The Complete Guide to Medicare Mental Health Coverage

Mental health is very important at all stages of life, but especially as we get older. According to the World Health Organization, around 14.1% of adults aged 70 and over live with a mental disorder, with the most common mental health conditions being depression and anxiety. This isn’t surprising when you consider the social and environmental changes that seniors may experience. Someone who spent their days and nights running a high-stress financial firm may feel a reduced sense of purpose after retirement. A person who enjoyed running marathons and hiking in their free time might now feel betrayed by their body as their physical health begins to diminish.

Fortunately, Medicare covers many mental health services. Below is a simple breakdown of how Medicare supports mental health care.

If you have Original Medicare, your Part A and Part B coverage will work in tandem to give you adequate mental health coverage.

Part A, which is your hospital insurance, covers inpatient mental health care in a hospital or psychiatric facility. However, there is a lifetime limit. Medicare Part A will only pay for up to 190 days of inpatient psychiatric hospital services. If you were to surpass that threshold, you would be on the hook for all costs associated with your stay.

Part B, your medical insurance, covers a range of outpatient mental health services, including visits with:

With this coverage, you would typically pay 20% of the Medicare-approved cost for these services after you’ve met your deductible.

A lot of mental health conditions are treated or helped by medication. This is why having prescription drug coverage, or Medicare Part D, is beneficial.

Each Part D plan will have a formulary listing all of the drugs that it covers. These are all subject to the plan’s discretion, since they are not required to cover all drugs. However, they are required to cover all, with some exceptions, antidepressant, anticonvulsant, and antipsychotic medications. Even with these legal protections, it is extremely important that you ensure the plan you want to enroll in covers the needed drugs.

If you or someone you know is struggling with their mental health and has Medicare, take advantage of Medicare.gov’s “Find and Compare Tool” to find mental health providers near you that take Medicare.

However, you don’t want to forget your most important resource, your insurance agent. Your agent will help you select a plan that has adequate mental health coverage. If you do not currently have an agent, reach out to us today, and we will connect you with a friendly, licensed agent whose only goal is to ensure you have the coverage you need.