People of all ages experience mental and behavioral health challenges, including:
- Anxiety
- Depression
- Eating disorders
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Substance use disorders
These problems can become chronic and so severe that they endanger our physical health and hurt our performance at work, at school, or in our family. So it’s not a good idea to ignore them. Luckily, there are many treatments that can make a huge difference, including:
- Individual therapy
- Group therapy
- Family counseling
- Medication
How Medicare covers various mental health therapies
The Affordable Care Act requires Medicare to cover mental and behavioral health treatments. Different parts of Medicare come into play depending on where care is received (Parts A and B are known as “Original Medicare.”).
- Part A covers hospital stays, skilled nursing care, home health visits, and hospice care.
- Part B covers doctor visits, outpatient services, and other medical expenses.
- Part C, Medicare Advantage plans, are offered by private insurance companies and include Part A, Part B, and sometimes Part D coverage along with many extras.
- Part D plans, also offered by private insurance companies, cover prescription drug costs.
Here’s how Medicare covers treatment in various care settings.
Outpatient mental health treatment
Health services received in a doctor’s office are covered by Medicare Part B, including:
- Individual and group psychotherapy
- Psychiatric (medication) management of mental health conditions
- Substance use disorder treatment
After members meet their Part B deductible, they pay 20 percent of the Medicare-approved amounts for outpatient treatment. Treatment in an outpatient hospital clinic may require additional copays or coinsurance.
Many Medicare Advantage plans have a network of mental and behavioral health providers. Their members may not have to pay a Part B deductible when seeing in-network providers, and those visits will have the same copays as other in-network specialist visits.
Inpatient mental health treatment
Sometimes people are admitted to hospitals for mental and behavioral health treatment, especially when they need detoxification or 24/7 supervision. Then, their treatment is covered by Medicare Part A.
Care is usually much more costly in a hospital than in an outpatient setting. Usually, a deductible must be met over the first 60 days of hospitalization, followed by a daily copay of more than $400 thereafter.
Medicare Advantage plans may have different inpatient cost-sharing structures, which vary by plan.
Intensive outpatient programs
Intensive outpatient programs (IOPs) offer a level of care between outpatient and inpatient treatment and are covered by Medicare Part B. After members meet their Part B deductible, they pay a fixed percentage of the amount that Medicare has approved for the services they receive in these programs. They also pay coinsurance for each day that they receive services in a hospital outpatient setting or community mental health center. Medicare Advantage plans may have a different cost-sharing structure.
Partial hospitalization programs
Partial hospitalization programs (PHPs) provide structured outpatient psychiatric services totaling at least 20 hours of therapy per week. Patients get treated during the day and don’t have to stay overnight. Medicare coverage for PHPs works just like it does for IOPs.
Home services
Some individuals are unable to leave their homes for treatment. Medicare members classified as “homebound” may be covered 100 percent for mental health treatment inside their homes.
Telehealth
Telehealth — health care that’s received via phone or video conference — is well suited for mental and behavioral health treatment. Telehealth services are covered under Medicare Part B and work like in-person health practitioner visits: After members’ Part B deductible has been met, they pay 20 percent of the Medicare-approved fee for those services.
Some Medicare Advantage plans have no Part B deductibles and don’t require copays or coinsurance for telehealth visits.
Medicare and mental health prescription drugs
Medicare Part D prescription drug plans cover psychiatric medications just like other prescription drugs — according to what tier those drugs occupy in the plan’s formulary.
Finding a therapist who accepts Medicare
People should work with mental or behavioral health providers they feel comfortable with. Otherwise, their treatment may not succeed. Different treatment methods and strategies may be more effective for one patient than another.
When trying to choose a treatment approach and provider, it helps to:
- Read online reviews
- Ask for referrals from your primary care provider (PCP)
- Get recommendations from a local mental health facility
Sometimes it’s necessary to try more than one provider to find the right fit.
AmeriHealth Medicare members can locate in-network therapists using the Find a Provider tool.
The role of primary care doctors in mental health care
When someone is having a mental or behavioral health issue, talking to their primary care provider (PCP) is a great first step. PCPs can make an initial assessment, prescribe medications, and coordinate care. They can also make recommendations based on a patient’s needs.
PCPs also help screen for mental and behavioral health problems during a patient’s first “Welcome to Medicare” evaluation and at each annual wellness visit. These visits are covered 100 percent by Medicare.
Additional mental health resources in New Jersey
New Jersey offers a wealth of mental health resources just for Medicare members.
- The New Jersey Department of Human Services provides a variety of mental health services and resources, including counseling, crisis intervention, and supportive assistance.
- The Mental Health Association in New Jersey offers advocacy, education, training, and services to support people with mental health concerns.
- The New Jersey Division of Mental Health and Addiction Services offers a comprehensive directory of mental health services across the state.
Reach out to these resources if you need help.
Get care that’s right for you
If you are struggling with a mental or behavioral health challenge, you deserve to receive treatment — and Medicare covers that care differently depending on where it’s received.
If you are looking for a Medicare Advantage plan in New Jersey, AmeriHealth has four excellent options in Atlantic, Burlington, Camden, Gloucester, Mercer, Middlesex, and Ocean Counties.
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Website last updated 10/30/2024
