Medicare and Counseling
It has been commonly said that depression is normal with age. However, that is not always true. The truth is, it can get harder to determine signs of normal aging compared to the signs of mental health problems. Over the past two years, signs of depression and anxiety have increased due to the COVID-19 pandemic. If you, a loved one, or your primary care doctor see the need for therapy, you may be concerned if Medicare will cover such services or not.
The good news is that Medicare can help cover outpatient and inpatient care for mental health.
Types of Counseling Medicare Covers
Medicare covers the following counseling and therapy options:
- Mental health
- Family counseling
- Alcohol and Opioid misuse treatment
- Smoking and Tobacco treatment
- Cardiac rehabilitation
Under your Part B (part of Original Medicare) you will receive coverage for preventative screenings such as:
- Annual Depression screening (must be done in a primary care facility where follow-up treatment and referrals can be recommended)
- Annual Alcohol Misuse screening (allowed for people who are not dependent on alcohol; for those that are, you may qualify for counseling)
- A “Welcome to Medicare” screening (used once within the year you enroll in Medicare)
- Annual “Wellness” visit (doctor evaluates your health, may recommend additional treatments during this time)
* Remember that your primary care doctor must accept Medicare to receive coverage for treatment options.
Your Part B coverage can also help cover lab tests that your doctor orders.
Additional Covered Therapy
Family Counseling
In order for family or marital counseling to be covered under Medicare it must be part of your therapy for a mental illness, such as depression or anxiety. If treatment is from any of the following professionals, your services are usually covered if they accept Medicare’s assignment:
- Psychiatrist
- Clinical psychologist
- Clinical social worker
- Nurse practitioner
- Physician assistant
If you are looking for this type of counseling and in search of someone in your area that can help, you can use the Provider Search from Medicare.gov’s website.
Alcohol and Opioid Misuse
If your provider determines, based on your alcohol misuse screening, that treatment is needed, Medicare will help cover 4 brief face-to-face counseling sessions each year. If it is recommended that you have more than 4 therapy sessions, you may have to pay all or some of the costs associated.
Medicare will cover opioid use disorder treatment through opioid treatment programs. If you receive therapy through an opioid treatment program, Medicare will help cover doctors, management, psychotherapy, care coordination, and counseling activities.
If you are looking for a facility in your area to help, you can visit Medicare’s Talk to Someone website. Here you can select your state and select Opioid Treatment Program Services to see the list of those available in your state.
Smoking and Tobacco
With Part B under Original Medicare, you can receive up to 8 counseling sessions in a 12-month period to help you stop smoking or using tobacco. The visits must be issued and/or conducted by a doctor or Medicare-recognized provider.
What if I need to be hospitalized because of my mental illness?
If you are needing more intense care for mental health treatment, Medicare will help pay for partial hospitalization. This is a structured program that acts as an alternative to inpatient psychiatric care. The patient would receive treatment during the day but does not stay overnight. These services would be administered through a hospital’s outpatient department or a mental health center.
Will Medicare cover my medications for mental health?
The part of Medicare that covers prescription medications is Part D. This part of Medicare comes at a cost – you must purchase a stand-alone Medicare prescription drug plan in order to receive coverage. Medications administered at your doctor’s office, such as injections, are covered under Part B. If you have a Medicare Advantage plan, you will receive your medication coverage through your plan.
Under a stand-alone Medicare prescription drug plan, they are required to cover at least two medications under each category. If for some reason the medication you take is not on the plan’s formulary, then you can speak with your doctor regarding a possible change in your medication or apply for a formulary exception under the prescription drug plan you have.
Medicare Does Not Cover
Unfortunately, Medicare does not cover all types of therapy. For instance, using a pastor for marital or family counseling would not be covered by Medicare.