Medicare coverage of outpatient mental health services

Section IV.k. 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:

  • Individual and group therapy
  • Family counseling to help with your treatment
  • Tests to make sure you are getting the right care
  • Activity therapies, such as art, dance or music therapy
  • Occupational therapy
  • Training and education (such as training on how to inject a needed medication or education about your condition)
  • Substance abuse treatment
  • Laboratory tests
  • Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you

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:

  • general practitioners
  • nurse practitioners
  • physicians’ assistants
  • psychiatrists
  • clinical psychologists
  • clinical social workers
  • clinical nurse specialists

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.


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Medicare Part B costs

Paying for the doctor when you have Original Medicare

 
LINKS
National Alliance for the Mentally Ill (NAMI)

National Mental Health Information Center (Center for Mental Health Services)

Mental Health America

National Mental Health Consumers' Self-Help Clearinghouse

National Empowerment Center

National Directory of Medicare Regional Carriers and Intermediaries

Medicare.gov: National A/B MAC Information

 
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