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Does Medicare Cover Counseling?

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Medicare covers counseling and other mental health services provided by a licensed and certified mental health professional. This includes counseling during inpatient care, such as substance abuse counseling during a period of inpatient treatment. However, Medicare does not cover pastoral counseling, marriage counseling, or counseling over the phone, among other services.

Key Takeaways

  • Counseling is the treatment of mental health through discussion with a mental health professional.
  • A doctor may prescribe counseling instead of medication for mental health treatment, or in conjunction with medication.
  • Medicare covers many different counseling services, such as depression screenings, proper use of prescription medication, one-on-one therapy sessions, and family grief therapy during hospice care.
  • Medicare Advantage plans also provide coverage for medications used in conjunction with counseling coverage, but providers and facilities may be limited.
  • Medigap policies are available to Medicare beneficiaries to purchase for additional help with costs.

What Is Counseling?

Counseling, also known as psychotherapy or therapy, refers to the treatment of mental health through discussion with a psychiatrist or psychologist. Counseling can be done in person or remotely over a video call. Counseling helps a person to understand their feelings and behaviors during stressful situations and how to manage them with healthy coping skills, such as:1Mayoclinic.org, “Psychotherapy“, Accessed November 3, 2021

  • Conflict resolution
  • Marriage counseling
  • Anxiety or stress relief
  • Depression management
  • Coping with major life changes
  • Addiction recovery habits
  • Managing atypical thought patterns
  • Managing unhealthy reactions to stressful situations
  • Making peace with a chronic physical health problem
  • Recovering from a trauma that was experienced or witnessed
  • Managing feelings about sexual issues
  • Increasing sleep quality
  • Managing a high or low appetite

Counseling can be an excellent non-pharmacological alternative for treating mental health if medication is not desired. It can also be used in conjunction with medication if one or the other is not enough alone.1Mayoclinic.org, “Psychotherapy“, Accessed November 3, 2021

How Does Medicare Cover Counseling?

Medicare Part B covers many different outpatient mental health services:2Medicare.gov, “Mental health care (outpatient)“, Accessed November 3, 2021

  • 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 certain other licensed professionals (when allowed in your state).
  • Family counseling if the main purpose is to help with your treatment.
  • Testing to see if you’re getting the service 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. They can evaluate your changes year to year.
  • Outpatient mental health services for the treatment of inappropriate alcohol and drug use.

Medicare Part A provides coverage for counseling services as part of treatment in an inpatient facility, such as a general hospital or psychiatric hospital.3Medicare.gov, “Mental health care (inpatient)“, Accessed November 3, 2021

Annual Depression Screening

You pay nothing for your yearly depression screening if your doctor or health care provider accepts Medicare-assignment. You pay 20 percent of the Medicare-approved amount for visits to your 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. 4Medicare.gov, “Depression Screening“, Accessed November 17, 2021

Tobacco Usage

Medicare Part B covers eight counseling sessions within a twelve-month period for helping beneficiaries end their tobacco usage. Beneficiaries receive these counseling services at no cost if they are provided by a Medicare-approved counselor.5Medicare.gov, “Counseling to prevent tobacco use & tobacco-caused disease“, Accessed November 3, 2021

Alcohol Abuse

Medicare Part B covers annual alcohol abuse screening for their beneficiaries, as well as four counseling sessions within a twelve-month period to help a beneficiary recover from alcohol abuse. These counseling sessions are provided at no cost to beneficiaries, as long as the service is provided by a Medicare-approved counselor and the beneficiary is sober when receiving their alcohol abuse counseling.6Medicare.gov, “Alcohol misuse screenings & counseling“, Accessed November 3, 2021

Obesity

Medicare beneficiaries with a body mass index (BMI) of 30 or higher will receive coverage for obesity counseling at no cost to the beneficiary. This includes an initial BMI screening as well as behavioral counseling with a focus on diet and exercise to encourage healthy weight loss.7Medicare.gov, “Obesity behavioral therapy“, Accessed November 3, 2021

Sexually Transmitted Infections

Medicare will cover up to two counseling sessions for sexually active adolescents and adults who engage in risky sexual behaviors, such as having sex without protection from sexually transmitted infection (STI). STI screenings are covered annually if the beneficiary has a high STI risk, or as needed if the beneficiary is pregnant. These services are provided at no cost when performed by a Medicare-approved health care provider.8Medicare.gov, “Sexually transmitted infection screenings & counseling“, Accessed November 3, 2021

Hospice Care

Medicare fully covers spiritual and grief counseling for terminally ill beneficiaries receiving hospice care, as well as counseling for their families. Medicare defines terminally ill as having a life expectancy of 6 months or less. Beneficiaries pay nothing for Medicare services related to hospice care. Counseling provided during hospice care can be conducted by a mental health care professional in the beneficiary’s home or hospice facility if needed.9Medicare.gov, “Hospice care“, Accessed November 3, 2021

What Doesn’t Medicare Cover For Counseling?

Medicare only covers counseling services provided by a certified mental health care provider. Medicare will not cover counseling from a religious professional, such as a priest or pastor.  Medicare also does not provide coverage for these mental health care services:10cms.gov, “Medicare Mental Health“, Accessed November 15, 2021

  • Environmental intervention or modifications
  • Adult day health programs
  • Biofeedback training (any modality)
  • Marriage counseling
  • Report preparation
  • Results or data interpretation or explanation
  • Hemodialysis specifically for treating schizophrenia (experimental)
  • Transportation or outpatient meals
  • Phone services, or “apps”

How Much Does Counseling Cost?

The cost of counseling without coverage varies by the area, the counselor’s specialization, and the length of counseling sessions. Counseling costs usually range between $65 to $250 per hour, but they can be higher if the counselor has a greater reputation and specialization.11goodtherapy.org, “How much does therapy cost?“, Accessed November 17, 2021

Medicare Part B will cover 80 percent of approved costs for counseling services ordered by your doctor once you have paid the annual Part B deductible. As an inpatient, Medicare Part A will cover all approved counseling services once the Part A benefit period deductible has been paid. If the counselor charges Excess Charges, you will pay those out-of-pocket unless you have a Medicare Advantage plan or a Medigap policy that covers Excess Charges.

Medicare Advantage

Medicare Advantage plans are required to cover the same services as Medicare Part A and Part B, in addition to any expanded services offered. That includes counseling. However, a beneficiary’s out-of-pocket costs with a Medicare Advantage plan may be different than those with Original Medicare. Also, Medicare Advantage plan rules may require their members to use network providers for all services, supplies, and durable medical equipment.12Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed November 12, 2021

Medigap

People with Original Medicare can purchase additional insurance, called Medigap, to help cover their Medicare out-of-pocket costs.  Medicare supplement insurance, as it is also known, is available through private insurance companies. A Medigap policy will cover some or all of the out-of-pocket costs associated with Medicare-approved counseling services. These costs include:13Medicare.gov, “What’s Medicare Supplement Insurance (Medigap)?“, Accessed November 12, 2021

  • Deductibles
  • Coinsurance
  • Copayments

Summary

If you are living with chronic emotional distress or are struggling with your mental health, consult with your doctor for a screening and a counseling session. Counseling will help you better understand the issue at hand, how you feel about the issue, and how to manage the situation in a healthy manner. If you need help finding a licensed mental health professional that accepts Medicare in your area, you should try using Medicare’s provider comparison tool to find the mental health specialist you need.

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