Mental health care (partial hospitalization)
Medicare Part B (medical insurance) may cover partial hospitalization services you get through a hospital outpatient department or community mental health center if you meet certain requirements and your doctor or other qualified mental health professional certifies that you would otherwise need inpatient treatment.
Your costs in Original Medicare
- You pay a percentage of the Medicare-approved amount for each service you get from a qualified mental health professional if they accept assignment .
- After you meet the Part B deductible you also pay coinsurance for each day of partial hospitalization services you get in a hospital outpatient setting or community mental health center.
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
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
Partial hospitalization provides a structured program of outpatient psychiatric services as an alternative to inpatient psychiatric care. It’s more intense than care you get in a doctor’s or therapist’s office, and your care plan must state that you require at least 20 hours of therapeutic services per week. You get treatment during the day, and you don't have to stay overnight.
Things to know
As part of your partial hospitalization program, Medicare may cover:
- Occupational therapy that’s part of your mental health treatment
- Individual patient training and education about your condition
- Caregiver training services
- Principal illness navigation services
Medicare doesn't cover:
- Meals
- Transportation to or from mental health care services
- Support groups that bring people together to talk and socialize (this is different from group psychotherapy, which is covered.)
- Testing or training for job skills that isn't part of your mental health treatment
Related resources
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- National Institute of Mental Health (NIMH)
- Mental Health America
- National Alliance on Mental Illness (NAMI)
- National Council for Community Behavioral Healthcare
- Depression screenings
- Mental health care (inpatient)
- Mental health care (outpatient)
- Mental health care (intensive outpatient program services)
- Find hospitals