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According to the National Alliance on Mental Illness (NAMI) nearly one in five adults (around 18.5%, experience mental illness in a given year. Mental health diagnoses include schizophrenia, bipolar disorder, major depression, and anxiety disorders such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias. Untreated mental illness can have a serious impact on the life of the sufferer. According to NAMI, depression is the number one cause of disability worldwide. Fortunately, Original Medicare, Part A and Part B, covers many services related to mental health.
Medicare Part A Coverage of Mental Health
If your doctor determines that you need inpatient mental-health care, Medicare Part A generally covers services in either a general hospital or a psychiatric hospital. However, Medicare coverage for inpatient psychiatric hospital services is limited to 190 days during your lifetime. You would be required to meet a $1,364 deductible in 2019 for each benefit period. For days 1 to 60 of your hospital stay, there is $0 copayment. For days 61 to 90, there is a $341 coinsurance payment in 2019. After the 91st day in the hospital, you would have a $682 coinsurance in 2019 per each “lifetime reserve day” (up to 60 days in your lifetime) and after that, you would typically pay all costs.
Medicare Part B Coverage of Mental Health
Medicare Part B may cover one depression screening per year at no cost, if the doctor accepts Medicare assignment. The screening must be done in a doctor’s office or other primary care setting that can provide follow-up treatment and referrals if needed.
Part B also may cover visits with a variety of mental health professionals such as psychiatrists, clinical psychologists, clinical social workers, or licensed alcohol and drug counselors, among others. If a doctor determines it is necessary, you may be covered for individual or group psychotherapy, family counseling, and psychiatric evaluation. You will generally pay 20% of the Medicare-approved amount for these services from providers who accept assignment, and the Part B deductible will apply. If you get these services in a hospital outpatient clinic or department, you may also have a copayment due.
Medicare Part D Prescription Drug Plans Coverage of Mental Health
Medicare Part D Prescription Drug Plans are required to cover almost all drugs classified as antidepressants, antipsychotics, and anticonvulsants, which may be prescribed for some mental health problems.
According to the Food and Drug and Drug Administration (FDA), examples of antidepressants include:
- Prozac (generic: fluoxetine)
- Cymbalta (generic: duloxetine)
- Elavil (generic: amitriptyline)
- Nardil (generic: phenelzine)
- Wellbutrin (generic: bupropion)
Examples of antipsychotics include:
- Latuda (generic: lurasidone)
- Seroquel (generic: quetiapine)
- Geodon (generic: ziprasidone)
- Invega (generic: paliperidone)
- Abilify (generic: aripiprazole)
I hope you understand the mental health coverage available under Medicare a bit better now. If I can answer any other questions for you, please reach out at your earliest convenience. You can use one of the links below to request a phone appointment or get an email with personalized information for you. If you want to compare Medicare plans that fit your health needs and budget, click the Get Quotes button on this page.
Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. Limitations and restrictions may apply.