Medicare Benefits

Traditional Medicare (Original Medicare) covers a range of mental health services, but there are limitations. Here’s a breakdown of what is and isn’t covered:

What Medicare Covers for Mental Health

1. Outpatient Mental Health (Medicare Part B)

• Therapy & Counseling: Covers individual, group, and family therapy with licensed professionals (counselors, psychiatrists, psychologists, social workers).
• Psychiatric Evaluations: Covers diagnostic tests and assessments.
• Medication Management: Covers visits to psychiatrists for medication review.
• Telehealth Services: Covers virtual mental health services in certain cases.
• Partial Hospitalization Programs (PHPs): Intensive outpatient treatment that does not require full hospitalization.

2. Inpatient Mental Health (Medicare Part A)

• Hospital Stays: Covers psychiatric hospitalizations (up to 190 days in a lifetime for psychiatric hospitals, but general hospital stays are unlimited).
• Medications & Treatments: Covers treatments administered during hospital stays.
• Nursing & Therapy Services: Includes care while admitted to a hospital for mental health conditions.

3. Prescription Medications (Medicare Part D)

• Covers most outpatient prescription drugs for mental health, including antidepressants, antipsychotics, and mood stabilizers (formularies vary by plan).

What Medicare Does NOT Cover

• Long-Term Psychiatric Hospitalization: Coverage is limited to 190 days in a lifetime for specialized psychiatric hospitals.
• Routine Counseling from Unapproved Providers: Medicare only covers therapy from specific providers (e.g., counselors, social workers, psychologists), not life coaches.
• Most Alternative Treatments: Services like acupuncture (except for chronic pain) and holistic therapy are generally not covered.
• 24/7 Custodial Care in a Nursing Home: Medicare does not cover long-term residential mental health care.
• Over-the-Counter Medications & Some Prescription Drugs: If a mental health drug isn’t on the plan’s formulary, it won’t be covered under Part D.