Mental Health and Resources Under Medicare: Advice for Seniors

March 1, 2020

Written by: June Duncan

Most older adults understand that Medicare is an important resource that helps them cover the ever-increasing cost of health care. But having coverage and knowing where to find help if you suffer from depression are two different things.

Some aspects of mental health care are covered and some are not, so using Medicare effectively and efficiently depends to a large degree on knowing where to turn for information.

Remember to review your annual Medicare plan carefully so you understand benefits and where to turn if mental health services are needed.

Online Resources
Medicare has posted a comprehensive online informational resource for beneficiaries needing mental health care authored by the Centers for Medicare and Medicaid Services. Medicare Part B covers outpatient mental health services provided outside of a hospital and in a hospital’s outpatient department. As a Part B beneficiary, you are eligible for one depression screening each year, though it must be conducted in a primary care doctor’s office or primary care clinic. No cost is associated as long as your physician accepts Medicare Part B assignment (meaning he or she agrees to charge no more or less than what Medicare provides).

Psychotherapy — both group and individual — with doctors or other mental health professionals is covered, as is family counseling (with the objective of aiding your depression treatment).

Substance abuse treatment, psychiatric evaluation, medication management, diagnostic tests, and partial hospitalization are also covered by Medicare.

Providers Covered
There’s a wide degree of latitude when it comes to the kinds of mental health providers you can see as a Medicare Part B beneficiary. In addition to general practitioners, physicians’ assistants, and nurse practitioners, you’re eligible for coverage if you see a psychiatrist, clinical psychologist, social worker, or clinical nurse specialist. Be aware that your visits must be at a clinic, doctor’s office, or therapist’s office, and make sure to check on whether a non-medical doctor has been certified by Medicare and accepts an assignment.

Finding a Care Provider
Time can be of the essence if you’re suffering from a serious depressive condition and need timely intervention. As such, knowing where to find a Medicare-certified provider is important. Psychology Today offers an online search resource that allows you to find a Medicare therapist, psychologist, or counselor in your area (you can even search by zip code). You can also find psychiatrists, treatment centers, and support groups nearby.

Plans and Preventive Coverage
There are also online resources designed to help you locate Medicare Advantage plans in your area by searching according to zip code. You can also find preventive care services such as where to go for an alcohol misuse screening (one per year is covered). You are also eligible for a “Welcome to Medicare” visit, which introduces new beneficiaries to the preventive care options available under Medicare Part B, though this needs to be done within your first year of Medicare coverage and includes a review of your risk of depression.

Medical Social Services
In many cases, individuals who need mental health care require assistance in arranging care as well as coverage. Neither Medicare Part A or B cover medical social service providers — unless services are provided in a hospital or skilled nursing facility. Part B covers medical social services only as part of in-home healthcare from a Medicare-certified home healthcare provider.

Medicare is an indispensable asset for older adults who require medical and non-medical health services. However, there are many conditions and rules that determine the nature and extent of care you can expect, including services for depressed individuals.

Do some research if you’re suffering from depression and need to find a provider nearby who’s Medicare-certified.

June DuncanJune is the co-creator of Rise Up for Caregivers, which offers support for family members and friends who have taken on the responsibility of caring for their loved ones. She is author of the upcoming book, The Complete Guide to Caregiving: A Daily Companion for New Senior Caregivers.