Medicare coverage of outpatient mental health services
Section IV.l. Mental Health Services
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Medicare Part B helps pay for outpatient mental health services in the following ways:
Beginning in 2014, Original Medicare will pay 80 percent of its approved amount for the outpatient mental health services listed below. You or your supplemental insurance is responsible for the remaining 20 percent coinsurance. Medicare Advantage plans must cover the same services as Original Medicare; however, your plan will likely require you to see an in-network mental health care provider. If you have a Medicare Advantage plan, contact your plan to see what your copayments are for seeing an in-network mental health provider.
The services Medicare covers include:
You can get mental health services in an outpatient hospital program, a doctor’s or therapist’s office or a clinic. Medicare will help pay for outpatient mental health services you receive from:
If you see non-medical doctors (such as psychologists or clinical social workers), make sure that these providers are Medicare-certified and take assignment, meaning that they accept Medicare's approved amount as payment in full. Medicare will only pay for the services of non-medical doctors if they accept Medicare and take assignment (participating providers).
Medicare will pay for the services of medical doctors (such as psychiatrists) who do not take Medicare assignment (non-participating providers), but these doctors can charge you up to 15 percent above Medicare's approved amount in addition to the Medicare coinsurance. Some states have stricter limits on how much doctors can charge you. Click here for more information on the different types of Medicare providers.
Know that psychiatrists are more likely than any other type of provider to opt-out of Medicare. Be sure to ask any provider if they take Medicare before you begin receiving services. Remember, if you see an opt-out provider, they must have you sign a private contract. The contract states that your doctor does not take Medicare and you must pay the full cost of the service yourself. Medicare will not reimburse you if you see an opt-out provider. If your provider does not have you sign a contract, you are not responsible for the cost of care.
To save money, only use doctors who take assignment.
Annual Preventive Screening for Depression
Medicare covers yearly screenings to detect depression that you receive in doctor’s offices or other primary care settings that can assure appropriate diagnosis, treatment and follow-up. For more information on Medicare’s coverage of the yearly depression screening, please click here.
*Keep in mind that Medicare prescription drug plans (Part D) must cover almost all antidepressant, antipsychotic, and anticonvulsant prescription drugs used to treat mental health conditions.