• Hospital Copay Medicare
• Copay For Medicare Patients

Last Updated : 09/12/20183 min read

According to the National Institute of Health’s National Institute of Mental Health, almost 18% of all adults in the United States suffer from some type of mental or emotional disorder such as depression or anxiety. If you are enrolled in Original Medicare (Part A and Part B) and your doctor recommends counseling for a mental health condition, these services are generally covered by Medicare both on an inpatient and outpatient basis. Your Medicare Part A and B deductibles, copays and coinsurance amounts may apply.

1. However, plans are not required to cover benefits in the same way. For example, Part A and Part B (e.g., Original Medicare) are private fee-for-service coverage. Medicare pays approximately 80 percent of all covered services, and the beneficiary pays the remainder as an out-of-pocket cost or with supplemental insurance (e.g., Medigap).
2. Members will have no copays, deductibles or coinsurance out-of-pocket costs for covered services for treatment of confirmed cases of COVID-19, regardless of where the treatment takes place. This could include telehealth, primary care physician visits, specialty physician visits, facility visits, labs, home-health and ambulance services.

$3 copay: $6 copay: $0 copay: Tier 2 (Generics) $10 copay: $20 copay: $20 copay: Tier 3 (Preferred Brands) $47 copay: $94 copay: $141 copay: Tier 4 (Non-Preferred Brands) $100 copay: $200 copay: $300 copay: Tier 5 (Specialty Medications) 29% coinsurance: Not offered: Not Offered.

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Does Medicare cover both inpatient and outpatient counseling?

If you are admitted to the hospital, either a general hospital or a psychiatric hospital, Medicare will generally pay 80% of the allowable charges for counseling services you receive from a credentialed health professional who participates with the Medicare program.

If you receive outpatient counseling at a doctor’s office, an outpatient hospital facility, or a mental health clinic, Part B also generally covers 80% of the allowable charges. In both cases, you are responsible for your Part B deductible and coinsurance amounts.

For Medicare Part B to cover these services, you must receive counseling from one of the following types of credentialed health professionals who accept assignment:

• Psychiatrist or other doctor.
• Clinical psychologist.
• Clinical social worker.
• Clinical nurse specialist or nurse practitioner.
• Physician assistant.

Does Medicare cover other types of counseling?

There are other specific situations in which Medicare may cover specialized counseling services. For example:

Hospital Copay Medicare

• Grief and loss counseling for hospice patients and their families.
• High-intensity behavioral counseling about sexually transmitted infections for at-risk sexually active adults.
• Behavioral counseling to help you lose weight if you meet certain medical requirements.
• Counseling sessions to help you quit smoking.
• Alcohol misuse counseling if it’s provided in a doctor’s office or other primary care setting.

These specialized types of counseling are usually limited to a certain number of sessions per year. Ask your health care provider for details if he or she recommends these counseling services.

Are there other options for Medicare coverage of counseling?

If you have a mental health condition that may require intensive treatment or long-term therapy, you may want to consider a Medicare Supplement plan, or Medigap. These plans cover all or part of your Part A and/or Part B deductibles and coinsurance amounts and help you better manage your out-of-pocket costs with Original Medicare.

Medicare Advantage plans (Medicare Part C) are another option for potential additional counseling coverage. Medicare Advantage plans are offered by private insurance companies approved by Medicare and are required to cover everything that’s included in Original Medicare (except hospice care, which is still covered under Part A), but they may offer additional benefits to help you with your treatment.

For example, many Medicare Advantage plans include Part D coverage for prescription drugs, as well as coverage for routine dental, vision, and hearing care. It’s important to note that not all plan types and benefit options may be available in every location. You must also continue to pay your Part B premiums plus any additional premium required by your plan if you enroll in a Medicare Advantage plan.

Need more information about Medicare and counseling?

Copay For Medicare Patients

If you’d like to know more about Medicare coverage for mental health and counseling, I’m happy to answer your questions. If you prefer, you can schedule a phone call or request an email by clicking on the buttons below. You can also find out about plan options in your area by clicking the Compare Plans button.