Does Medicare Cover Counseling Services?

Dear Savvy Senior,

Does Medicare cover outpatient counseling services for its beneficiaries? Since the death of my sister last year, I’ve struggled with depression and anxiety and would like to get some help.

Sad Senior

Dear Sad,

I’m sorry for your loss. Yes, Medicare covers both outpatient and inpatient mental health services to help beneficiaries with depression, anxiety and many other needs. Here’s what you should know.

Outpatient Coverage

If you have original Medicare, your Part B coverage will pay 80 percent (after you’ve met your $198 Part B deductible) for a variety of counseling and mental health care services that are provided outside a hospital, like individual or group therapy, family counseling and more. They also cover services for treatment of beneficiaries who struggle with alcohol and drug abuse.

You, or your supplemental insurance is responsible for the remaining 20 percent coinsurance.

Medicare also gives you the option of getting treatment through a variety of mental health professionals such as psychiatrists, psychologists, clinical social workers and clinical nurse specialists.

To get this coverage, you’ll need to choose a “participating provider” that accepts Medicare assignment, which means they accept Medicare’s approved amount as full payment for a service.

If you choose a “nonparticipating provider” who accepts Medicare but does not agree to Medicare’s payment rate, you may have to pay more. And if you choose an “opt-out provider” that does not accept Medicare payments at all, you will be responsible for the entire cost.

To locate a mental health care professional in your area that accepts Medicare assignment, use Medicare’s online Physician Compare tool. Go to Medicare.gov/PhysicianCompare and type in your ZIP code, or city and state, then type in the type of profession you want to locate, like “psychiatry” or “clinical psychologist” in the search box. You can also get this information by calling Medicare at 800-633-4227.

Inpatient Coverage

If you need mental health services in either a general or psychiatric hospital, original Medicare Part A covers this too (after you’ve met your $1,408 Part A deductible). Your doctor should determine which hospital setting you need. If you receive care in a psychiatric hospital, Medicare covers up to 190 days of inpatient care for your lifetime. And if you use your lifetime days but need additional care, Medicare may cover additional inpatient care at a general hospital.

Additional Coverage

In addition to the outpatient and inpatient mental health services, Medicare also covers yearly depression screenings that must be done in a primary care doctor’s office or clinic. Annual depression screenings are covered 100 percent.

And if you have a Medicare prescription drug plan, most medications used to treat mental health conditions are covered too.

Medicare Advantage

If you happen to get your Medicare benefits through a private Medicare Advantage plan, they must provide the same coverage as original Medicare does, but they may impose different rules and will likely require you to see an in-network provider. You’ll need to contact your plan directly for details.

And for more information, call Medicare at 800-633-4227 and request a copy of publication #10184 “Medicare & Your Mental Health Benefits,” or you can read it online at Medicare.gov.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.