Is Therapy Covered by Insurance?
- Learn what types of mental health care are covered by Medicare, how often you can access therapy and if you can combine insurance plans for more coverage.
If you're a Medicare recipient, it can be difficult to determine exactly what's covered under your plan. If you require counseling or other mental health services, you're probably wondering if Medicare covers therapy or not.
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Does Medicare Cover Therapy?
Yes, Medicare does help pay for therapy and a variety of other mental health services.
However, it's important to note that to receive this coverage, beneficiaries must be enrolled in Medicare Part B, which includes both medically necessary and preventative services for its members.
Additionally, there are some limitations to the services that can be accessed, and beneficiaries may be required to pay a deductible and a co-pay, depending on the service they access.
Covered Services
Medicare Part B can help to pay for a variety of therapies and related services. That includes:
- Individual and group therapy when provided by licensed professionals.
- Family counseling.
- Annual depression screenings.
- Psychiatric evaluations.
- Diagnostic testing related to mental health conditions.
Additionally, Medicare Part B covers a portion of the cost for those who require partial hospitalization. These services are covered for those who require therapy due to drug or alcohol addictions.
Coverage Amounts and Co-Pays
While some services are covered fully, such as depression screenings, others may require the beneficiary to pay 20% of the Medicare-approved amount. That includes visits to a healthcare provider to diagnose mental health conditions. Services that are provided by hospital outpatient services may be subject to additional co-pays.
Co-pays can be reduced by combining Medicare with other insurance plans.
Provider Exceptions
While Medicare Part B does cover partial costs of therapy and other mental health services, it does require that this care is provided by a licensed healthcare professional, such as a psychiatrist, clinical social worker or nurse practitioner. Additionally, services must be provided in a healthcare provider's office, hospital outpatient department or a community mental health center.
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