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Dear Connie,
My husband and I are struggling because he’s been feeling down lately.
I’m trying my best to support him, but I’m beginning to feel he needs more help. And I’m starting to feel hopeless in my efforts. This has been coming and going for a while now. I’m wondering, does Medicare cover mental health and counseling?
Thank you for reaching out. There is help available for you both. If you or your husband are in crisis, please seek help immediately. You can call 911 or call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org.
Unfortunately, men over the age of 85 tend to experience conditions like anxiety or mood disorders at a higher rate, along with the highest suicide rate. We are happy that you’ve taken notice of mental health warning signs and are seeking help.
Mental health is an essential part of our overall well-being. Nearly 25% of adults 65 and older are living with a mental health condition like anxiety or depression, and less than 50% receive treatment. So, you and your husband are not alone. But, you should also know that it’s not a standard part of aging, so help should be sought out and is available.
We understand that it can be challenging to support someone who’s having mental health challenges. We suggest you seek counseling on your own and with your husband if needed.
Agent tip:
“If you only have Original Medicare, we recommend that you also look into a Medicare Supplement or Medicare Advantage plan that can help cover mental health out-of-pocket costs, especially if a hospital stay or inpatient services are needed.“
Original Medicare does cover mental health. And Medicare covers counseling.
Original Medicare Part B covers outpatient mental health services.
Outpatient services include:
One depression screening per year in a primary care doctor’s office or clinic that provides follow-up treatment and referrals.
Individual and group psychotherapy with doctors or other licensed professionals, as allowed.
Family counseling if the primary purpose is to help a family member’s treatment.
A psychiatric evaluation and prescription drugs management.
Diagnostic tests and certain prescription drugs that aren’t usually self-administered, like injections.
Testing to discover the services and treatment needed.
Outpatient support for substance abuse.
Partial hospitalization, intensive outpatient program services, and more.
Intensive outpatient program services are a benefit that began coverage on January 1, 2024. Medicare will now cover intensive outpatient program services received at a hospital, community health center, Federally Qualified Health Center, or Rural Health Clinic. Intensive outpatient programs offer more rigorous care than in a doctor’s or therapist’s office and may include group and individual therapy sessions. They are more rigorous than a weekly therapy session. You don’t need to qualify for inpatient treatment but must participate in at least 9 hours of services (group and/or individual sessions) to keep receiving services.
These services must be given by Medicare-approved providers who accept Medicare assignment. Providers can include psychiatrists and other doctors, marriage and family therapists, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician assistants. Medicare Part B covers outpatient mental health services, including services provided at a doctor’s or other health care provider’s office, a hospital outpatient department, a community mental health center, a Federally Qualified Health Center, or a Rural Health Clinic.
Another positive mental health update for 2024 is that more mental health workers will begin to accept Medicare. Finding a mental health care provider in your area may be easier. In response to the mental health crisis weighing heavily on seniors and years of advocacy, starting January 1, 2024, more than 400,000 marriage and family therapists and mental health counselors will begin accepting Medicare payments for the first time.
Original Medicare includes one yearly depression screening if the doctor or healthcare provider accepts the assignment. For other mental health services, you must pay the Part B deductible ($240 in 2024) and 20% of Medicare-approved amounts for visits to the doctor or other health care providers to diagnose and treat the mental health condition.
For instance, if the average rate for a counseling session is $100, you would pay $20 for each visit after the Part B deductible is met. Original Medicare would pay for the other $80.
If your husband receives additional mental health services, such as partial hospitalization at a hospital outpatient facility, he may owe additional fees to the hospital.
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Because Original Medicare doesn’t have a maximum out-of-pocket cost, many people enroll in a Medicare Supplement that helps pay for part or all of those costs—or a Medicare Advantage plan. A Medicare Advantage plan covers the same mental health services as Medicare Part A and Part B but with extra dental, vision, and hearing benefits, often with better coverage and fewer out-of-pocket costs.
As a first step, we suggest reaching out to your husband’s primary care physician for a depression screening and a referral to additional services.
If you only have Original Medicare, we recommend looking into a Medicare Supplement or Medicare Advantage plan to help cover mental health out-of-pocket costs, especially if he may need a hospital stay or inpatient services.
If you want to review Medicare Supplement (Medigap) or Medicare Advantage plans that offer mental health coverage, a local licensed Connie Health agent can help you review plans that fit your needs. If you’re already enrolled in a Medicare Advantage plan, review your Evidence of Coverage (EOC), or speak with your plan provider or a Connie Health agent to review your plan’s coverage of mental health services and other benefits you need.
I hope that this information was helpful to you and that you now understand whether Medicare covers mental health and mental health counseling.
