Does Medicare Cover Mental Health Counseling? A Complete Guide

Never before have Americans been at such high risk for mental health disorders. Mental Health America reports that nearly one in five Americans is dealing with a mental illness right now. The number of mental health sufferers has gradually increased for several years. As the coronavirus pandemic hit, drastic changes to all aspects of Americans’ lives further exacerbated our mental health crisis.

Of the over 50 million Americans experiencing a mental illness right now, more than 12 million have admitted to having serious suicidal thoughts. That is equivalent to nearly 5% of all Americans. For multiracial individuals, the figure is more than twice as high.

Nearly one third of those suffering from any form of mental illness have been unable to find treatment. One in ten of those believe they are unable to afford medical care for their mental health problems. However, Medicare plans offer a range of mental health services to their beneficiaries. Here is a detailed look at Medicare plans for mental illness.

What is Medicare Cover for Mental Health?

Mental health conditions can affect anyone at any time. They are not restricted to adults only but can also develop in children, adolescents, and seniors. With more than 20% of Americans struggling with their mental health, it is not surprising that plans like Medicare cover mental healthcare services.

Medicare covers a range of screenings, programs, and services that support patients’ recovery from mental illness. It is not always easy to recognize the symptoms of illnesses like depression and anxiety by yourself. Everyone feels sad or nervous from time to time. But if those emotions persist and you start losing interest in activities you normally enjoy, it may be time to seek professional help.

You may also notice physical signs, like having trouble falling or staying asleep. Other mental illness sufferers find that their energy levels drop, and they lose their appetite. Others again withdraw from their circle of friends and avoid social occasions or other engagements. Social withdrawal may go as far as preventing people from leaving their homes entirely.

All those signs and symptoms could be indicators of a mental health condition. Left untreated, the condition may become more serious as time progresses, and may lead to suicidal thoughts or even suicide attempts. Getting a professional diagnosis from a Medicare-associated medical health professional is the first step toward recovery for many patients.

Once a thorough diagnosis has been made, your doctor or another mental health professional will suggest a treatment plan. Under their Medicare plan, patients may have coverage for programs and services in inpatient and outpatient settings. Medicare also helps cover the cost of prescription drugs that are needed for some mental health conditions. In short, Medicare coverage can give mental health patients access to life-changing treatments.

Medicare Mental Health Coverage – How Does it Work?

Medicare covers a wide range of services and treatments to help those with mental illness. Those services include screenings for specific illnesses, inpatient, and outpatient services. The coverage also applies to telehealth services and treatments requiring partial hospitalization.

Outpatient Services

Outpatient services are the kinds of medical visits and treatments patients generally receive outside of a hospital setting. Locations might be doctor’s or therapist’s offices, or clinics. Patients may also visit hospital sights but receive their treatment through the outpatient department.

This part of mental healthcare is covered under Medicare Part B, also known as medical insurance. As a patient, you gain access to a wide range of mental health specialists, including:

  • Psychiatrists
  • Clinical psychologists
  • Clinical nurse specialists and nurse practitioners
  • Clinical social workers
  • Physician assistants

Healthcare providers that choose to participate in Medicare Part B must accept patient assignments. An assignment is like a contract. The healthcare professional agrees to be paid directly by Medicare for the services they provide to patients. Patients may still have to cover deductibles, hospital copayments, or coinsurance, however.

In short, Medicare will help cover the cost of mental health treatments, but patients or their families may still receive a bill. Anyone worried about the cost of the treatment should talk to their doctor or other mental health care provider before committing to an appointment.

Inpatient Services

Inpatient mental healthcare refers to treatments that patients receive when they are admitted to hospitals as inpatients. This type of care is covered by Medicare Part A, which is also known as hospital insurance. The treatment can be delivered in the psychiatric ward of a general hospital or in a specialized psychiatric hospital that only looks after patients with mental health concerns.

Part A covers a range of services, including:

  • General nursing
  • Semi-private rooms
  • Meals
  • Prescription drugs
  • Additional hospital supplies and services

Medicare mental health cover also includes a limited number of days of hospitalization in each benefit period. A benefit period begins on the day a patient is admitted to the hospital and ends 60 days after they have been discharged.

