There is no denying that mental health care is important to your overall well-being, and you may wonder if this is covered in your Medicaid or Medicare coverage. To understand your Medicare or Medicaid coverage, here is a breakdown – to know what is covered, who is eligible, and what to expect according to your plan.
Does Medicare cover mental health care?
Yes, Medicare covers mental health care for both inpatient and outpatient services. Here is how the coverage works:
Inpatient mental health care (Medicare Part A)
If you need to be admitted to a hospital for mental health treatment, Medicare Part A will cover your stay, whether it is in a general hospital or a psychiatric hospital. However, there is a lifetime limit of 190 days for stays in psychiatric hospitals.
Costs for 2024:
- $1,632 deductible per benefit period.
- No coinsurance for days 1 to 60.
- $408 daily coinsurance for days 61 to 90.
- $816 daily coinsurance for lifetime reserve days (up to 60 days).
Outpatient mental health care (Medicare Part B)
Medicare Part B covers outpatient services, which include therapy sessions, diagnostic evaluations, and care provided by licensed professionals like psychiatrists and clinical psychologists.
What is included:
- Individual and group therapy.
- Annual depression screenings.
- Medication management.
- Family counseling (if it supports your treatment).
After meeting the $240 deductible for 2024, you will pay 20 percent of the Medicare-approved amount for services.
Does medicaid cover mental health care?
Yes, Medicaid covers mental health services, but the specifics vary by state. In general, Medicaid includes:
- Therapy and counseling.
- Psychiatric evaluations.
- Prescription medications for mental health conditions.
- Substance use disorder treatment.
- Inpatient and outpatient care.
Medicaid programs often include services not covered by Medicare, such as peer support and community-based care. It is important to check your state’s Medicaid program for detailed information.
How do I know if I am eligible for mental health coverage?
Medicare eligibility
To qualify for Medicare, you must meet one of the following criteria:
- Be 65 years or older.
- Have a qualifying disability.
- Have end-stage renal disease.
You must also be enrolled in either Medicare Part A or B to access mental health benefits.
Medicaid eligibility
Eligibility for Medicaid depends on income and family size, and each state has its own guidelines. Medicaid expansion in many states has increased access to mental health care for low-income individuals and families.
Does Medicare cover mental health prescriptions?
Yes, Medicare covers mental health medications under:
- Medicare Part D: Provides prescription drug coverage. You can purchase a standalone Part D plan or enroll in a Medicare Advantage plan that includes drug coverage.
- Medicare Advantage: These plans often include mental health medications, but costs and formularies can vary.
Medicare Part D is required to cover antidepressants, antipsychotics, and anticonvulsants.
What are partial hospitalization and intensive outpatient programs?
Medicare Part B covers partial hospitalization programs (PHPs) and, starting in 2024, intensive outpatient programs (IOPs). These are structured treatment plans that do not require an overnight hospital stay but provide more care than typical outpatient services.
Partial hospitalization
- Requires a minimum of 20 hours of care per week.
- Includes therapy, medication management, and group sessions.
Intensive outpatient
- Requires between 9 and 20 hours of weekly treatment.
- Starting in 2024, coverage will not require a doctor to certify the need for inpatient care.
How do I find mental health providers covered by my plan?
For Medicare:
- Use the Medicare Physician Compare tool on Medicare.gov to find mental health professionals who accept Medicare.
For Medicaid:
- Contact your state Medicaid office or visit their website to find in-network providers.
Telehealth options, expanded during the COVID-19 pandemic, now make accessing care even easier for both Medicare and Medicaid beneficiaries.
Knowing your coverage options can help you navigate your mental health care with confidence. Whether you rely on Medicaid, Medicare, or both, there is support available to meet your needs.