Connie Health helps you throughout your Medicare journey. We’d be happy to help you find a plan with the health coverage you need at a budget that is right for you. If you have additional coverage questions, contact a local licensed Connie Health agent at (623) 223-8884.
What is the Medicare-approved amount for mental health services?
There isn’t a fixed Medicare-approved amount for mental health services. Instead, Medicare sets this amount with a mental health services provider. It is the amount that should be paid for a particular service. When seeking a mental health services provider, you should seek someone who accepts Medicare assignment. These providers will generally cost less and are covered by Medicare. If you choose a provider that does not accept Medicare, you may need to pay for all services out-of-pocket or have a higher coinsurance amount.
Generally, Original Medicare Part B pays 80% of the Medicare-approved amount for mental health services. You would first need to pay the Part B deductible, then the 20% coinsurance of the Medicare-approved amount.
If you want help paying for out-of-pocket costs, you may explore a Medicare Supplement or Medicare Advantage plan. A Medicare Supplement plan (Medigap) will help pay for out-of-pocket costs, such as the 20% coinsurance for mental health services. A Medicare Advantage plan offers equal coverage to Original Medicare, and often, it is lower cost, has better coverage, and offers extra benefits like routine dental, vision, and hearing.
If you’d like to explore Medicare Advantage plans that cover mental health services, a local licensed Connie Health agent can help you find a plan in your area with the benefits you need. If you’re already enrolled in a Medicare Advantage plan, review your Evidence of Coverage (EOC) or speak with your plan provider or a Connie Health agent to review your plan’s coverage of mental health services.
Does Medicare pay for mental health counseling?
Yes, Medicare pays 80% of Medicare-approved amounts for mental health counseling. You would pay the Medicare Part B deductible and 20% of Medicare-approved amounts. For instance, if the average rate for a counseling session is $100, you would pay $20 for each visit after the Part B deductible is met. Original Medicare would pay for the other $80.
Medicare Advantage plans also cover mental health counseling, often providing higher coverage than Original Medicare. If you’d like to explore Medicare Advantage plans that cover mental health counseling, a local licensed Connie Health agent can help. If you’re already enrolled in a Medicare Advantage plan, review your Evidence of Coverage (EOC), speak with your plan provider or a Connie Health agent to review your plan’s coverage of mental health counseling.
How much does Medicare pay for mental health counseling?
Original Medicare pays for 80% of Medicare-approved amounts for visits to the doctor or other healthcare providers to diagnose or treat a mental health condition. You would pay the Part B deductible and 20% of Medicare-approved amounts.
For instance, if the average rate for a counseling session is $100, you would pay $20 for each visit after the Part B deductible is met. Original Medicare would pay for the other $80.
Medicare Advantage plans may provide better coverage at a lower cost than Original Medicare. If you’d like to explore Medicare Advantage plans that cover mental health counseling, a local licensed Connie Health agent can help. If you’re already enrolled in a Medicare Advantage plan, review your Evidence of Coverage (EOC) and speak with your plan provider or a Connie Health agent to review your plan’s coverage of mental health counseling.
Does Medicare pay for outpatient mental health counseling?
Yes, Original Medicare Part B pays for part of outpatient mental health counseling. It will cover 80% of the Medicare-approved amount. You would pay the Part B deductible and 20% coinsurance of the Medicare-approved amount. For example, if the Medicare-approved amount for outpatient mental health counseling is $100 per session, you would pay the Part B deductible, then $20 for each session.
These services must be given by Medicare-approved providers who accept Medicare assignment. Providers can include psychiatrists and other doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, marriage and family therapists, mental health counselors, and physician assistants.
Medicare Part B covers outpatient mental health services, including services provided at a doctor’s or other health care provider’s office, a hospital outpatient department, a community mental health center, a hospital, a Federally Qualified Health Center, or a Rural Health Clinic.
Medicare Advantage plans often offer better coverage of mental health counseling at a lower cost, with extra benefits like routine dental, vision, and hearing. If you’d like to explore Medicare Advantage plans that offer outpatient mental health counseling, a local licensed Connie Health agent can help find a plan in your area. If you’re already enrolled in a Medicare Advantage plan, review your Evidence of Coverage (EOC) or speak with your plan provider or a Connie Health agent to review your outpatient mental health counseling coverage.
I am a Spanish-speaking Texas Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2007. I am on the the Advisory Committee for Foster Grandparents, Senior Companions, and RSVP Houston. I enjoy traveling, a backyard BBQ, and volunteering in my community.
(623) 223-8884 | TTY: 711
(623) 223-8884 | TTY: 711
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