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Medicare's Coverage of Mental Health Services

  • August 19th, 2014

Some aspects of aging can take a mental toll on the elderly as well as a physical toll. The cost of outpatient mental health services can be steep, but Medicare will cover a portion of the cost.

After you pay your deductible, Original Medicare will pay 80 percent of the cost for outpatient visits to mental health professionals. If you have a Medigap policy, it may cover the additional 20 percent.

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The following are some of the services that Medicare covers:

  • Visits to a psychologist or other professional counselor
  • Family therapy as long as the focus of the therapy is on the Medicare recipient, not the family
  • Substance abuse treatment
  • Occupational therapy that is part of mental health treatment
  • Prescription medicine that cannot be self-administered
  • Art, dance, and music therapy if it is provided as part of a program to prevent the recipient from being admitted to the hospital

Services must be provided by doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, or physician assistants. Medicare will pay for services only if they are provided by a mental health professional who accepts Medicare payments, so check with your health professional before you receive services.

Medicare also covers inpatient care at a general or psychiatric hospital. For information on Medicare's hospital coverage, click here. Unlike with non-mental health services, Medicare puts a cap on coverage for inpatient psychiatric care. Medicare only pays for up to 190 days of inpatient psychatric hospital services in a lifetime.

If you have Medicare Advantage, coverage rules may be different, so check with your plan before receiving services. 

For the booklet Medicare and Your Mental Health Benefits from, click here.

Last Modified: 08/19/2014
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