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Seeking Mental Health Care with Medicare Coverage

Posted by David Ghiorso, CPA, June 7, 2022

Most of us recognize that mental health is just as important as physical or medical health. In fact, feeling mentally healthy helps us to stay in shape, take care of ourselves, and prevent many physical ailments. But after retirement, mental health concerns often arise. This can happen due to loss of identity from a career, loneliness, boredom, and other stress factors associated with a major life change.

As with physical health conditions, prevention of mental health problems is key. That’s why all Medicare plans offer some basic preventive services, such as…

  • A “Welcome to Medicare” visit during your first coverage year, during which you will be screened for a number of conditions including your depression risk
  • An annual screening for depression, through your primary care physician
  • An alcohol misuse screening each year
  • Annual wellness exams that cover mental health concerns, and referrals for mental health services when necessary

Of course, even the best prevention does not always ward off all mental health concerns. If you do develop symptoms and need to seek treatment, Medicare offers coverage for that as well. On an outpatient basis, you can receive:

  • Psychiatric evaluations and diagnosis
  • Individual and/or group therapy, depending upon doctor’s orders and/or your preferences
  • Family therapy, depending upon the situation
  • Up to four sessions of alcohol abuse counseling

Medicare does offer coverage for psychiatric medications, but each plan’s formulary (list of covered drugs) is a bit different. So, we do recommend that you work closely with an insurance agent who is knowledgeable about different Medicare Advantage or Part D plans, to identify one that offers the right coverage for your prescription needs.

And of course, sometimes hospitalization is needed for more serious mental health situations. In the event that you need to stay in a hospital, Medicare Part A does cover up to 190 days in a hospital in your lifetime. Services you receive while in the hospital will be billed to Medicare Part B. An Advantage plan rolls these services into one plan.

The plan you have matters.  Medicare Advantage Plans and Medicare Supplement Plans will differ in the way you access mental health benefits.  If you have any Medicare Advantage Plan, contact your broker or insurance company for details on how to access care. If you have Original Medicare, you can see any provider that will accept it.

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