Jack's Blog on Medicare Plan Choices

Medicare Part B provides extensive coverage for outpatient mental health services, offering beneficiaries access to a wide range of treatments and interventions.

Covered Services:

Medicare Part B covers the following outpatient mental health services:

1. Individual and group psychotherapy
2. Family counseling (when the main purpose is the patient’s treatment)
3. Psychiatric evaluation and medication management
4. Diagnostic tests
5. Partial hospitalization programs
6. Annual depression screening
7. Alcohol misuse screening and brief counseling

Cost-Sharing:

1. Very important, an annual depression screening is covered at no cost to you.
2. Otherwise, you are responsible for the Part B deductible and 20% coinsurance for most services under original Medicare.
3. Medicare Advantage plans provide mental health visits at the specialist copayment.

Provider Requirements:

Services must be provided by Medicare-approved providers, including:

1. Psychiatrists
2. Clinical psychologists
3. Clinical social workers
4. Nurse practitioners
5. Physician assistants

Telehealth Services:

Medicare has expanded coverage for telehealth mental health services, allowing beneficiaries to receive care from home. This includes:

1. Individual and group psychotherapy
2. Substance use disorder treatment
3. Diagnostic psychiatric evaluations

Prescription Drug Coverage:

While Part B generally doesn’t cover outpatient prescription drugs, medications administered by a healthcare provider during an outpatient visit may be covered. For self-administered drugs, beneficiaries typically rely on Medicare Part D plans.

Medicare Advantage Considerations:

Medicare Advantage (Part C) plans must provide at least the same level of coverage as Original Medicare for outpatient mental health services. Some plans may offer additional benefits or lower cost-sharing.

Important Notes:

1. There’s no limit on the number of outpatient mental health visits covered by Medicare per year.
2. Beneficiaries should always confirm that their provider accepts Medicare assignment to avoid excess charges.
3. Some services may require prior authorization, especially under Medicare Advantage plans.

Here is my disclaimer.  I gather most of my information from Medicare.gov and to the best of my knowledge, it is accurate.  Please use this information as a guideline.

Before choosing an Advantage or Supplement plan, ensure you have a thorough understanding of Medicare itself. When it’s time to explore your options, don’t fall for a sales pitch from a single company or an agent representing only one provider.

At “More Plans More Choices,” I can provide you with side-by-side comparisons from various insurance carriers. More carriers plus more plans equals more choices.

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