Are Mental Health Services (like Therapy) Covered Under Medicare?
Behavioral / Mental Health Services + Medicare
Sometimes it can be problematic for older adults to differentiate indicators of mental health difficulties for typical aging-related changes. They may think that experiencing sadness or anxiety is an ordinary symptom of growing older, particularly when they live with taxing health conditions or lose loved ones.
Deteriorating health and the challenges of coping with a variety of diseases can put seniors at a greater risk for mental health disorders such as depression and anxiety. If an individual is grappling with thoughts of self-harm or relentless feelings of sadness or hopelessness, they need to talk to a doctor about receiving the help needed.
It’s especially important to be aware that Medicare includes many benefits to care for a senior’s mental well-being, including psychological counseling, preventive screenings and outpatient treatment programs.
Mental health refers to our emotional, psychological and social welfare. Our mental health can have a profound effect on how we think, feel and act. From a holistic perspective, mental health comprises a big part in our overall health. Just as Medicare helps cover physical ailments, it also offers a wide range of benefits to sustain emotional, psychological and social health.
What Part of Medicare Supports Preventative Mental Health?
Preventative care can help pinpoint patients who are inclined toward mental health struggles so that they can secure the needed treatment more quickly. Medicare Part B includes plenty of preventative services, such as screenings to evaluate an individual’s risk for certain mental health disorders.
Medicare Covers the Following Preventative Mental Health Benefits:
- The office of a doctor or medical practice.
- Family counseling, if the central reason is to maintain the individual’s mental health treatment.
- Testing to evaluate whether or not the individual is receiving the services they need and if they are helping them, including particular lab tests.
- Partial hospitalization: These are rigorous outpatient services that an individual receives during the day but doesn’t require an overnight stay in the hospital.
- Annual depression screening: All individuals with Medicare receive one free evaluation for depression per year on condition that the doctor accepts Medicare assignment.
- Alcohol abuse screening: Some individuals with mental health difficulties may wrestle with alcohol or drug abuse. Medicare covers one alcohol misuse screening each year. If the person is alcohol-dependent, they could also be qualified for counseling.
- “Welcome to Medicare” visit: This preliminary preventative visit contains an assessment of an individual’s risk for depression. The person is obliged to have an exam within the first year of acquiring Medicare coverage.
- “Wellness visit”: During this particular annual visit, the doctor will evaluate the individual’s physical and mental health and, at that time, they’ll be given the opportunity of bringing up any mental health matters with their physician. The physician can offer recommendations based on the person’s risk factors or refer the person for further care.
Does Medicare Cover a Behavioral Health Therapist?
Medicare Part B will cover mental health services an individual receives as an outpatient, such as through a clinic or therapist’s office.
Medicare also covers counseling services, such as diagnostic assessments, but not necessarily limited to:
- Psychiatric evaluation and diagnostic tests
- Individual therapy
- Group therapy
- Family counseling (if the goal of therapy is to help an individual’s condition)
- Alcohol abuse counseling (up to four sessions)
Additional eligibility conditions may apply to qualify for these benefits. Keep in mind that Medicare doesn’t cover every manner of therapy. An individual does not qualify for marital counseling or counseling with a pastor. He/she is only covered for mental health services through a licensed psychiatrist, clinical psychologist or other healthcare specialist who accepts Medicare assignment.
Some individuals with mental health disorders may need more rigorous treatment than a doctor or therapist can provide. Medicare also covers outpatient treatment programs, where recipients can receive more thorough or structured mental health services without being admitted for inpatient hospital care. These programs are known as partial hospitalization programs and are normally offered through a hospital’s outpatient unit or a community mental health clinic. An individual may be eligible for a partial hospitalization program if their doctor confirms that they’d otherwise would need to be hospitalized as an inpatient.
Patient Payments
Medicare will pay for a segment of a designated Medicare-approved expense for mental health services delivered by licensed professionals who accept Medicare assignment. The individual is accountable for copays, coinsurance, deductibles and any fees charged for the service that is higher than the Medicare-authorized amount.
Mental health services, for instance individual counseling provided in an outpatient setting, will be covered at 80 percent of the approved charge with Medicare Part B after the annual deductible ($233 in 2022) is achieved. The patient pays the other 20 percent. If the individual has a Medicare Advantage plan, the plan must offer mental health services as a Medicare-covered service. Any out-of-pocket expenses incurred in the form of copays count toward the individual’s out-of-pocket limit set by the MA plan.
Are you a provider of Medicare-approved mental health therapy services? Are you having difficulty in keeping up with all the changes in behavioral health billing? We invite you to talk to us, in order to discover how we can help you improve your revenue management protocol. It’s not as costly as you might have been led to believe and most likely will end up keeping more dollars in your business bank account.