Mental health care (partial hospitalization)

Note

If you or someone you know is in crisis, call or text 988 or chat 988lifeline.org.

Call 911 if you're in immediate medical crisis.

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.

Find out cost

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

Frequency of services

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 and individual patient training and education about your condition.

Medicare only covers partial hospitalization if the doctor (or other qualified mental health professional) and the partial hospitalization program accept assignment .

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

Is my test, item, or service covered?