Mental Health Care: What's Covered Under Medicare

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Your mind is the most powerful part of your body. So it's not surprising that your mental health plays a big role in your overall health and well-being, too. That's why it's important to get the care you need when you aren't feeling like yourself.

Getting help for mental health may feel intimidating. But remember, you're not alone. From counseling to medication, there is treatment available to help you feel better. And, Medicare Advantage plans help cover mental health care.

In fact, some Medicare Advantage plans offer even more than what Original Medicare (Parts A and B) offers when it comes to mental health care, says Suzanne Hemp, director of clinical health services at Aetna.


"With traditional Medicare, you get what you see and that's it. No more, no less," she says. "But some Medicare Advantage plans are expanding and providing more coverage."

All Medicare Advantage plans must provide at least the same level of mental health care coverage as Original Medicare. As you might expect, coverage, costs, rules, and restrictions for mental health care will vary based on your plan, so call your plan for specific coverage details before seeking care.

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Inpatient mental health care coverage

A short-term stay in a hospital or mental health treatment center is necessary when doctors determine a person needs to be closely monitored and accurately diagnosed, have their medications adjusted or stabilized, or be monitored during an acute episode when their mental illness temporarily worsens. This is called inpatient mental health care. Both Medicare Part A and Medicare Advantage plans help cover inpatient mental health services that are received in either a psychiatric hospital (a hospital that only treats mental health patients) or a general hospital. This coverage includes:

  • Your room
  • Meals
  • Nursing care
  • Therapy or other treatment for your condition
  • Lab tests
  • Medications
  • Other related services and supplies

Your doctor or mental health provider can determine which hospital setting you need. Depending on where you go for inpatient treatment, there may be limits to your coverage.

"With Original Medicare, as well as with Medicare Advantage plans, there is a lifetime limit on the number of inpatient days at a free-standing behavioral health facility," says Hemp.

This means if you receive care in a psychiatric hospital (rather than a general hospital), Medicare Part A and Medicare Advantage plans will only cover up to 190 days of inpatient care in your lifetime. If you use your lifetime days but need additional mental health care, your plan may cover your care at a general hospital. Call your plan for specific details about your inpatient mental health care coverage.

Outpatient mental health care coverage: providers

Outpatient mental health care is also covered by Medicare Part B and Medicare Advantage with these types of health professionals:

  • Psychiatrist or other doctor
  • Clinical psychologist
  • Clinical social worker
  • Clinical nurse specialist
  • Nurse practitioner
  • Physician assistant

These visits typically take place in a doctor's office or health center, and are often considered counseling or therapy. Both Medicare Part B and Medicare Advantage plans only cover these visits when they're provided by a health care provider who accepts the assignment. If you have a Medicare Advantage plan, it's important to go to a health care professional who's within your plan's network, or you could face paying out-of-network charges.

Hemp says it's also important to make sure the health care professional you're going to is recognized by the Centers for Medicare & Medicaid Services (CMS).

"A health care professional could well be within a Medicare Advantage plan's behavioral health network, but if they're not a provider type that CMS recognizes, it won't be a covered outpatient visit," she says.

A licensed mental health counselor, for example, is a type of health care professional that is not recognized by CMS.

For maximum coverage, make sure the professional you're seeing for outpatient mental health care accepts Medicare, is within your plan's network, and is recognized by CMS. If you have any questions regarding your outpatient mental health care coverage, call your plan.

Outpatient mental health care coverage: services

When you see a health care professional for outpatient mental health care, Medicare Part B and Medicare Advantage plans help cover the following services:

  • One depression screening per year (must be done in a primary care doctor's office or primary care clinic that can provide follow-up treatment and referrals)
  • Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services
  • Family counseling (if the main purpose is to help with your treatment)
  • Testing to find out if you're getting the services you need and if your current treatment is helping you
  • Psychiatric evaluation
  • Medication management
  • Certain prescription drugs that aren't usually "self-administered" (drugs you would normally take on your own), like some injections
  • Diagnostic tests
  • Partial hospitalization
  • A one-time "Welcome to Medicare" preventive visit (visit includes a review of your possible risk factors for depression)
  • A yearly "Wellness" visit (doctors can evaluate changes in your mental health and well-being year to year)

To find out your specific coverage for these services, call your plan.

Additional coverage with Medicare Advantage plans

When it comes to mental health care coverage, a Medicare Advantage plan can give you that extra, well, advantage.

"Case management is an incredibly valuable component of Medicare Advantage plans that you won't get with Original Medicare. You may find a community case management service with Original Medicare, but it wouldn't tie back to your health care," Hemp says.

Some Medicare Advantage plans will also cover treatment in certain intensive outpatient settings and physician-administered psychiatric medications. Remember, all Medicare Advantage plans are different, so call your plan to find out your specific mental health coverage details.

If you think you may need help for a mental health condition, you're not alone. These conditions are more common than you may think, which is why there are so many options available for mental health care. If you think you may need help with a mental health condition, talk to your doctor. Then, call your plan to understand your specific coverage so you can make the best decisions for your health.

Rachel Quetti is a health care writer at Aetna with experience in senior wellness, Medicare, commercial health care, and consumer engagement. When Rachel isn't trying out new fitness classes, she is cooking up fun, (mostly) healthy recipes in the kitchen. Rachel lives in Watertown, Massachusetts and has a degree in journalism from the University of Massachusetts, Amherst.

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