Mental health care (inpatient)

Your costs in Original Medicare

You pay this for each benefit period: 

• $1,600 deductible
• Days 1–60: $0 coinsurance per day
• Days 61–90: $400 coinsurance per day 
• Days 91 and beyond: $800 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to a maximum of 60 reserve days over your lifetime) 
• Each day after the lifetime reserve days: All costs
• 20% of the Medicare-Approved Amount for mental health services you  get from doctors and other providers while you're a hospital inpatient.

Mental health care services help diagnose and treat people with mental health disorders, like depression and anxiety.

You can get these  services either in a general hospital or a psychiatric hospital (a  facility that only cares for people with mental health disorders). There’s no limit to the number of benefit periods you can have, whether you’re getting mental health care in a general or psychiatric hospital.

However, if you're in a psychiatric hospital (instead of a general  hospital), Part A only pays for up to 190 days of inpatient psychiatric  hospital services during your lifetime.

Medicare doesn't cover:

• Private duty nursing
• A phone or television in your room
• Personal items, like toothpaste, socks, or razors
• A private room, unless  medically necessary

• One depression screening per year. The screening must be done in a primary care doctor’s office  or primary care clinic that can provide follow-up treatment and  referrals.
• Individual and group psychotherapy with doctors (or with certain  other licensed professionals, as the state where you get the services  allows).
• Family counseling, if the main purpose is to help with your treatment.
• Testing to find out if you’re getting the services you need and if your current treatment is helping you.
• Psychiatric evaluation.
• Medication management.
• Certain prescription drugs that aren’t usually “self administered”  (drugs you would normally take on your own), like some injections.
• Diagnostic tests.
• Partial hospitalization.
• A one-time “Welcome to Medicare” preventive visit. This visit includes a review of your possible risk factors for depression.
• A yearly “Wellness” visit. Talk to your doctor or other health care provider about changes in your mental health since your last visit. 

Part B also covers outpatient mental health services for treatment of substance abuse.

• You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment.
• After you meet the Part B deductible, you pay 20% of the  Medicare-Approved Amount   for visits to your doctor or other    health care provider   to diagnose or treat your condition. 
• If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional  copayment   or    coinsurance   amount to the hospital.

Mental health services  help diagnose and treat people with mental health disorders, like  depression and anxiety. These visits are often called counseling or  psychotherapy.

Part B covers mental health services and visits with these types of health professionals: 

• Psychiatrists or other doctors
• Clinical psychologists
• Clinical social workers
• Clinical nurse specialists
• Nurse practitioners
• Physician assistants

Medicare only covers the visits if you get them from a health care provider who accepts  

assignment.

Part B covers outpatient mental health services, including services  that are usually provided outside a hospital, in these types of  settings:

• A doctor’s or other health care provider's office
• A hospital outpatient department
• A community mental health center

• 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 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.

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.

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. You get  this treatment during the day, and you don't have to stay overnight.  Medicare helps cover partial hospitalization services you get through a  hospital outpatient department or community mental health center.

As part of your partial hospitalization program, Medicare may cover these:

• Occupational therapy that’s part of your mental health treatment
• Individual patient training and education about your condition

Medicare only covers partial hospitalization if the doctor and the 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