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Mental health care (outpatient)

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Medicare Part B (Medical Insurance)

 helps pay for these outpatient mental health 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 with certain other licensed professionals, as the state where you get the services allows).
  • 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 since your last visit. 

Part B also covers outpatient mental health services for treatment of substance abuse.

Your costs in Original Medicare

  • You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment.
  • After you meet the Part B deductible, you pay 20% of the Medicare-Approved Amount for visits to your doctor or other health care provider to diagnose or treat your condition. 
  • If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance 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
  • If 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 if, or how much, Medicare will pay for them.

What it is

Mental health services help diagnose and treat people with mental health disorders, like depression and anxiety. These visits are often called counseling or psychotherapy.

Things to know

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

  • Psychiatrists or other doctors
  • Clinical psychologists
  • Clinical social workers
  • Clinical nurse specialists
  • Nurse practitioners
  • Physician assistants

Medicare only covers the visits if you get them from a health care provider who accepts 

assignment

.

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

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

 

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