Mental health care (outpatient)

Mental health care (outpatient)

How often is it covered?

 

 covers mental health services and visits with these types of health professionals: 

  • Psychiatrist or other doctor
  • Clinical psychologist
  • Clinical social worker
  • Clinical nurse specialist
  • Nurse practitioner
  • Physician assistant

These visits are often called counseling or therapy. Medicare only covers the visits when they’re provided by a health care provider who accepts 

.

 

Part B covers outpatient mental health services, including services that are usually provided outside a hospital, like in these settings:

  • A doctor’s or other health care provider's office
  • A hospital outpatient department
  • A community mental health center

Part B also covers outpatient mental health services for treatment of inappropriate alcohol and drug use.

 

Part B helps pay for these covered outpatient services:

  • One depression screening per year. The screening must be done in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals.
  • Individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services.
  • Family counseling, if the main purpose is to help with your treatment.
  • Testing to find out if you’re getting the services you need and if your current treatment is helping you.
  • Psychiatric evaluation.
  • Medication management.
  • Certain prescription drugs that aren’t usually “self administered” (drugs you would normally take on your own), like some injections.
  • Diagnostic tests.
  • Partial hospitalization.
  • A one-time “Welcome to Medicare” preventive visit. This visit includes a review of your possible risk factors for depression.
  • A yearly “Wellness” visit. Talk to your doctor or other health care provider about changes in your mental health. They can evaluate your changes year to year.
Who's eligible?

All people with Part B are covered.

Your costs in Original Medicare
  • You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment.
  • 20% of the for visits to your doctor or other to diagnose or treat your condition. The Part B applies.
  • If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional or amount to the hospital.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • Whether your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

Return to search results