Medicare Part B covers outpatient An outpatient is a patient who has not been formally admitted into the hospital as an inpatient. Most outpatient care is covered under Medicare Part B (medical insurance). mental health care, including the following services:
- Individual and group therapy
- Substance use disorder treatment
- Tests to make sure you are getting the right care
- Occupational therapy Occupational therapy is therapy that helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes.
- Activity therapies, such as art, dance, or music therapy
- Training and education (such as training on how to inject a needed medication or education about your condition)
- Family counseling to help with your treatment
- Laboratory tests
- Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you
- An annual depression screening. Speak to your primary care provider for more information
Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. covers the outpatient mental health services listed above at 80% of theMedicare-approved amount. This means that as long as you receive services from a participating provider, you will pay a 20% coinsurance after you meet your Part B deductible. If you are enrolled in a Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan, contact your plan for cost and coverage information for mental health services. Your plan’s deductibles and copayments/coinsurance may apply.
Medicare covers mental health care you receive through an outpatient hospital program, at a doctor’s or therapist’s office, or at a clinic. You may receive services from the following types of providers:
- General practitioners
- Nurse practitioners
- Physicians’ assistants
- Psychiatrists
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
If you see a non-medical doctor (such as a psychologist or clinical social worker), make sure that your provider is Medicare-certified Medicare-certified means offering services at a level of quality approved by Medicare. Medicare will not pay for services received from a health care provider that is not Medicare-certified. and takes assignment Assignment is Medicare’s approved amount for a service or item. Original Medicare pays 80% of this amount and you (or your supplemental insurance) are responsible for the remaining 20%, called a coinsurance. See also: Take Assignment, Participating Provider, and Non-Participating Provider. . Medicare will only pay for the services of non-medical doctors if they take assignment.
Note: Psychiatrists are more likely than any other type of provider to opt out of Medicare. Be sure to ask any provider if they take your Medicare insurance before you begin receiving services. Remember, if you see an opt-out Opt-out providers do not accept Medicare at all and have signed an agreement to be excluded from the Medicare program. They can charge whatever they want for services, and Medicare will not pay for care you receive from an opt-out provider (except in emergencies). The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you. 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.