At the beginning of each benefit period, a deductible becomes due. Depending on how long someone needs to be hospitalized for their mental health condition, they may also need to make a coinsurance payment for every day they remain in the hospital.

Original Medicare payments for mental health hospitalization are limited to so-called lifetime reserve days. The number of lifetime reserve days may vary depending on individual Medicare plans. Beyond those days, patients need to cover the entire cost of hospitalization.

Any patient receiving services normally associated with outpatient care during their period of hospitalization will be billed for 20% of the Medicare-approved amount for mental health services. Supplement insurance like Medigap or other privately-held insurance policies may cover those services. In addition, Medicare Advantage plans are structured differently.

Partial Hospitalization

Partial hospitalization is an alternative to full inpatient treatment for mental health conditions. Patients participating in this type of treatment follow a structured program of outpatient psychiatric services.

Partial hospitalization programs may be delivered by a hospital’s outpatient department. Patients may also be able to access them through their community mental health center. The program can take a large part of the patient’s day, but patients do not stay in the hospital overnight.

Medicare’s coverage of partial hospitalization may also include occupational therapy as part of a person’s mental health treatment plan. Patient education about their condition and training in this context may also be included.  

What are the Medicare Benefits for Mental Health?

Medicare covers a wide range of mental health services, but there are some limits. To avoid nasty surprises, it is important to check individual plans. Here are some of the most popular benefits of Medicare for mental health:

  1. Inpatient and outpatient services
  2. Mental health counseling
  3. Mental health medication
  4. Preventative care
  5. Diagnostic services

1. Inpatient and Outpatient Services

Medicare for mental health conditions includes coverage for mental health treatments and services patients receive from a doctor directly as well as during a hospital stay. Both of those classes of services have limitations, though.

Patients may be liable for deductibles, copayments, and coinsurance. For that reason, patients may want to consider supplementary insurance, such as Medigap or a private healthcare policy.

2. Mental Health Counseling

Mental health counseling is also known as psychotherapy or talk therapy. This type of therapy has been proven to be highly effective for a wide range of common conditions. Counseling works extremely well as a treatment for stress, and many patients notice improvements after only a few sessions.

Mental health counseling also supports recovery from depression and anxiety, low self-esteem, or grief. Medicare covers counseling sessions within the framework of its inpatient and outpatient cover.

3. Mental Health Medication

Aside from psychotherapy or counseling, medication is a common component of mental health treatments. Some mental health professionals use a combined approach of medication and counseling. Others prescribe medication to help control symptoms enough for therapy to become possible.

Original Medicare for mental health does not cover drugs automatically. To be eligible, patients need to join a Medicare drug plan or another Medicare-approved private healthcare plan. Most of these plans will have a list of drugs that are included in their coverage. Original Medicare covers medication management services.

4. Preventative Care

Preventing mental illness is preferable to treating it. This is not only true from a healthcare provider’s perspective. But preventing mental illness also protects family members and loved ones from dealing with the complexities of such a condition.

That is why Medicare covers mental health screenings. Once individuals join Medicare, they become eligible for a “Welcome to Medicare” visit with a medical professional that is specifically geared toward preventing mental illness. During the session, the medical professional and the client review the individual’s risk factors for depression.

Following that, Medicare for mental health covers one annual depression screening. This screening can be performed in a primary care clinic or with the patient’s primary care doctor. Both may also provide referrals or follow-up treatment.

5. Diagostic Services

Whilst patients without medical training may be able to spot potential signs and symptoms of mental illness, proper treatment is impossible without a professional diagnosis. That is why Medicare covers a full psychiatric evaluation to diagnose mental health conditions.

Based on that diagnosis, mental health professionals will develop a care plan that is suited to the condition and the individual both.

What is the Medicare Approved Amount for Mental Health Services?

Medicare pays doctors and other mental healthcare professionals a set amount of money for specific treatments. This is known as the Medicare-approved amount. When a medical professional accepts a Medicare patient, they agree to bill no more than this amount.

