Medicare Reimbursement for Psychiatric Services for Depression, Anxiety Disorders Etc

by Mary Jane
(Indiana)

I just read an article that talks about how depression and anxiety disorders often go undiagnosed in the aging population. Many aging seniors and their family members attribute feelings of sadness or anxiety to growing old.

While depression and aging may not be a normal part of aging, I believe that this story missed an important factor.

What the story does not share, I believe your visitors would appreciate knowing.

Many seniors are financially stretched, living on a fixed budget.

Unfortunately, many seniors don’t get the necessary help or treatment for depression because Medicare reimburses psychiatric services differently.

The physicians are reimbursed at the rate of 50% of the allowed charge for a psychiatrist, psychologist or psychotherapist and the beneficiary (or the patient) is responsible for the other 50%. As you know, this can be costly.

There are new rules in effect for 2010 and 2011.

Medicare will reimburse at the rate of 55%.Leaving the patient to be responsible for paying the other 45%.

It will not be until 2014 that mental health services be reimbursed at 80% of the allowed charges, Leaving the remaining 20% to be paid by the patient.

Mary Jane,
You are so right about seniors being concerned about their money. I know close to the end of the year, many with HMO’s have prescription plans that run out of coverage and they are responsible for paying for their own medications. They make too much money to qualify for any type of assistance, but not enough to pay for the cost of the medications, the co pays to the doctors, all their bills, such as heat, air and food.

I can see why depression and anxiety goes untreated.

It is a vicious circle. Which comes first? Depression and anxiety or the inability to pay for necessary staples and chronic stress?

Thank you, again, Mary Jane for bringing attention to a very important subject.

Updated 2023 on Medicare reimbursement for psychiatric services

If you are Medicare-eligible, you may be able to receive reimbursement for psychiatric services. Medicare provides coverage for many services related to mental health care including diagnosis, treatment, and counseling. Medicare covers both inpatient and outpatient care that is provided by a Medicare-approved professional.

Although Medicare Part A covers hospitalization costs, it does not cover the cost of psychiatric services on its own. However, if your doctor recommends these services as part of a medically necessary plan of care, Medicare Part B can provide coverage for those costs. To qualify for this type of reimbursement, the service must be provided at an approved Medicare facility or by an approved Medicare provider.

Medicare also provides coverage for certain preventive screenings such as depression screening and alcohol misuse screening. Medicare Advantage plans may provide additional coverage for mental health services, such as televisits or tele therapy sessions with a Medicare-approved provider. For more information on Medicare coverage of psychiatric services, visit Medicare's website or contact your local Medicare office.

Through Medicare, you can access the care you need to maintain your mental health. Knowing what type of coverage is available can help ensure that you receive the best possible care at the most affordable cost. To learn more about Medicare reimbursement for psychiatric services, reach out to an experienced Medicare specialist today.

Medicare Advantage plans are expected to cover televisits for Medicare mental health patients in 2023. This expanded coverage will make it easier for Medicare beneficiaries to access care from the comfort of their own home, reducing wait times and providing more convenient options for receiving care. Medicare televisits must meet Medicare’s standards of quality and safety, but they may be a great option if you require psychiatric services that cannot be provided in-person due to distance or other factors. Additionally, Medicare televisits are often less expensive than in-person services, so it is worth exploring this option before booking an appointment with a Medicare-approved provider.

If you have questions about Medicaid reimbursement for psychiatric services or need help finding an approved Medicare provider.