Medicare and Your Mental Health Benefits
Mental health conditions, like depression or anxiety, can happen to anyone at any time. If you think you may have problems that affect your mental health, you can get help. Talk to your doctor or other health care provider if you have:
- Thoughts of ending your life (like a fixation on death or suicidal thoughts or attempts)
- Sad, empty, or hopeless feelings
- Loss of self-worth (like worries about being a burden, feelings of worthlessness, or self-loathing)
- Social withdrawal and isolation (don’t want to be with friends, engage in activities, or leave home)
- Little interest in things you used to enjoy
- A lack of energy
- Trouble concentrating
- Trouble sleeping (like difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness)
- Weight loss or loss of appetite
- Increased use of alcohol or other drugs
Mental health care includes services and programs to help diagnose and treat mental health conditions. These services and programs may be provided in outpatient and inpatient settings. Medicare helps cover outpatient and inpatient mental health care, as well as prescription drugs you may need to treat a mental health condition.
This booklet at the link below gives you information about mental health benefits in Original Medicare. If you get your Medicare benefits through a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, check your plan’s membership materials, and call the plan for details about how to get your Medicare-covered mental health benefits.
Medicare Part A (Hospital Insurance) helps cover mental health care if you’re a hospital inpatient. Part A covers your room, meals, nursing care, therapy or other treatment for your condition, lab tests, medications, and other related services and supplies.
Medicare Part B (Medical Insurance) helps cover mental health services that you would get from a doctor and services that you generally get outside of a hospital, like visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor. Part B may also pay for partial hospitalization services if you need intensive coordinated outpatient care. See page 10 for more information about partial hospitalization services.
Medicare prescription drug coverage (Part D) helps cover drugs you may need to treat a mental health condition.
Table of Contents
Introduction - Page 5
Mental health care & Medicare - Page 5
Medicare helps cover mental health services - Page 6
Section 1: Outpatient mental health care & professional services- Page 7
What Original Medicare covers - Page 7
What you pay- Page 9
Medicare may cover partial hospitalization - Page 10
What Original Medicare doesn’t cover - Page 10
Section 2: Inpatient mental health care - Page 11
What Original Medicare covers - Page 11
What you pay - Page 11
What Original Medicare doesn’t cover - Page 12
Section 3: Medicare prescription drug coverage (Part D)- Page 13
Medicare drug plans have special rules - Page 13
Learn more about Medicare prescription drug coverage - Page 16
Section 4: Get the help you need - Page 17
Help if you have limited income & resources - Page 17
Your Medicare rights - Page 19
Your Medicare appeal rights - Page 19
Mental health resources - Page 20
Section 5: Definitions - Page 21