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Saturday November 1, 2014

Savvy Living

Savvy Senior

How Medicare Covers Outpatient Mental Health Services

Does Medicare cover outpatient counseling or therapy sessions for seniors? My husband has really struggled with depression since retiring and needs help. What can you tell us?

Yes, Medicare recently upgraded its coverage of outpatient mental health services to help beneficiaries with depression and other needs. Here’s how it works.

Once you have met your $147 Part B deductible, original Medicare Part B will pay 80% of the cost of certain outpatient counseling and therapy services such as group therapy and family counseling. Part B also covers services for treatment of beneficiaries who struggle with inappropriate alcohol and drug use. The remaining 20% coinsurance will be paid by you or your supplemental insurance.

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

It’s also important to understand that if your husband decides to see a non-medical doctor (such as psychologists or a clinical social worker), you’ll need to make sure that he or she is Medicare-certified and takes assignment. A doctor that takes assignment means they accept Medicare’s approved amount as full payment. If they don’t, Medicare will not pay for the services.

Medicare will pay for the services of Medicare-certified medical doctors (such as psychiatrists) who do not take assignment. However, these doctors can charge you up to 15% above Medicare’s approved amount in addition to the 20% coinsurance for which you will be responsible.

To locate a mental health care professional in your area that accepts Medicare assignment, use Medicare’s online Physician Compare tool. Just go to medicare.gov/physiciancompare and type in your zip code or city and state, then enter the type of profession you want to locate in the “What are you searching for?” box. You can also get this information by calling Medicare at 800-633-4227.

Medicare Advantage


If you and your husband get your Medicare benefits through a private Medicare Advantage plan, it must cover the same services as original Medicare but the plan will likely require him to see an in-network provider. You’ll need to contact your plan directly for the details.

Additional Coverage


In addition to outpatient mental health services, you should also know that Medicare covers yearly depression screenings. The screenings must be done in a primary care doctor’s office or primary care clinic that can assure appropriate diagnosis, treatment and follow-up. Annual depression screenings are entirely covered.

Medicare will also cover almost all medications used to treat mental health conditions under the Part D prescription drug program. If your husband is prescribed an antidepressant or some other medication for his condition and he has a Part D plan, you should call his plan to confirm coverage. You can also search the plans formulary (the list of medications they cover) on their website.

For more detailed 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/publications/pubs/pdf/10184.pdf.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.

Published October 24, 2014
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