Medicare pays for both inpatient and outpatient mental health care, including the cost of therapy. However, some out-of-pocket expenses may apply.
Medicare is a federal insurance program for people ages 65 years old and older or those below 65 with specific health conditions.
Medicare provides coverage for therapy and other mental health care needs. Medicare Part A helps cover hospital stays, while Medicare Part B helps cover doctor visits and day programs in the hospital. Medicare Part D helps pay for medications.
This article discusses how a person may get mental health services through Medicare, the out-of-pocket costs, and how to get help to cover extra costs.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Individuals with Medicare Part B are eligible for one “Welcome to Medicare” preventive visit within the first 12 months after they enroll.
One part of this visit is an evaluation by a healthcare professional for their potential risk of depression.
Individuals are also eligible for yearly “wellness” visits. These can occur every 12 months after the first year of having Medicare Part B. These visits include overall health checks, health advice, and advanced care planning. They can also involve a cognitive assessment that can check for signs of dementia as well as other conditions such as depression or anxiety.
In addition to the wellness visits, Medicare covers certain mental health services both inside and outside of a hospital.
Part A coverage
Medicare Part A pays for inpatient care when a person needs admittance to a general or psychiatric hospital.
Part A only covers eligible costs in a free-standing psychiatric hospital for a maximum of 190 days per lifetime. The number of benefit periods for mental health care received in a general hospital is unlimited.
Learn more about Medicare Part A.
Part B coverage
Medicare Part B pays for one depression screening each year. The screening must take place in the office of a primary care doctor or similar to ensure there is appropriate follow-up care.
Part B also pays for single or group therapy by state-licensed experts. Family therapy may receive coverage when it is to help with a person’s treatment.
Mental health services also receive coverage when one of these healthcare professionals provides it:
- a psychiatrist
- clinical psychologists
- clinical social workers
- clinical nurse specialists
- a nurse practitioner
- a physician assistant
Other mental health support services receive coverage by Part B, including:
- tests to see if the current treatment is working
- evaluation and prescription drug follow-up visits
- some prescribed medication that healthcare professionals give in the doctor’s office
- diagnostic tests
- partial hospitalization
Partial hospitalization is a structured day program that replaces inpatient care. Treatment is more intensive than a weekly office visit.
Medicare may pay for partial hospitalization at a community mental health center when the center meets certain rules. The center must offer 24-hour emergency care and clinical evaluation.
During partial hospitalization, Medicare does not cover:
- meals
- transport
- support groups, though group therapy has coverage
- job skills testing or training that is not part of treatment
Medicare Parts A and B do not cover prescribed medication that someone takes at home, but individuals can use Medicare Part D to help pay for these costs.
Learn more about Medicare Part B.
A person’s mental health
Mental health is important in every stage of life, and life events can trigger both physical and emotional responses. Some triggers may include:
- job loss
- retirement
- grief and loss
- violence
- bullying
- loneliness and isolation
Some factors that affect mental health are family history, biology, nutrition, problems sleeping, and physical health.
According to the
Early signs may help identify that healing or treatment could be necessary. Some of those signs
- eating too little or too much
- low energy levels
- feeling helpless or hopeless
- irritability or restlessness
- mood swings
- sleeping too much or not enough
- unexplained aches and pains
- thoughts of harming themselves
- smoking, drinking, or using recreational drugs more than usual
Psychotherapy, known as talk therapy, uses techniques to help people improve their mental health by addressing emotional difficulties and behaviors that may be troubling.
Medicare Part B covers most outpatient mental health treatments, including psychotherapy. The therapist must meet all state licensing requirements. The individual is also responsible for any deductibles or coinsurance amounts.
Types of psychotherapy that may receive coverage include:
- cognitive behavioral therapy (CBT)
- dialectical behavioral therapy
- interpersonal therapy
- supportive therapy
- psychoanalysis and psychodynamic therapy
If a mental health condition is severe enough to require inpatient hospital treatment, Medicare Part A will cover the costs of treatments.
Some services are not eligible for Medicare coverage. These include:
- adult day health programs
- biofeedback
- marriage counseling
- pastoral counseling
- environmental modifications
- preparing reports
- explaining results or data
- schizophrenia hemodialysis
- transport and meals
- phone applications or services
There are some out-of-pocket costs for mental health care with Medicare.
Part A
Medicare Part A deductions and coinsurance payments include:
- a $1,632 deductible in 2024 for each inpatient hospital benefit period
- 20% coinsurance for approved costs after the deductible has been met
- copayments of: $0 for days 1 to 60 in each benefit period
- $408 pre-day for days 61 to 90 in each benefit period
- $816 for each lifetime reserve day a person uses from day 91
- all costs after someone has used their lifetime reserve days in full
A person has 60 lifetime reserve days to use during their lifetime.
Part B
In Part B, there are out-of-pocket costs for diagnosis and treatment.
A person must pay 20% of the Medicare-approved amount after the Part B deductible is met.
The Part B deductible for 2024 is $240. This amount can change each year.
There are programs available if a person needs additional support with extra costs.
Program of All-Inclusive Care for the Elderly (PACE)
Medicare and Medicaid manage this program that helps people meet their healthcare needs within the community. A team of community healthcare providers from a PACE center organizes care for individuals.
Medicaid
People who qualify for Medicaid may have access to support services in their area. This includes case management, home care, personal care, and transport to doctor appointments.
Extra Help
Extra Help provides help for people with limited resources who need to pay for prescribed medication. To qualify, a person must prove they get needs-based benefits such as Medicaid or Supplemental Security Income. Extra Help can also help pay for monthly premiums and annual deductibles.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare Part A helps cover the hospitalization costs of mental health care, while Part B helps pay for therapy and partial hospitalization costs.
Medicare also covers an annual mental health screening with an approved Medicare health expert.
Original Medicare does not pay for meals, transport, or most prescribed drugs. A person can enroll in Medicare Part D to help cover prescription medication.
An individual may have to pay a deductible, coinsurance, or copayment toward mental health care costs. However, help is available through programs such as Extra Help, Medicaid, or the Program of All-Inclusive Care for the Elderly (PACE).