clinical professional counselors (LCPC), or similar, depending on the state. These types of counselors have master's or doctoral degrees — plus clinical experience — and provide various types of therapy, including psychotherapy. They identify mental health conditions and provide counseling but do not prescribe medication.

Another group of psychologists that take Medicare includes licensed marriage and family therapists (LMFT) with master's or doctoral degrees in marriage and family therapy. Mental illness can affect other family members, and coverage is included when it is part of a treatment plan.

Licensed clinical social workers (LCSW) have master's or doctoral degrees with a concentration in clinical social work. As health care professionals, they diagnose and treat mental, emotional, and behavioral disorders. They may specialize in specific mental illnesses or behavioral issues for specific age groups and cannot prescribe medications. Mental health services provided by an LCSW are covered by Medicare Part B (Medical Insurance).

Clinical nurse specialists (CNS) are advanced practice registered nurses (APRN) with master's or doctoral degrees in nursing. They're certified in a niche nursing specialty — mental health, in this case — where they have advanced knowledge and clinical skills. They're trained in advanced physiology, pharmacology, and physical assessment in addition to their specialty area. Based on the state regulations where they practice, they can diagnose, treat, and prescribe medications. A CNS typically works in hospitals or mental health clinics, often managing the care of complex and vulnerable populations. Mental health services provided by a CNS are covered by Medicare Part B (Medical Insurance).

Nurse practitioners (NP) specializing in mental health are qualified to prescribe and monitor medication — like psychiatrists — and provide counseling. Other names for this function include psychiatric mental health nurse practitioners or advanced practice psychiatric nurses.

They must have a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP). NPs work individually or collaboratively with other health care providers in hospitals, private practice, long-term facilities, or outpatient settings. They perform assessments, order testing, diagnose, prescribe, and perform procedures within their specialty practice. Mental health services provided by NPs are covered by Medicare Part B (Medical Insurance).

Physician assistants (PAs) who specialize in mental health provide those services under the supervision of a psychiatrist. They're an integral part of a mental health team in many mental health settings, whether inpatient or outpatient. Patient assessment is a significant part of a PA's job, after which they can make a diagnosis, order labs, and make referrals to other providers.

After completing master's programs with clinical rotations, they are experts in psychopharmacology and can prescribe psychiatric medications, including controlled substances. Their value is in helping improve access to mental health services where physician shortages are commonplace. Medicare Part B (Medical Insurance) covers mental health services by a physician assistant.

Original Medicare comprises Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers inpatient mental health services if you're admitted as a general or psychiatric hospital inpatient. Costs are similar to any other inpatient hospital stay, including deductibles, copays, and coinsurance. However, Medicare will only cover 190 days in a psychiatric hospital in total over your lifetime, not including any time spent in a general hospital, even for mental health treatment.

Part B covers outpatient mental health care: those services you receive in a doctor's or therapist's office, outpatient department at a hospital, or community health center. All providers must accept assignment and agree to the Medicare-approved amount as full payment. Part B also helps pay for partial hospitalization if more intense treatment is needed than is available in an office and if your doctor certifies the need. Treatment is in a hospital outpatient department or mental health center, but you don't stay overnight. Individual and group psychotherapy with licensed professionals is also covered by Part B, plus an annual depression screening, diagnostic testing, treatment-related family counseling, medication management, and psychiatric evaluation.

Medicare beneficiaries with Part C Medicare Advantage by law have all the coverage provided by Original Medicare. In some cases, they will receive additional coverage. All typical deductibles, copays, and coinsurance must be paid according to the individual plan.

Once you decide to find a mental health provider, you have several options:

• Your Medicare plan may have a list of approved providers that they provide coverage for.

• Ask friends, family, or someone in your community for referrals. The advantage is that these people know you and will likely recommend someone you'd feel comfortable with. However, their recommendations may not be covered by your Medicare plan.
  

• Ask your primary care physician to suggest someone. You’ll benefit from that person knowing your medical history, but always be sure to check if their services will be covered.
  

• Veterans can call (877) 222-8387 and get provider names from the U.S. Department of Veterans Affairs.
  

• SAMHSA, or the Substance Abuse and Mental Health Services Administration, can help you find affordable mental health services by calling (800) 662-4357.

Medicare offers a physician comparison website. Read on for a step-by-step process of how to use it:

• Create an account on the Medicare website if you don't already have one
• Once logged in, under "Doctors & Clinicians," click "Search for doctors near you"
• Enter your location, plus a specialty, and click "Search"

A long Medicare mental health providers list will appear, starting with those closest to you. After the name and contact information, details of Medicare assignment, available telehealth services, performance information, and other factors will be listed. You can add or remove more filters, such as:

• Distance
• Gender
• Medicare assignment
• Board certification
• Telehealth services
• Type of practice
• Hospital affiliation

Mark the providers that interest you, and once you have several, click the "Compare" button to access a side-by-side comparison. From there, you can choose those providers that best meet your needs.

Online directories and databases are resources you can use to locate mental health providers. Here are five recommended by Medicare:

• National Institute of Mental Health
• Substance Abuse and Mental Health Services Administration
• Mental Health America
• National Alliance on Mental Illness
• National Council for Mental Wellbeing

As you choose a mental health provider, certain factors can be significant. Here are some questions that may help you find the best candidates:

• What are your qualifications? This includes education, training, licenses, and the number of years in practice.
• What is your specialization?
• What services do you offer? Counseling, medication, or both?
• Do you offer telehealth services?
• Do you accept my Medicare plan, and do I need a referral?
• What is your philosophy and treatment approach?
• What are your office hours?
• What do you charge?
• How long are your sessions?

There may be some other factors that are particularly important to you. For you to get the most out of your treatment, you want to develop a good relationship in a welcoming and safe space and remove all barriers to attending sessions. These can include:

• Gender
• Age range
• Size of practice
• Communication style

Finding the right mental health provider that you feel comfortable with may take more than one try, and that’s perfectly okay. If you meet with someone and don't feel at ease, feel free to let them know directly or by text, phone call, or email.

Your mental health influences every aspect of your life, and an issue left untreated can grow until it affects your physical health, relationships, and thoughts. Don’t let embarrassment delay your efforts to seek help, as you're not alone — about one-quarter of Medicare beneficiaries live with a mental illness.

Equally important is knowing that you have the best Medicare coverage possible so you're not adding to the stress of seeking care. A call to OpenMedicare at (844) 910-2061 is the first step to reaching a health insurance agent who can help you get access to the solid mental health coverage you deserve!

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.