Medicare takes care of part of this amount, and patients cover the balance. Before commencing treatment, it is important for patients to check that their provider accepts the assignment and therefore agrees to this type of billing.

Medicare Mental Health Providers List in the United States

Medicare Advantage providers vary from state to state. Here is a list of the top ten providers that operate in most states across the country:

  1. AARP: AARP offers more than healthcare plans. Its plans are aimed at people who are reaching retirement age, and they are supported by UnitedHealthcare.
  2. Aetna: Aetna’s Medicare Advantage plans are among the more low-cost options. They come with a large number of benefits but have had average reviews for user satisfaction.
  3. Anthem: Anthem plans are currently available in 14 states. They stand out for flexibility and the option to choose additional benefits.
  4. Blue Cross Blue Shield: This provider is actually a network of more than 30 individual companies, making Blue Cross Blue Shield one of the largest suppliers in the field.
  5. Cigna: Cigna offers Medicare Advantage plans across approximately half of the country. The company is known as a fairly low-cost provider that also offers Medicare drug plans.
  6. Humana: At the time of writing, Humana was the most widely available provider of Medicare Advantage plans in the U.S. Their plans are highly rated.
  7. Kaiser Permanente: Kaiser Permanente may only be available in a few states, but the company’s plans are consistently highly rated.
  8. Medica: Medica is available in all 50 states and now has 1.4 million members. Its main service areas are Minnesota, the Dakotas, and Wisconsin.
  9. UnitedHealthcare: UnitedHealthcare is another provider whose policies are widely available with good ratings from patients.
  10. Wellcare: Wellcare joined forces with Centene in 2020 but has been struggling with ratings since that time. Perhaps, 2023 brings a turnaround.

Which Mental Health Disorders are Covered under Medicare?

Original Medicare and Medicare Advantage cover patients for a wide range of mental health concerns. Plans cover patients for anxiety and depression, two of the most common mental health challenges in the United States today. Moreover, they offer treatment for stress, grief, and other conditions.

It is important to check that a doctor or other mental health professional accepts the assignment from Medicare and agrees to the Medicare-approved amount for mental health services before committing to a course of treatment.

Are Behavioral Health and Mental Health Therapies or Counseling also Included?

Medicare may help patients pay to manage behavioral health problems. Those problems include depression, anxiety, and other conditions. Behavioral and mental health therapies, including counseling, have been found to be highly effective in treating these conditions.

If a healthcare provider offers the Psychiatric Collaborative Care Model, Medicare may cover behavioral health treatment. This care model includes a thorough care plan and involves an ongoing, monthly assessment of the condition that is being treated.

In addition, patients participating in this approach to mental and behavioral healthcare receive medication support and have access to counseling. Medicare plans may also cover other types of treatments that their provider recommends.

The goal of this plan is to use a comprehensive approach to behavioral and mental healthcare. Patients participating in this plan receive all these services every month throughout the duration of their treatment.

As with other Medicare services, patients may still be responsible for covering a monthly fee as well as a deductible and coinsurance.

How can Truecare24 Help with Mental Health Services?

Truecare24 offers easy access to a wide range of mental health services. The company has curated a nationwide network of mental healthcare professionals, many of which accept Medicare assignments.

The Truecare24 network covers adults of all ages as well as children and adolescents. Patients are able to search for medical professionals online and avoid long delays in accessing the help they need. Those living in remote areas may access online treatments, which can also be covered under Medicare.

Remote healthcare or telehealth can be easier to fit into a busy lifestyle and may help avoid lengthy journeys and the costs associated with seeing a counselor in person. This type of treatment may have been a necessity at the height of the coronavirus pandemic. By now, the approach has been embraced by many healthcare providers as a cost-effective, patient-friendly way of accessing care.

Truecare24’s counseling services cover a wide range of behavioral and mental health concerns, including chronic stress, major depressive disorder, and anxiety. Treatment is also available for people suffering from low self-esteem or those who are finding it hard to deal with grief and loss.

As an established provider and proven partner for leading healthcare providers in the mental health space, Truecare24 is extremely well-placed to respond to the needs of Medicare patients across the entire country.

About TrueCare™

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