Mental Health
Did you know Medicare covers mental health evaluation and treatment?
Original Medicare covers inpatient mental health services and a wide range of services for treatment, as well as outpatient mental health services, like a mental health examination and counseling with mental health providers, including psychiatrists, clinical psychologists, licensed marriage and family therapists, and more. If an individual has both Medicare and Medicaid through a Sentara Dual Eligible Special Needs Plan (D-SNP), they won't have copays for mental health services.
Living with grief, trauma, substance abuse, or mental health disorders
Mental health care is an essential part of maintaining your overall well-being. Mental health issues can leave you feeling isolated, like you’re the only person who has ever experienced those intense feelings. Painful emotions and traumatic events can also cause physical reactions, like increased heart rate, changes in appetite, sleep and mood disruptions, struggles with memory retrieval, difficulty concentrating, increased inflammation, and lower immunity.
Four tips to help manage intense emotions
- Prioritize yourself. You don’t need to make sacrifices for the comfort of others or hide your pain right now. Don’t compare yourself, or shame yourself out of your feelings. Now is the time to look inward and do a wellness check. Take each day moment by moment and look for small things can bring you joy.
- Don’t neglect your physical health. Even though the smallest things may feel overwhelming, try your best to eat at least one nutritious meal each day, shower regularly and practice good dental hygiene, and try to get enough sleep.
- Exercise every day. This may be the last thing on your mind when you’re feeling overwhelming emotions, but a simple walk can give you an immediate boost of mood, memory, and energy. Don’t pressure yourself to complete exercises outside of your comfort zone. Just pick a small goal like walking and stick to it every day.
- Reach out. It’s important to get your annual physical exam each year. Talk to your doctor about your mental health and whatever might be bothering you. Your doctor can give you a depression screening, which is covered by Original Medicare. From there, you can get a referral for follow-up treatment.
Even if you’re not going through grief, trauma, or substance abuse, your mental health is still vitally important. Counseling or coaching with a mental health professional can help improve your emotional resilience and cognitive function.
What Medicare covers
Under Part A, Original Medicare covers inpatient mental health services and a wide range of services for treatment, like semi-private rooms, general nursing, meals, and medications. Part A covers comprehensive support, supplies, and services needed for your treatment, whether in a general hospital or a specialized psychiatric hospital.
Under Part B, Original Medicare covers outpatient mental health services, like evaluation and subsequent visits with mental health providers, including psychiatrists, doctors, clinical psychologists, licensed marriage and family therapists, mental health counselors, addiction counselors, clinical nurse specialists, clinical social workers, nurse practitioners, and physician assistants. Telehealth sessions are also covered.
Medication management is another vital service covered by Part B, as well as treatment for opioid use disorder and alcohol misuse. There are some cases where partial hospitalization programs are needed for the structured outpatient psychiatric services. Intensive outpatient program services are also covered.
Find a comprehensive list of covered services at medicare.gov.What Medicare doesn’t cover
There are a few things Original Medicare doesn’t cover, like support groups for socialization and mutual support. It does cover group psychotherapy led by a licensed professional. It also doesn’t cover testing or training for job skills that aren’t directly part of your mental health treatment.
Original Medicare also doesn’t cover transportation to or from your mental health care services. If you have a Medicare Advantage plan, like Sentara Medicare, you may be eligible for visits to plan-approved, health-related locations, such as doctor appointments.* If you have a qualifying chronic condition, you may also qualify for non-medical transportation for trips to plan-approved locations, such as churches, grocery stores, community events, senior centers, etc.
Medicare cost considerations
For an inpatient stay, the cost structure is based on benefit periods. When you’re admitted to the hospital, a benefit period begins. It ends when you haven’t received any inpatient care for 60 consecutive days. During each benefit period, you’ll need to meet a deductible before Medicare begins to pay. After meeting the deductible, Medicare covers the full cost for 60 days. From day 61 to 90, you’ll pay a daily coinsurance amount. After 90 days, there are 60 lifetime reserve days available, with higher coinsurance costs. Once the lifetime reserve days are used, you’ll be responsible for all costs. There’s a lifetime limit of 190 days for inpatient psychiatric hospital services. Learn more at medicare.gov.
- Days 1–60: (of each benefit period): $0 after you meet your Part A deductible ($1,676).
- Days 61–90: (of each benefit period): $419 each day.
- After day 90: (of each benefit period): $838 each day for each lifetime reserve day (up to 60 days over your lifetime).
- After you use all of your lifetime reserve days, you pay all costs.
For outpatient therapy, you’ll need to meet your yearly Part B deductible, which is $257 for the year 2025. After meeting the deductible, you’ll pay 20% of the Medicare approved amount. Before you have your initial depression screening or any counseling sessions, you’ll need to find out whether the provider accepts assignment. Assignment means the provider accepts Medicare reimbursement at the Medicare-approved amount. If you choose a non-participating provider, you may need to pay in full upfront and get reimbursed. If a provider is non-participating, ask if they can file the claim with Medicare on your behalf. If the answer is no, you will have to cover the entire amount yourself or find a different provider.
What Isn’t Covered by Medicare
While Medicare provides extensive coverage for many mental health services, it’s important to understand what’s not covered to avoid any surprises.
It’s advised to plan for these uncovered expenses as part of your overall mental health care strategy. Being aware of what’s not included in your Medicare coverage helps you prepare for the potential costs and seek out additional resources or support if needed. This allows you to focus more on your treatment and less on the unexpected financial burdens.
You are not alone
If you are in immediate need of mental health support, text the word HOME to 741741 to speak to counselors at the nonprofit Crisis Text Line any time of day, 24/7.
Trained counselors are also available at the 988 Suicide & Crisis Lifeline 24/7. Dial or text 988 (TTY 711) to speak with a counselor.
Did you know Medicare Advantage plans are required by law to cover the same services as Original Medicare? Call a Licensed Plan Advisor today to find out how a plan from Sentara Medicare can offer more benefits than having Original Medicare alone.
1-877-550-3285 (TTY: 711)
April 1-Sept. 30 | Mon.-Fri. | 8 a.m.-6 p.m.
Oct. 1-March 31 | 7 days a week | 8 a.m.-8 p.m.
Or visit sentaramedicare.com
Sources:
U.S. Department of Veterans Affairs
*Pick-up and drop-off locations must be within the service area. Rides are one-way. Trips over 50 miles require authorization. Number of trips vary by plan. Sentara Medicare is an HMO Dual Eligible Special Needs Plan (HMO D-SNP) that has contracts with Medicare and the Virginia Department of Medical Assistance Services’ Medicaid program. “Cardinal Care” is the brand name of Virginia Medicaid. Y0174_0425_SHPMH_460058_C