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Medicare Part B Coverage of Mental Health

Medicare Part B Coverage of Mental Health

 

Medicare Part B may cover one depression screening per year at no cost, if the doctor accepts Medicare assignment. The screening must be done in a doctor’s office or other primary care setting that can provide follow-up treatment and referrals if needed.

Part B also may cover visits with a variety of mental health professionals such as psychiatrists, clinical psychologists, clinical social workers, or licensed alcohol and drug counselors, among others. If a doctor determines it is necessary, you may be covered for individual or group psychotherapy, family counseling, and psychiatric evaluation. You will generally pay 20% of the Medicare-approved amount for these services from providers who accept assignment, and the Part B deductible will apply. If you get these services in a hospital outpatient clinic or department, you may also have a copayment due. Having a Medicare Supplement plan in addition to original Medicare Plan A and Plan B, will cover the 20% portion of Medicare-approved amounts as well as deductibles and copayments.

How often is mental health care (outpatient) covered?

Medicare Part B (Medical Insurance) covers mental health services and visits with these types of health professionals:

  • Psychiatrist or other doctor
  • Clinical psychologist
  • Clinical social worker
  • Clinical nurse specialist
  • Nurse practitioner
  • Physician assistant

Medicare only covers these visits, often called counseling or therapy, when they’re provided by a health care provider who accepts assignment.

Part B covers outpatient mental health services, including services that are usually provided outside a hospital, like in these settings:

  • A doctor’s or other health care provider's office
  • A hospital outpatient department
  • A community mental health center

Part B also covers outpatient mental health services for treatment of inappropriate alcohol and drug use.

Part B helps pay for these covered outpatient 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 main purpose is to help with your treatment.
  • Testing to find out 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.P
  • artial hospitalization.
  • A one-time “Welcome to Medicare” preventive visit. This visit includes a review of your potential risk factors for depression.
  • A yearly “Wellness” visit. This is a good time to talk to your doctor or other health care provider about changes in your mental health so they can evaluate your changes year to year.

Who's eligible?

All people with Medicare Part B are covered.

Your costs in Original Medicare

  • You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment.
  • 20% of the Medicare-approved amount for visits to a 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.
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