Mental health services are finally getting their due, which includes being covered by Medicare. In fact, it used to be that if you were using Medicare, you had to pay for half of all services you received. Fortunately, this law changed in 2008, and you now only have to pay for 20 percent of all outpatient mental health services. Medicare covers inpatient mental health services under Part A, and Part B covers outpatient mental health services.
What Does Medicare Part A Pay For?
If you have a Medicare Part A plan, you have inpatient coverage only. For each benefit period, you’ll be eligible to receive:
- No coinsurance fees for the first 60 days
- $400 coinsurance daily for days 61-90
- $800 coinsurance daily for days 91+
Of course, before this coverage kicks in, you’ll have to pay for your hospital deductible. In 2023, this means you’ll owe $1,600. Once it becomes 2024, the price will go up to $1,632.
It’s also important to know that you’ll only receive 60 reserve days to use throughout your entire lifetime. What’s a reserve day, you ask? It’s any amount of time past 90 consecutive days that you stay hospitalized. So, it’ll cost you $800 per day, and you can’t exceed 60 of these days.
Another thing you need to be aware of is that you can’t spend more than 190 days in a psychiatric hospital. We don’t mean per year, either. This is a lifetime limit. The good thing is that Medicare doesn’t count any days you spend in a general hospital, regardless of whether you’re there for mental health services.
What Does Medicare Part B Pay For?
Medicare Part B offers outpatient mental health services. These include counselors, psychiatrists, clinical social workers, clinical psychologists, etc. However, you must find a mental health specialist who accepts Medicare. The good news is that this program is being expanded in 2024 to include more mental health professionals, along with adding enhanced outpatient care.
Some of the mental health services included are:
- An annual depression screening from your primary care physician
- Coverage for partial hospitalization
- Medication management
- Family Counseling
- Diagnostic tests
- Psychiatric evaluation
What if the Counselor I Go to Doesn’t Accept Medicare?
We’ve all been there; you find a doctor or counselor you like, but then you discover they don’t accept Medicare. What now? Unfortunately, you’ll be 100 percent responsible for paying for the mental health services they provide. Because of this, it’s extremely important to make sure they accept Medicare before you go see them.
What if I Need Mental Health Prescription Drug Coverage?
Medicare Part A will not help you with mental health prescriptions. However, you can opt-in to either Medicare Part D or a Medicare Advantage plan. Be sure to check both plans to see what one covers the specific prescriptions you need. You may find that Part D will help you cover what you need, whereas Medicare Advantage will not (or vice versa). Therefore, always check and verify that you’re opting in to a program that can help you with your specific needs.
Should I Purchase a Medigap Plan?
Medigap’s purpose is to cover the 20 percent gap between using Medicare and the total coinsurance price you must pay. There are several similar programs, including the gap insurance that’s offered to people who purchase a new car. In the car example, if something happens to total a car, gap insurance would kick in to pay off the car loan. This happens after you apply whatever money your car insurance paid for your totaled car, of course.
More specifically, Medigap’s purpose is to cover your coinsurance fees. This can provide a lot of financial relief, but it’s not quite as simple as that. You see, Medigap plans can be pricey, so it may or may not be worth it to you. It’s also difficult to switch your Medigap plan. Therefore, if you decide to purchase one, make sure it’s the right one for your specific situation.
Immediate Mental Health Services
Medicare can help you receive mental health services, but getting an appointment with a counselor probably won’t happen quickly. Therefore, if you need to receive immediate help for a mental health crisis, please call 911 or go to your closest hospital or crisis center.