People with Medicare are happy campers. Nearly four-fifths of Medicare consumers (78%) give their Medicare plan four or five stars, with five as the highest rating, according to a 2020 Insure.com survey.
But just because they’re satisfied with their coverage doesn’t mean they understand it. Like any insurance plan, Medicare can seem confusing if you don’t take the time to learn about it.
Take mental health services. Some people may not realize that Medicare covers a range of such services, including individual and group psychotherapy and psychiatric evaluations.
There’s usually no limit to the number of mental health sessions Medicare will cover, although you may incur out-of-pocket costs depending on the nature and scope of the outpatient services you receive.
Despite Medicare’s wide-ranging coverage, you still need to do a little due diligence when selecting a provider.
“It can be tricky to find a psychiatrist or psychologist who contracts with Medicare and accepts Medicare and its approved rate,” said Danielle Roberts, co-founder of Boomer Benefits, an insurance agency in Fort Worth.
If you choose original Medicare (as opposed to a Medicare Advantage plan), you will pay a small annual Part B deductible (currently $203). From there, you pay 20% of the Medicare-approved amount for covered medical services. Many Medicare consumers purchase a Medicare supplement insurance policy—a Medigap policy—that covers copays and plugs other gaps.
If you opt for Medicare Advantage, you participate in a managed care network—an HMO or PPO—so read your “Summary of Benefits and Coverage” which provides a plan overview. Before choosing a mental health professional, confirm that provider is in your network.
Knowing in advance what Medicare covers helps when you’re struggling with mental health issues and searching for providers. Grieving widows, for example, may not realize that Medicare covers counseling.
Only 15% of widowed Medicare beneficiaries take advantage of mental health services covered by Medicare following the death of a spouse, according to a new survey of 400 widowed seniors by MedicareAdvantage.com. And 1 in 5 widowed beneficiaries avoid therapy or other mental health services due to the anticipated cost or because they’re unaware Medicare covers these services.
“So many people don’t know grief counseling is available to them through Medicare,” Roberts said. That’s one reason she urges all Medicare beneficiaries to get their free annual wellness visit, which includes screenings for a range of medical issues such as depression and cognitive impairment.
Based on the results of this visit, your medical provider can identify physical or mental health concerns—and recommend that you seek a specialist for additional care.
“It’s a good early indicator if they see any red flags,” said Christian Worstell, a licensed insurance agent with MedicareAdvantage.com. “When you lose a loved one, the last thing on your mind is your Medicare benefits. But grief might manifest over time. It can sneak up one or two or three years later and expose itself,” so yearly wellness checks can play a vital role in identifying health problems before they intensify.
As long as you’re aware that Medicare covers mental health counseling—and you’re willing to try it—the next step is approaching the process with the right attitude. Seniors who have never sought out mental health professionals may not feel comfortable opening up about their emotions.
“You have to allow yourself to be vulnerable,” Worstell said. “Nothing will take [therapists] by surprise. They’ve heard it all.”