Medicare Counseling - Mental Health Therapy Coverage

By: Agnus Smith
Published: Wednesday, November 21 2018
Last Updated: 4 years ago

Managing multiple health issues can put seniors at risk of developing mental health issues such as depression or anxiety. Many people wonder if mental health counseling is available through Medicare, and the answer is yes. Although, in many circumstances, mental health therapy is covered, though managing the intricacies can seem a little tricky at first. Here are a few common questions about Medicare therapy.

What Is Medicare Counseling?

Medicare counseling is mental health coverage through Medicare. The mental health counseling can be provided by any doctor or therapist who will accept your coverage. Whether this is attending regular therapy, visiting a licensed psychiatrist, or visiting a licensed social worker. Your primary care doctor can provide you with a referral to Medicare counseling that will ensure you get the proper care you need.

It is important to find a provider who accepts Medicare assignments, to avoid any unnecessary charges at your expense.

Will Medicare Pay for Your Mental Health Therapy?

Yes, Medicare will pay for any licensed psychiatrist or medical health professional who will accept your plan. Medicare counseling covers a wide range of mental health services. Depending on your plan, you are entitled to inpatient, outpatient, and regular therapy sessions, all covered by Medicare. Of course, usual copays and deductibles may still apply in these situations.

Covered Counseling Under Medicare Part B

Medicare Part B offers outpatient mental therapy, meaning any therapy outside of a hospital environment. This includes psychiatric evaluation, diagnostic tests, individual therapy, group therapy, family counseling (if the goal of therapy is to help your condition), and up to four sessions of alcohol abuse counseling. Unfortunately, marriage counseling is not covered under Medicare counseling.

Medicare Therapy Costs You Are Responsible For

The good news is that there isn't much that Medicare doesn't cover. For instance, Part A doesn't cover private rooms, a phone or television, personal items, and private nurses, so you will be responsible for any of these costs during your hospital stay. Part B doesn't cover meals, transportation, support groups, and job-skill training, which will be paid out of pocket by you. Other than this short list, Medicare counseling will help treat you in every other way possible to ensure you get the proper mental health treatment.

Inpatient Mental Health Counseling for Medicare Beneficiaries

While Part B offers many mental health benefits, inpatient stays are not included. It orders to be eligible for an inpatient mental health stay, you must be enrolled in Medicare Part A.

When Medicare Part A Takes Over

Medicare Part A includes hospital visits which are critical to your inpatient care. This includes hospital stays pertaining to mental health issues as well. The expenses covered include but are not limited to:

  • A semi-private room
  • Meals
  • Nursing services
  • Medications that are part of your inpatient treatment.
  • Any other services and supplies from the hospital.

Many people on Medicare Part B can become eligible for Part A after they turn 65 years old. If you sign up within 6 months of your 65th birthday your Medicare Part A coverage will start at once. If you are already collecting retirement benefits from either the Social Security Administration or the Railroad Retirement Board, then you are automatically eligible for Part A.

Prescription Drug Coverage for Medicare Counseling

Medicare therapy will also cover prescription drug coverage under certain circumstances. Part A will cover prescriptions necessary during a Medicare-covered hospital stay, Part B will pay for drugs administered by your provider, and Part D will pay for most outpatient drugs filled at a pharmacy.

If you wish to receive regular mental health prescriptions for your ongoing mental health issues, you must apply for Medicare Part D or other prescription drug coverage which will help you pay for the cost of your medications. Otherwise, you will be responsible for 100% of all prescription costs outside of a hospital setting or unless administered by a Medicare-covered medical professional.