Medicare has historically paid less for mental health care than for other medical care. That is changing.
The Mental Health Parity and Addiction Equity Act of 2008 required that private health plans cover both physical and mental health services equally. At the time, Original Medicare covered mental health treatment at 50 percent after the Part B deductible. The beneficiary paid the other 50 percent. But Medicare paid 80 percent for most other health care, as it still does today.
In short, Medicare was not required to abide by the same law as private plans. Beneficiaries paid a bigger share of the cost for mental health care than for other health care services.
What You Will Pay
You still will pay more for mental health care today, but it’s getting better. Congress passed legislation that reduces how much Medicare beneficiaries pay for outpatient mental health treatment. Over time, the cost will be consistent with coinsurance amounts for other medical services.
In 2013, you will pay 35% of the cost for mental health treatment after any deductibles are satisfied. (Medicare already pays 80 percent of the cost for doctor visits when the purpose is to diagnose a mental health condition rather than to treat it.) In 2014, your share will be 20%, the same as for other medical services.
What’s Covered
Mental health care includes services and programs to help diagnose and treat mental health conditions. Medicare covers outpatient and inpatient mental health care and prescription drugs you may need to treat a mental health condition. Your specific benefits will depend on the type of Medicare coverage you have.
In general, Medicare Part B covers outpatient mental health services. You usually get these services in a doctor or therapist’s office, in a clinic or in a hospital outpatient department. Part B helps pay for the following covered services (deductibles and coinsurance may apply):
- Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state to give these 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
- Occupational therapy that’s part of your mental health treatment
- Certain prescription drugs that aren’t usually self administered, like some injections
- Individual patient training and education about your condition
- Diagnostic tests
- Partial hospitalization (day programs in a hospital setting) may be covered
Medicare Part B also covers one depression screening per year. You must get the screening in a primary care office or clinic that can provide follow-up treatment and referrals. You pay nothing for this yearly depression screening if your doctor or health care provider accepts assignment.
Medicare Part A helps pay for mental health services that require you to be admitted to a hospital. You can get these services either in a general hospital or in a psychiatric hospital.
If you’re in a psychiatric, Part A only pays for up to 190 days during your lifetime.
Medicare Part D helps pay for prescription medications needed to treat mental health conditions.
If you get your Medicare benefits through a Medicare Advantage plan or another Medicare health plan, check your membership materials for information about mental health benefits
For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. - 8 p.m. local time, seven days a week.
Resources
Medicare.gov: Visit the official U.S. government site for Medicare and use the Plan Finder tool.
Medicare and Your Mental Health Benefits: Learn more from Medicare’s booklet about mental health benefits.
Y0066_130218_090139 CMS Accepted
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