May 2023: Medicare Coverage of Mental Health and Addiction Treatment
What is mental health care?
Mental health care refers to services and programs intended to help diagnose and treat mental health and illnesses. A mental illness is a condition that affects your thinking, feeling, or mood. Some examples of mental health conditions include depression, anxiety, and schizophrenia. Some also consider addiction, like opioid use disorder and alcoholism, to be mental health conditions. Mental health conditions are typically not the result of any single event or circumstance. Rather, they are complicated conditions involving multiples factors. More than 50% of people will be diagnosed with a mental health illness or disorder at some point in their life.
Inpatient Care
Medicare Part A covers inpatient mental health care in:
- General hospitals
- Psychiatric hospitals
General and psychiatric hospitals have the same out-of-pocket costs, which include the Part A deductible and daily coinsurances after 60 days of inpatient care. Contact your Medicare Advantage Plan for exact costs and rules.
Medicare only covers up to 190 days of inpatient care at a psychiatric hospital in your lifetime.
Outpatient Care
Medicare Part B covers outpatient mental health care, including but not limited to:
- Individual and group therapy
- Substance use treatment
- Activity therapies, like art or dance therapy
- Annual depression screening
- Opioid treatment program (OTP) services
If you have Original Medicare, you usually owe a 20% coinsurance. If you have a Medicare Advantage Plan, contact your plan for costs.
Prescription Drugs
Medicare Part D covers prescription drugs needed for mental health treatment if you have Part D, either through a:
- Stand-alone Part D plan
- Medicare Advantage Plan
You should check before joining a plan that it covers the medications you take. Part D plans are required to cover many drugs used to treat mental health conditions. This includes all antidepressant, anticonvulsant, and antipsychotic medications, with limited exceptions.
What kinds of mental health care providers should I see?
Consider these factors about providers to limit your out-of-pocket costs for mental health care:
- Make sure your provider accepts Medicare assignment, meaning that they accept Medicare’s approved amount as full payment for a service.
- Check that any non-medical doctors, like psychologists or clinical social workers, are Medicare-certified and take assignment. These providers may be more likely to have opted out of Medicare, meaning Medicare will not pay for any part of the service.
- Choose partial-hospitalization programs or Opioid Treatment Programs (OTPs) that accept Medicare.
- If you have a Medicare Advantage Plan, make sure that any provider you see is in your plan’s network.
Where can I begin if I need mental health care?
- Your doctor: Talk to your doctor about your mental health challenges and what care is best for you. Your doctor may be able to recommend mental health specialists to you.
- 988 Suicide and Crisis Lifeline: Call or text 988 for 24/7 support if you are in distress. Trained counselors can help you when you are in crisis, provide prevention and crisis resources for you or your loved ones, and best practices for professionals.
- Medicare: If you have Original Medicare, you can call 1-800-MEDICARE (633-4227) or go to Medicare.gov to find mental health care providers in your area.
- Medicare Advantage Plan: If you have a Medicare Advantage Plan, contact the plan directly to find mental health care providers who are in network and learn about related costs or restrictions.
- Part D plan: Contact your plan to learn if your prescription drugs are covered on by your Part D plan. If they are not, you and your doctor can request an exception or file an appeal to ask your plan to cover the drug.
- Substance Abuse and Mental Health Services Administration (SAMHSA): You can call SAMHSA at 800-662-HELP (4357) for additional help finding behavioral health care providers. SAMHSA may also be able to direct you to local resources.