Medicare Mental Health Coverage: What Seniors Need to Know

Mental health is just as important as physical health -- yet many seniors avoid seeking help because they assume Medicare won't cover it or they're unsure how to access care. Medicare actually covers a broad range of mental health services, and coverage has improved significantly in recent years.

Medicare Part B covers outpatient mental health services at 80% of the Medicare-approved amount after the Part B deductible. You pay the remaining 20%.

Covered outpatient services include:

• Individual and group psychotherapy
• Family counseling (when it helps with your treatment)
• Testing to find out if you have a mental health condition
• Psychiatric evaluation
• Medication management
• Depression screening (once per year, free)
• Alcohol misuse screening and counseling (free)

Who can provide covered mental health services:

• Psychiatrists
• Clinical psychologists
• Clinical social workers
• Clinical nurse specialists
• Nurse practitioners
• Physician assistants

Medicare Part A covers inpatient psychiatric care in a general hospital the same way it covers other inpatient care -- with the standard hospital deductible and coinsurance.

For care in a freestanding psychiatric hospital, Medicare has a lifetime limit of 190 days. This limit does not apply to psychiatric care received in a general hospital.

Medicare covers partial hospitalization programs (PHPs) -- intensive outpatient programs that provide structured mental health treatment for several hours per day, several days per week. PHPs are covered under Part B when you need this level of care to avoid inpatient hospitalization.

Medicare covers substance use disorder treatment including:

• Opioid treatment programs (OTPs) -- comprehensive treatment for opioid use disorder including medication-assisted treatment (methadone, buprenorphine)
• Alcohol and drug counseling
• Inpatient detoxification

Prior to 2010, Medicare covered outpatient mental health services at only 50% -- meaning you paid 50% out of pocket. The Mental Health Parity Act phased in equal coverage, and since 2014, Medicare covers outpatient mental health services at the same 80/20 rate as other Part B services.

Finding a mental health provider who accepts Medicare can be challenging -- many therapists and psychiatrists do not accept Medicare assignment. Resources for finding providers:

• Medicare.gov/care-compare -- search for mental health providers
• Psychology Today therapist finder (filter by Medicare)
• Your primary care doctor for referrals
• SAMHSA's National Helpline: 1-800-662-4357

Medicare Advantage plans must cover the same mental health benefits as Original Medicare. Many MA plans offer additional mental health benefits, such as telehealth mental health visits, lower copays for therapy, and wellness programs.

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.