Does Medicare Cover Therapy? 

Everyone faces mental and emotional challenges from time to time, but in some cases, these challenges can turn into ongoing struggles. Depression and anxiety can affect people of all ages, but too often, seniors affected by loneliness, isolation, and other health issues can be at greater risk. If left undiagnosed and untreated, depression and anxiety can affect your quality of life and overall wellness. 

Why do seniors struggle with mental and emotional health challenges?

Part of the reason for this is the ongoing stigma surrounding mental health in the United States, but age plays a part as well. Some seniors have struggled with mental and emotional health challenges for many years, but because these weren’t things that were talked about in their younger years, the problems went ignored.

Additionally, many seniors find it difficult to make new friends as social circles shrink. Children leaving the nest and friends and family living far away can lead to feelings of isolation. This can go on to have a negative impact on the mental health.

Seeking help for depression and anxiety

The good news is that help is available for mental and emotional health challenges. Seniors who experience these feelings are encouraged to speak with their primary care physicians to see what solutions are available.

In some cases, prescription medications can help to balance out neurotransmitters to bring a sense of peace and calm to the mind of someone dealing with mental and emotional challenges. In other cases, talk therapy may be a good solution.

Does Medicare cover therapy?

Medicare insurance is a program designed to provide coverage for a range of healthcare concerns for seniors and retirees as well as some Americans under the age of 65 who have qualifying conditions. Medicare benefits under Part B provide coverage for outpatient therapy as long as it can be demonstrated that therapy is a medical necessity. This coverage extends to individual therapy, group therapy and family counseling. If your therapist requests that family members attend sessions, they do not need to be eligible for Medicare to participate.

Under Part B, Medicare recipients pay 20% of the cost of therapy. This is a coinsurance, and this cost is in addition to your monthly premium and the deductible you must meet in order to utilize Part B benefits.

Medicare benefits and inpatient therapy

If you are admitted to a Medicare-participating hospital or skilled nursing facility (SNF) and receive inpatient therapy, Medicare benefits are applied under Part A. This part of Medicare covers your stay at the hospital, but some treatments may be billed separately depending on who is providing the service. Some doctors may bill under Medicare Part B for therapy services, and these services will be covered at 80% like with outpatient therapy services.

Keep in mind that inpatient coverage is limited in each benefit period. You can use Medicare benefits to pay for 60 days of hospital care or 20 days of SNF care each benefit period. Additional days are available in limited quantities by paying a per-day coinsurance rate.

Prescription medications in conjunction with therapy

Many seniors find that prescription medications in conjunction with therapy provide effective relief from conditions like depression and anxiety. If your doctor prescribes drugs as part of your therapy, these may be covered by the prescription drug benefit of Medicare Part D.

Medicare Part D is optional insurance that requires a monthly premium payment and a deductible. Not all drugs are covered by all Part D plans, so you will need to take a look at your plan’s formulary to see if your medications are eligible for Medicare coverage. This list includes all drugs covered by your plan and provides additional information about limitations and restrictions for certain medications.