Mental Health and Medicare
By: Ray Hurd Regional Administrator, Centers for Medicare & Medicaid Services
Mental health conditions like depression or anxiety can happen to anyone at any age. Feelings of loneliness and sadness or difficulty sleeping and trouble concentrating are all too often brushed aside by seniors and their caregivers as an unpleasant part of the aging process. While these symptoms can be completely normal, sometimes they’re not. When the joys of daily life are being negatively impacted, it’s time to get help.
If you or a loved one has Medicare, it’s important to know services and programs that diagnose and treat mental health conditions are covered. Medicare Part B (medical insurance) supports outpatient mental health services, including those provided in a clinic, hospital outpatient department, doctor’s or therapist’s office. Covered services range from individual and group psychotherapy to occupational therapy.
Medicare Part B covers three great ways for people to discuss their mental and physical health with their primary care physician.
• “Welcome to Medicare” preventive visit
• Annual “Wellness” visit
• Annual depression screening
Annual visits are important because they allow your doctor to evaluate changes from year-to-year and determine what is normal versus what could signal an underlying problem. These visits are free if your doctor participates in the Medicare program.
Before making your appointment, confirm with your doctor that he or she participates in the Medicare program and ask if you will be responsible for any deductibles or coinsurance payments.
After meeting your yearly Medicare Part B deductible ($147.00), the amount you pay for mental health services depends on whether the purpose of your visit is to diagnose your condition or to get treatment. For visits to diagnose your condition, you would pay 20% of the Medicare-approved amount. For outpatient treatment of your condition, like psychotherapy, you would pay 35% of the Medicare-approved amount in 2013. If you have a Medicare Supplement Insurance policy or Medicare Advantage, contact your plan for information on your out of pocket responsibilities.
Please note that if you receive services in a hospital outpatient clinic or department, you may have to pay an additional copayment or coinsurance amount to the hospital. This amount will vary depending on the service provided.
If you or someone you know might benefit from learning more about Medicare’s coverage of mental health services, please contact your local State Health Insurance Assistance Program (SHIP) in Massachusetts at 1-800-243-4636. You can also request a free copy of “Medicare and Your Mental Health Benefits” by visiting www.medicare.gov/publications or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.