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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 like 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 in Texas?
Hoping for help,
Virginia from Houston, Texas
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.
Mental health is an essential part of our overall well-being. It’s estimated that 20% of people age 55 and older will experience a mental health concern. 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.
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.
We understand that it can be challenging to support someone who’s having mental health challenges. If needed, we suggest that you seek out counseling on your own and with your husband.
“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 he may need a hospital stay or inpatient services.“
Original Medicare does cover mental health. And Medicare covers counseling.
Outpatient services include:
These services must be given by Medicare-approved providers who accept Medicare assignment. Providers can include psychiatrists or other doctors, 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, or a community mental health center.
One yearly depression screening is included with Original Medicare if the doctor or health care provider accepts the assignment. For other mental health services, you must pay the Part B deductible ($226 in 2023) 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.
Because Original Medicare doesn’t have a maximum for out-of-pocket costs, many people enroll in a Medicare Supplement that helps pay for part or all out-of-pocket 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 benefits like dental, vision, and hearing.
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 that you also look into a Medicare Supplement or Medicare Advantage plan that can help cover mental health out-of-pocket costs, especially if he may need a hospital stay or inpatient services.
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 (TTY: 711).
Read more by Jasmine Alberto
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.