There’s a growing importance towards mental health care, with many more people needing access to it or feeling as though they can make that step to getting help for their mental health.
The common misconception is often that therapy is unaffordable on a fixed income. It’s often considered something that’s only for the rich and famous. The reality, though, is that Medicare does cover mental health services, much to the surprise of some people.
Navigating the system, though, is one that requires an understanding of what’s covered, who qualifies and how to find participating providers.
Understanding Medicare Mental Health Coverage
To begin the process, you want to have a good understanding of Medicare’s mental health coverage. There are two types: outpatient and inpatient care.
Medicare Part B (Outpatient Care)
Part B is coverage of individual and group therapy sessions. It also offers coverage for psychiatric evaluations, as well as diagnostic tests.
There’s also coverage of annual depression screenings, which are 100% covered if the doctor accepts assignment. Outpatient care typically doesn’t occur in a hospital or clinic.
Medicare Part A (Inpatient Care)
With Medicare, you can also get coverage for inpatient psychiatric hospital stays. However, there’s a 190-day lifetime limit for psychiatric hospital care, so you’ll want to be mindful of how much time is likely to be spent on one or several future hospital stays you might find yourself having.
Medicare Advantage (Part C)
Private plans have to cover the same services as Original Medicare. Out-of-pocket costs and networks may differ.
Understanding these different insurance coverages provided by Medicare is something to be aware of, so that you can choose the right option.
Out-of-Pocket Costs and Financial Responsibilities
It’s good to know what the out-of-pocket costs might be and the financial responsibilities that you’ll need to adhere to when using Medicare for therapy purposes.
When it comes to the annual Part B deductible, it’s something that must be met first before money can be used through Medicare.
With the Original Medicare (Part B), the standard 20% coinsurance will mean you pay exactly 20% of the Medicare-approved amount for most doctor services, durable medical equipment and outpatient therapy. Medicare pays the remaining 80%, provided, of course, that you have met your annual deductible.
The use of the Medicare Supplement Insurance (Medigap) policies fills the gaps in Original Medicare (Part A and B). You pay a monthly private premium that directly covers or significantly reduces your out-of-pocket costs. This includes the uncapped 20% Medicare Part B coinsurance for both medical services and outpatient care.
Eligible Mental Health Providers
So, who does Medicare cover when it comes to eligibility of mental health providers? The mental health providers to look for include:
- Psychiatrists and clinical psychologists.
- Clinical social workers (LCSWs).
- Nurse practitioners and physician assistants.
- Marriage and family therapists (LMFTs) and mental health counselors (LMHCs).
Providers will need to accept Medicare assignment in order to minimize out-of-pocket costs. Now that you know what mental health providers are available, let’s take a look at how you can secure a Medicare therapist.
Step-by-Step Guide to Finding a Medicare Therapist
To find a Medicare therapist, there are several steps to ensure you find not only the right one financially, but one that fits your needs and matches your personality.
1. Use official tools
When you’re looking to find a Medicare therapist, you should be using official tools. The Medicare.gov ‘Find Care’ tool is where you want to begin your search.
You can use this tool to find and compare therapists who take Medicare. From physicians to hospitals and nursing homes. You can use the maps and filters provided on the site to help identify providers that are right for you.
2. Ask your primary doctor
You’ll need to request a referral to a professional who accepts Medicare from your primary doctor. This is easy enough to do, but it’s that first step to getting help.
3. Check online directories
Online directories are a good way of finding the help you need. Utilise specialized search filters on Psychology Today or out-of-pocket assistance directories.
4. Verify directly
Calling the therapist’s office directly is a good way of confirming that they take your specific Medicare plan. This is definitely important to do, especially when some directories online may be outdated.
It’s also good to double-check with the therapist directly, even if you’re sure they allow your Medicare plan. It’s helpful to ensure you’re definitely covered instead of receiving some surprise medical bills through the mail.
Mental health is vital, and having access to mental health services is imperative to help treat those who are struggling.
The Importance of Getting Therapy
There are many reasons why getting therapy is important, regardless of age or background. Here are just some of the reasons why you should have access to affordable therapy.
Safe and objective outlet
Therapy offers a confidential environment that helps you to speak openly with someone who is ultimately impartial and focused just on your needs rather than anything else.
Develops coping strategies
Therapists can help in equipping you with the actionable tools that handle everyday stressors from trauma, grief and major life changes.
Breaks unhelpful patterns
Therapists will explore your past and present. They can recognize any recurring negative behaviors and thought processes, identifying where they may have begun too. It allows you to make healthier choices
Improves relationships
Therapy helps in fostering self-awareness and translates to better communication, boundary setting and stronger personal or professional relationships.
Emotional regulation
It helps you to understand and process a wide range of emotions. It enables you to respond to challenges with greater resilience rather than reacting impulsively, which is something you might have done before getting therapy.
Accessing affordable therapy through Medicare is important for many people who are looking to explore the option of therapy for themselves. With that in mind, make sure to follow these tips and understand what process you need to successfully secure a therapist to work with your needs and wants.
