Healthcare Educators


Medicare Mental Health Benefits: What Does Medicare Cover?

by | Mar 8, 2022

Many seniors and people with disabilities struggle with mental health and substance abuse issues. Many seniors and people with disabilities also depend on Medicare for their healthcare. This leads to an important question – how does Medicare cover mental health and substance abuse? Here’s a look at the Medicare mental health benefits available and why they’re important.

Mental Illness and Substance Abuse Statistics

Mental illness is very common. According to the National Institute of Mental Health, nearly one in five U.S. adults has some form of mental illness.

The CDC says that about 20% of people aged 55 or older have some type of mental health concern, and the most common issues are anxiety, cognitive impairment and depression or other mood disorders. Seniors are especially vulnerable to loneliness and isolation. According to the National Academies of Sciences, Engineering, and Medicine, nearly one in four community-dwelling U.S. adults aged 65 or older are social isolated.

People with disabilities often experience mental health concerns, as well. The CDC says that adults with disabilities report frequent mental distress nearly five times as often as adults without disabilities.

Substance abuse is another, sometimes related issue. According to the American Addiction Centers, a survey found that 10.7% of seniors reported binge drinking in the last month, and 1.6% of seniors report having an alcohol abuse disorder. Additionally, 1.3% of seniors report having misused opioids during the last year.

Original Medicare Coverage for Mental Health and Substance Abuse

Medicare enrollees have access to several important substance use disorder and mental health benefits.

In Original Medicare, Medicare Part B covers one alcohol misuse screening once per year with no out-of-pocket costs. If the primary care doctor determines the patient is misusing alcohol, Medicare will cover up to four brief face-to-face counseling sessions each year. Medicare Part B also covers opioid use disorder treatment and counseling to prevent tobacco use.

Medicare covers one depression screening per year, with no out-of-pocket costs in Original Medicare. Inpatient mental health care is covered under Medicare Part A, and deductible and coinsurance costs apply. Outpatient mental health services, including psychotherapy, family counseling, psychiatric evaluation, diagnostic tests, partial hospitalization, medications that aren’t self-administered and medication management, are covered under Medicare Part B, and copays and deductibles may apply.

Medicare beneficiaries are also encouraged to talk to their doctor about mental health concerns during their initial “Welcome to Medicare” visit and their yearly wellness visits.

Coverage in Medicare Advantage Plans and Medicare Part D

Medicare Advantage and Medicare Part D plans vary, so you should refer to your plan details to determine coverage and costs for various services, prescriptions and treatments related to mental health and substance use disorder.

Each prescription drug plan has a formulary, which is a list of covered drugs. Medicare says that Medicare drug plans do not have to cover all drugs, but they are required to cover most antidepressant, anticonvulsant and antipsychotic medication. If you have questions about whether a prescription is covered and how much you’ll pay, contact your plan.

Medicare Advantage plans are required to cover the medically necessary services that Original Medicare covers. Some plans may also offer additional mental health benefits that are not covered under Original Medicare. Because these benefits can vary, you need to check with your plan to see what’s covered and what your costs will be.

If you are interested in Medicare mental health benefits, it’s smart to review coverage options during your initial enrollment and annual election periods. Compare coverage and costs for any prescription medications or treatments you think you might need.

Do you need help navigating your Medicare mental health benefits and plan options? Medicare Educators is here to help. Contact us.