Your Medicare Coverage
Is my test, item, or service covered?
Mental health care (partial hospitalization)
How often is it covered?
Medicare Part B (Medical Insurance) covers partial hospitalization in some cases. 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. This treatment is provided during the day and doesn’t require an overnight stay. Medicare helps cover partial hospitalization services when they’re provided through a hospital outpatient department or community mental health center. Along with your partial hospitalization program, Medicare may cover occupational therapy that’s part of your mental health treatment and/or individual patient training and education about your condition.
Medicare only covers partial hospitalization if the doctor and the partial hospitalization program accept assignment.
Medicare doesn't cover:
- 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.
For Part B to cover a partial hospitalization program, you must meet certain requirements, and your doctor must certify 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 doctor or certain other qualified mental health professionals if your health care professional accepts assignment. You also pay coinsurance for each day of partial hospitalization services provided in a hospital outpatient setting or community mental health center, and the Part B deductible applies.
To find out how much your specific test, item, or service will cost, talk to your doctor or other 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
- The location 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. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
- Safer, More Effective Pain Management (CDC)
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- National Institute of Mental Health (NIMH)
- Mental Health America Globe icon
- National Alliance on Mental Illness (NAMI) Globe icon
- National Council for Community Behavioral Healthcare Globe icon
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). TTY: 1-800-799-4TTY (1-800-799-4889). You can call and speak with a counselor 24 hours a day, 7 days a week.
Call 911 if you're in immediate medical crisis.