Does Medicare Cover Counseling Services?

More than ever, counseling is a popular and effective service for people of all ages. Seniors with Medicare often receive counseling to treat mental health disorders, cope with life changes, deal with grief and loss, and maintain their cognitive health.

For many people, the biggest barrier to starting counseling is the cost. According to a 2018 survey from Cohen Veterans Network, 34 percent of Americans say that poor insurance coverage prevents them from seeking mental health services. It’s normal to worry about cost and coverage for any type of medical care. Some health insurance plans provide great coverage for mental health services, and others are lacking.

Most older adults in the United States have health insurance through Medicare. If you or a senior loved one has Medicare, you may wonder if the plan covers therapy, online counseling, and other mental health services. Before you start counseling, you should know what to expect for insurance coverage and out-of-pocket costs.

Who is eligible for Medicare?

To be eligible for full Medicare benefits, you must be 65 or older and a U.S. citizen or permanent legal resident who has lived in the country for five years. Also, you or your spouse must have worked long enough to be eligible to receive either Social Security or railroad retirement benefits. Your spouse must be at least 62 years old for you to receive Medicare based on their work history.

Medicare also covers younger people with disabilities in certain situations. If you have been entitled to Social Security disability benefits for at least 24 months or have received a disability pension from the Railroad Retirement Board, you can qualify for Medicare. People with end stage renal disease and Lou Gehrig’s disease qualify as well.

If you or your spouse’s work record doesn’t qualify you for full Medicare but you are a citizen or legal resident of five or more years, you can still get benefits. However, you will likely have to pay higher premiums for Medicare Parts A and B.

When you become eligible for Medicare, you should receive a statement from Social Security. If you’re not sure whether you’re eligible, you can use the online eligibility tool or contact your local Social Security office.

Does Medicare cover counseling?

Mental health counseling is covered by Medicare Part B. However, there are some restrictions and qualifications. Coverage only applies to treating diagnosed mental health disorders that are listed in the Diagnostic and Statistical Manual of Mental Disorders.

Medicare covers a wide range of outpatient mental health services. Here are the most common types of services you can receive with Medicare:

  • Group and individual counseling
  • Diagnostic testing
  • Psychiatric evaluation
  • Family counseling
  • Substance use disorder treatment
  • Medication management

Medicare allows for one free depression screening per year from their primary care physician. For all services except screenings, patients must pay the deductible. As of 2020, the Medicare Part B deductible is $198. Patients also have to pay the coinsurance for individual, group, and family counseling as well as diagnostic tests.

Medicare Supplemental Insurance, also known as Medigap, can help you cover copayments and coinsurance for therapy. Medigap plans are supplied by private companies and are intended to cover out-of-pocket costs that Medicare Parts A and B don’t cover. As of 2020, Medigap no longer covers the Part B deductible. If you already had a Medigap plan prior to 2020 that covers your deductible, you can keep this coverage and are commonly referred to as being “grandfathered in.” No new members are eligible to buy into a Medigap plan that covers the deductible.

There are several different Medigap plans available. Many people buy it to help cover costs for all of their medical services. To decide whether it would be cost-effective for you to buy Medigap, you should look at your own healthcare costs and your out-of-pocket expenses.

Medicare Advantage, also known as Medicare Part C, covers some mental health counseling as well. Medicare Part C is an alternative to Medicare Parts A and B. Some Part C plans may have a smaller network of healthcare professionals, though, so you’ll have fewer options for counselors. Part C plans may require a referral from a primary care doctor, too, so the process of finding a therapist and starting counseling can be lengthy. Medicare Advantage plans often limit their in-network providers and close their panels so many therapists don’t have a chance to become in-network.

Does Medicare cover online counseling?

In the past, Medicare has had strict limits for most telehealth services, including online counseling. Medicare used to only offer telehealth services in Professional Shortage Areas, which are federally-designated rural areas with a lack of healthcare providers. Even in these areas, online counseling was not covered until more recently.

The 2018 SUPPORT Act extended telehealth services to Medicare recipients in all areas. However, this act focuses on addiction treatment, so it only extended online counseling for substance use disorder treatment and treatment of co-occurring mental health disorders.

Since March 2020, Medicare telehealth coverage has expanded due to the COVID-19 pandemic. Currently, the in-person mental health services that were covered by Medicare can now be provided through telehealth.

With these changes, you do not need an established relationship with a counselor to receive online counseling. Even if you’ve never had counseling before, you can start now with telehealth services. Healthcare experts aren’t sure how long these changes will last, though. When the pandemic is over, restrictions on telehealth services may increase again. Many therapists and other healthcare workers are hopeful that this expansion of Medicare coverage will be permanent.

Counseling is a valuable resource for people of all ages, but one of the biggest obstacles is the cost. Fortunately, seniors with mental health disorders can receive counseling and many other mental health services through Medicare. Although there may still be some out-of-pocket costs, Medicare will cover most of the bill for many patients.

Aging can bring about some difficult thoughts, emotions, and experiences. If you or your senior loved one is struggling with mental health, Blue Moon Senior Counseling can help. We specialize in counseling for older adults, and we are covered by Medicare Part B. We do not need a doctor’s order and individuals can self-refer. We are also currently offering online counseling for new and existing clients. Contact us today for more information.

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