Medicare Benefits & Your Mental Health

Medicare Benefits & Your Mental Health

We don’t hesitate to use our Medicare benefits to get a flu shot or treat a physical ailment. We chat with friends and family over dinner about our efforts to lower cholesterol or the results of a recent wellness check-up. But when it comes to mental health issues, there seems to be a lack of conversation.

Medicare beneficiaries tend to neglect a very serious and important subject – their mental health. Although it can be an uncomfortable subject, it is absolutely crucial that beneficiaries take advantage of the Medicare mental health benefits available to help them deal with any mental health issues they experience, just as they would address physical concerns.

Why It’s Important

Studies show that seniors have a greater risk than younger people of developing some mental disorders and experiencing complications. However, many of these illnesses can be accurately diagnosed and treated. According to the World Health Organization, over 20% of adults aged 60 and over suffer from a mental or neurological disorder and 6.6% of all disability among over-60s is attributed to neurological and mental disorders.

Common Mental Illnesses

Depression is a common disorder for individuals over 65 years of age, sometimes brought on by a change in family, lifestyle, or independence. Some seniors experience forms of dementia, such as confusion, memory loss, or disorientation, and are concerned that admitting these problems may lead to a loss of independence or the diagnosis of Alzheimer’s Disease. Although there is no cure for Alzheimer's, drug and non-drug treatments may help with both cognitive and behavioral symptoms.

Eligibility

Many Medicare beneficiaries do not realize that Medicare covers mental health care services to help with conditions such as depression or anxiety. However, if you have Medicare Part B (Medical Insurance), you are covered for mental health services. Counseling or therapy visits with a psychiatrist, clinical psychologist, clinical social worker, physician assistant, clinical nurse specialist, and nurse practitioner are all covered by those who accept assignment.

General Pricing

Health care coverage may include mental health services provided in an outpatient setting, such as a doctor’s office, other health care provider’s office, such as a psychiatrist or clinical psychologist, or hospital outpatient department.  For visits to a doctor or other health care provider to diagnose your condition, you pay 20% of the Medicare-approved amount as long as that provider accepts assignment.  
The Part B deductible applies for both visits to diagnose or treat your condition. 
Inpatient mental health care is covered under Part A.  Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.

Medicare Part B Mental Health Benefits Cover:

  • One depression screening per year. The screening must be done in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals
  • Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services
  • Family counseling, if the main purpose is to help with your treatment
  • Testing to find out if you’re getting the services you need and if your current treatment is helping you
  • Psychiatric evaluation
  • Medication management
  • Certain prescription drugs that aren’t usually “self-administered” (drugs you would normally take on your own), like some injections
  • Diagnostic tests
  • Partial hospitalization
  • A one-time “Welcome to Medicare” preventive visit, including a review of your potential risk factors for depression
  • An annual wellness visit, which is a good time to talk to your doctor or other health care provider about changes in your mental health so they can evaluate your changes year to year

If you or a loved one is showing any symptoms of depression, anxiety, or any other mental health disorder, please talk to your doctor about your concerns. Taking care of your mental, as well as your physical, health can make a big difference in your quality of life.

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