Mental health care (outpatient): Intensive outpatient program services
Medicare Part B (Medical Insurance) covers services that include intensive psychiatric care, counseling, and therapy
Description
Intensive outpatient programs offer a level of care for mental health conditions (including substance use disorders) between traditional once-weekly therapy or counseling, and inpatient or partial hospitalization psychiatric care. The services are more intensive than care you'd get in a doctor's or therapist's office and may include things like group and individual therapy sessions, mental health education, and medication management.
You may benefit from intensive outpatient program services if your care plan states you require at least 9 hours of therapeutic services each week.
Coverage details
You don’t need to qualify for inpatient treatment to get intensive outpatient program services.
Part B also covers these services at Opioid Treatment Programs when you're getting treatment for Opioid Use Disorder.
Costs
- You pay a percentage of the Medicare-approved amount for each service you get from a qualified mental health professional if they accept assignment .
- If you’re getting treatment for Opioid Use Disorder, you usually won’t have to pay any copayments for these services if you get them from an Opioid Treatment Program provider that participates in Medicare and meets other requirements. If you have a Medicare Advantage Plan , check with your plan to find out if you have to pay a copayment.
- After you meet the Part B deductible , you also pay coinsurance for each day of intensive outpatient program services you get in a hospital outpatient setting or community mental health center.
Facility
You can get these services in hospitals, community mental health centers, Federally Qualified Heath Centers, Rural Health Clinics, or Opioid Treatment Programs (when you’re getting treatment for Opioid Use Disorder).
Ask your doctor or healthcare provider how much your test, item, or service will cost.
Your doctor may recommend services that Medicare does not cover or offers too frequently. This could end up in additional costs for you. Make sure to ask your doctor about the reasons for these recommendations and what Medicare will actually cover.
Specific amounts you could owe depend on:
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