There are some important considerations to take when choosing your provider, if you would like to ensure your care is covered and to save money. Let’s discuss Medicare coverage and outpatient mental health care services more.
Medicare Part B covers outpatient mental health care, including the following services:
Individual and group therapy
Substance use disorder treatment
Tests to make sure you are getting the right care
Occupational therapy
Activity therapies, such as art, dance, or music therapy
Training and education (such as training on how to inject a needed medication or education about your condition)
Family counseling to help with your treatment
Laboratory tests
Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you
An annual depression screening (speak to your primary care provider for more information)
Original Medicare covers the outpatient mental health services listed above at 80% of the Medicare-approved amount. This means that as long as you receive services from a participating provider, you will pay a 20% coinsurance after you meet your Part B deductible. If you are enrolled in a Medicare Advantage Plan, contact your plan for cost and coverage information. Your plan’s deductibles and copayments/coinsurance may differ.
Medicare covers mental health care you receive through an outpatient hospital program, at a doctor’s or therapist’s office, or at a clinic. You may receive services from the following types of providers:
General practitioners
Nurse practitioners
Physicians’ assistants
Psychiatrists
Clinical psychologists
Clinical social workers
Clinical nurse specialists
If you see a non-medical doctor (such as a clinical psychologist or clinical social worker), make sure that your provider is Medicare-certified and takes assignment. Medicare will only pay for the services of non-medical doctors if they take assignment.
It is also important to note that psychiatrists are more likely than any other type of provider to opt out of Medicare. Be sure to ask any provider if they take your Medicare insurance before you begin receiving services. Remember, if you see an opt-out provider, they must have you sign a private contract. The contract states that your doctor does not take Medicare and you must pay the full cost of the service yourself. Medicare will not reimburse you if you see an opt-out provider. If your provider does not have you sign a contract, you are not responsible for the cost of care.
If you have Original Medicare and need help finding a participating provider, you can use Medicare’s Physician Compare tool online or call 1-800-MEDICARE. If you have a Medicare Advantage Plan, call your plan directly for a list of mental health care providers in your plan’s network. For additional assistance accessing behavioral health care providers and other local resources, call the Substance Abuse and Mental Health Services Administration (SAMHSA) at 800-662-4357.