Will Medicare Cover My Anxiety and Depression?
If you’re living with anxiety and/or depression, you’re not alone. Anxiety disorders are considered the United States’ most common mental illness, with 40 million adults aged 18 and older (more than 18% of the population) affected. While anxiety disorders are very treatable, only 36.9% of those living with them seek treatment. Depression also comes along with anxiety, with nearly one-half of those diagnosed with depression simultaneously diagnosed with anxiety.i
Medicare benefits can be a resource for covering the cost of anxiety and depression. Let’s break down the various parts so that you can better understand how to chart your own course toward recovery.
Original Medicare and Mental Health Care
Part A (hospital care) covers hospital visits and stays in skilled nursing facilities. Should your condition result in an inpatient stay, coverage for anxiety and depression typically includes:
- General hospital expenses
- Psychiatric hospital expenses
Part A coverage for mental health differs from typical Part A offerings in that if you stay at a psychiatric hospital, rather than a general one, it will only cover up to 190 days during your lifetime. Part A also diverges from typical coverage here in that your medical services during an inpatient hospital stint are covered by Part B.
Part B (medical care) addresses medically necessary and preventative services stemming from anxiety and depression. These include:
- One annual depression screening in a primary care doctor’s office or clinic
- Individual and group psychotherapy
- Family counseling if applicable
- Testing to ensure your services and treatment are improving your condition
- Psychiatric evaluation
- Medication management
- Drugs that are typically not self-administered, such as injections
- Diagnostic tests
- Partial hospitalization
- A one-time Welcome to Medicare preventative visit, which includes a review of your risk factors
- An annual wellness visit during which your provider can evaluate changes in your mental health
- Outpatient treatment for excessive drug and alcohol use.
While you pay nothing for the depression screening, you are responsible for 20% of doctor and provider visits.
The Part B deductible ($233 in 2022) also applies.
Living with More than One Chronic Condition?
Medicare considers some mental illnesses, like major depressive disorders, to be chronic conditions. If you have depression and/or anxiety plus one or more other chronic conditions, you may qualify for Chronic Care Management under Part B.
Some of the most common conditions labeled as chronic by Medicare include asthma, arthritis and diabetes.
Part B Chronic Care Management services include:
- Around-the-clock provider access
- At least 20 minutes of related services monthly
- An individually crafted care plan
- Regular check-ins with your doctor or provider
Providers who can bill for this include:
- Physician assistants
- Nurse specialists
- Nurse practitioners
Those who cannot bill for Chronic Care Management include:
- Limited-license doctors
Medicare Advantage and Mental Health Care
Also known as Part C, these privately sold plans encompass all the benefits offered by Original Medicare (Parts A and B), but also may offer extended benefits such as dental, vision, prescriptions and wellness programs. Since they also have provider networks, it’s best to check with your preferred professional to make sure that they’re covered by the Advantage plan that you’re considering.
Chronic Condition Special Needs Plans are also part of Medicare Advantage’s offerings and are tailored to those living with specific diseases such as bipolar disorder, major depressive disorder, paranoid disorder, schizophrenic disorder and schizoaffective disorder.
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All Chronic Condition Special Needs Plans must provide prescription drug coverage. While some plans mandate that you use only network providers, others will let you go out of network. You’ll typically need a referral for specialist visits, but not for services such as in-network pap tests, pelvic exams and yearly screening mammograms.
You’ll have to choose a primary care doctor or care coordinator. Care coordinators are one of the most notable benefits of a C-SNP. Their job is to help you stay current with your care needs. This may mean getting the right prescription drugs, scheduling appointments or monitoring other related activities.
Prescription Coverage for Mental Health through Part D
Part D (prescription drugs) is an add-on to Original Medicare, which does not provide coverage for medications.
Part D covers mental health-related medications including most:
- Antipsychotic drugs
- Anticonvulsant drugs
- Antidepressant drugs
Each individual Part D plan has its own formulary, so be sure that your specific medications are covered under a given plan before enrolling. Additionally, Part D coverage can be obtained through Medicare Advantage,
which typically offers extended benefits beyond Original Medicare.
Medicare Supplement Insurance and Mental Health Care
Also known as Medigap, Medicare Supplement Insurance helps bridge the gap between Original Medicare and your mental health costs. For example, when it comes to hospitalization, Medigap may allow you extended stays as opposed to the 190 days over a lifetime afforded by Original Medicare. Though Part A does cover hospitalization, you may still encounter Part B costs for your mental health provider. Under Medigap, all hospitalization copays and coinsurance are covered.
In addition, most Medigap plans will cover your Part A deductible ($1,556 in 2022) for your hospital stay.
A few other things to know:
- All Medigap plans are applicable to part or all your psychiatrist’s copays and coinsurance
- Only Medigap Plan C and Plan F will cover the Part B deductible for your doctor
- Only Medigap Plan F and Plan G will cover excess charges from your psychiatrist
What are the Risk Factors for Depression and Anxiety?
Depression and anxiety are very complex mental health conditions. Most cases are the result of various risk factors combined.
Risk factors for depression include:
- Death or loss
- Major life events
- Other illnesses
- Substance abuse
- Medication side effects
Risk factors for anxiety include:
- Personality type
- Other mental health disorders
- Substance abuse
- Stress stemming from an illness or pent-up feelings
While these risk factors are common, yours may differ. Consult a mental health professional with questions as to your individual risk factors.
When you’re living with anxiety or depression, the last thing you want to do is add the stress of costly health care bills. There are many resources out there to help you with your mental health, and you shouldn’t be scared to use them because of the cost.
Medicare can help you defray many of these costs, so you can focus on living the life you deserve. For more information on what Medicare plans are best to help you manage your mental health issues, we can help.
Call us to speak to a licensed agent specializing in Medicare health and supplemental plans in your area for guidance.
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Denise Austin, 65, Ensurem Ambassador
Best-Selling Author, Creator of Fit Over 50 Magazine
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