Medicare Mental Health Coverage: Therapy, Psychiatry, and Inpatient Care

Depression affects approximately 15% of Medicare beneficiaries, and anxiety disorders are even more common -- yet mental health conditions are dramatically undertreated in older adults. Many seniors don't realize Medicare covers mental health care, or they face barriers to accessing it. Here is what Medicare covers and how to use your benefits.

Medicare Part B covers outpatient mental health services when provided by a Medicare-enrolled provider:

Individual therapy: One-on-one sessions with a psychiatrist, psychologist, licensed clinical social worker (LCSW), licensed professional counselor (LPC), or marriage and family therapist.

Group therapy: Group sessions with a mental health professional.

Psychiatric evaluation: Comprehensive assessment of mental health conditions.

Medication management: Visits with a psychiatrist or other prescriber to manage psychiatric medications.

Cost: 20% coinsurance after the Part B deductible -- the same as other Part B services. (Before 2010, Medicare covered only 50% of outpatient mental health costs -- the Mental Health Parity Act brought it to 80%.)

Medicare covers one depression screening per year at no cost to you -- no deductible, no coinsurance -- when performed in a primary care setting.

This is a preventive service. If you screen positive for depression, your doctor can refer you for treatment.

Medicare covers:

• Alcohol misuse screening and counseling (4 brief counseling sessions per year at no cost)
• Opioid use disorder treatment -- including medication-assisted treatment (buprenorphine/Suboxone, methadone at opioid treatment programs)
• Substance use disorder counseling

Medicare Part A covers inpatient psychiatric hospitalization -- but with an important limitation:

Psychiatric hospital lifetime limit: Medicare covers only 190 days of inpatient care in a freestanding psychiatric hospital over your lifetime. Once you've used 190 days, Medicare will not cover additional inpatient psychiatric hospital stays.

General hospital psychiatric units: The 190-day limit does NOT apply to psychiatric care received in a general hospital's psychiatric unit. These stays are covered under the standard Part A benefit with no lifetime limit.

Cost: Part A deductible and coinsurance -- same as other inpatient stays.

Partial hospitalization is an intensive outpatient program for people who need more support than weekly therapy but don't require 24-hour inpatient care.

What PHP provides: Structured therapeutic programming for several hours per day, several days per week -- including group therapy, individual therapy, medication management, and skills training.

Cost: 20% coinsurance after the Part B deductible.

Medicare has expanded telehealth coverage for mental health services -- allowing you to receive therapy and psychiatric care via video from your home. This is particularly valuable for seniors with mobility limitations or those in rural areas with limited mental health providers.

Finding a Medicare-enrolled mental health provider can be challenging -- many therapists don't accept Medicare. Resources:

• Psychology Today therapist finder: psychologytoday.com/us/therapists -- filter by Medicare
• SAMHSA treatment locator: findtreatment.gov
• Medicare.gov provider finder: medicare.gov/care-compare
• Your primary care doctor: Can provide referrals to Medicare-enrolled mental health providers

Many older adults grew up in an era when mental health treatment was stigmatized. Depression and anxiety are medical conditions -- not character flaws or signs of weakness. Effective treatment is available and covered by Medicare. If you or a loved one is struggling, reaching out for help is a sign of strength.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.