Brenda Lyle – Special to FLORIDA TODAY
Reader question: Does Medicare cover mental health treatment for seniors?
Answer: Mental health issues and treatment have become front and center during the pandemic.
Social isolation has created loneliness and depression among all age groups, particularly seniors.
Many are reluctant to admit they are struggling for fear they will be diagnosed with dementia.
Others may just ignore their depression and anxiety, concerned about paying for mental health treatment on their fixed income.
But there is good news: Mental health counseling IS covered under Medicare.
According to Medicare.gov, Medicare Part B (Medical Insurance) helps pay for these outpatient mental health services:
- One depression screening per year. The screening must be done in a primary care doctor’s office or clinic that can provide follow-up treatment and referrals.
- Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state.
- Family counseling — if the main purpose is to help with your treatment.
- Testing to determine if you are getting the necessary services and successful treatment.
- Psychiatric evaluation.
- Medication management.
- Certain prescription drugs that are not usually “self-administered,” like some injections.
- Diagnostic tests.
- Partial hospitalization.
- “Welcome to Medicare” — a one-time preventive visit, which includes a review of your depression risk factors.
- Annual “wellness” visit. Talk to your doctor about changes in your mental health. They can evaluate your changes year to year.
- “Tele-health” appointments — by telephone or computer, from your own home.
Medicare Part B limits coverage for mental health services and visits to these types of health professionals:
Psychiatrist or other doctors; Clinical psychologist; Clinical social worker; Clinical nurse specialist; Nurse practitioner; Physician assistant.
Importantly, Medicare only covers the visits when they’re provided by a health care provider who accepts assignment. Then…
- You pay nothing for your yearly depression screening.
- You pay just 20% of the Medicare-approved amount for visits to your doctor or other health care provider to diagnose or treat your condition. The Part B deductible applies.
- If you get your services in a hospital outpatient clinic or department, you may have to pay an additional co-pay or co-insurance amount to the hospital.
Generally, the cost for mental health counseling is similar to what you might pay for a trip to your regular doctor.
If you have an “Advantage Plan” or “Medicare Replacement,” check with your insurance provider for a list of mental health professionals that will accept your insurance and review your co-pay and deductibles annually.
Don’t delay. Your mental health is too important.
One Senior Place can connect you with a network of mental health providers in Central Florida.
You can reach out to us through OneSeniorPlace.com or call 321-751-6771.
One Senior Place is a marketplace for resources and provider of information, advice, care and on-site services for seniors and their families. Questions for this column are answered by professionals in nursing, social work, care management and in-home care. To submit a question, send an email to askOSP@OneSeniorPlace.com or visit One Senior Place, The Experts in Aging at OneSeniorPlace.com.
Brenda Lyle is a Certified Care Manager for One Senior Place, Greater Orlando.