Starting therapy is a difficult process. A patient or their loved ones must not only find the right treatment to suit their needs, but also the right therapist. Figuring out what treatments insurance covers makes an already difficult problem that much more complex. But we are here to help!
Whether Medicare covers psychotherapy, or any mental health treatment, depends on several things. First, the patient must be eligible for Medicare benefits. For someone over the age of 65, this involves being a U.S. citizen or legal resident and working at least 10 years in Medicare-covered employment. For those under 65, Medicare coverage is available to those who have collected Social Security Disability (SSD) payments for 24 months, those with Amyotropic Lateral Sclerosis (ALS), and those with End Stage Renal Disease (ESRD). The good news is Social Security Disability offers benefits for many mental illnesses. These can include depression, schizophrenia, anxiety, bipolar disorder, and substance abuse disorders. If you meet eligibility requirements, you will usually be enrolled automatically in Parts A and B.
Whether Medicare will cover psychotherapy also varies based on where you receive your treatment. Your chosen health care provider must accept assignment. This means that the provider must agree to have Medicare pay them directly. The provider must also accept the payment Medicare approves for the service, and not bill you above the Medicare deductible and coinsurance.
Part A coverage
Medicare Part A will cover any mental health services which you receive as an inpatient. These services include medically necessary treatments, such as psychotherapy and cognitive behavioral therapy (CBT). They do not include costs associated with phones and televisions in your room, personal items like razors and socks, private nursing, or private rooms. While Medicare Part A will cover inpatient mental health care in both general hospitals and psychiatric facilities, there is a 190 day lifetime limit to the care you receive in a psychiatric hospital. For general hospitals, there is no lifetime limit, though it will only cover 90 days of hospital care per benefit period.
Part B coverage
With Medicare Part B, you don’t need to be hospitalized to have your psychotherapy covered. Medicare Part B covers mental health care services typically given outside of a hospital setting. Among these services are:
- individual and group psychotherapy
- activity therapy
- occupational therapy
- family counseling
- yearly depression screenings
- psychiatric evaluation
You also have a variety of providers to choose from. Medicare Part B will cover these services offered by:
- clinical psychologists
- clinical social workers
- clinical nurse practitioners
- physicians assistants
- other doctors
Note that visits to these professionals are only covered if they accept assignment. Medicare can help pay for the services of medical providers who opt out of assignment, but the providers can charge you more than Medicare’s approved amount. Depending on the state you live in, that amount can be substantial. Since psychiatrists are more likely than any other type of provider to opt out of Medicare, be sure to know whether your therapist accepts Medicare before using their services. Providers who opt out of Medicare will have you sign a private contract stating they do not take Medicare.