Medicare.
Medicare provides a range of behavioral health benefits, covering services related to both mental health and substance use disorders. These services are available through different parts of Medicare—Part A (hospital insurance), Part B (medical insurance), and sometimes through Medicare Advantage plans (Part C). Here’s a detailed breakdown of the behavioral health benefits that Medicare typically covers.
​
​
MediCare Typically Covers:
Outpatient Mental Health Services
(Medicare Part B)
Individual and Group Therapy: Medicare covers outpatient counseling and therapy provided by licensed mental health professionals such as psychiatrists, clinical psychologists, clinical social workers, and counselors (if they meet certain Medicare qualifications).
Psychiatric Evaluations: Includes diagnostic evaluations, medication reviews, and assessments of a patient’s mental health status.
Medication Management: Medicare covers medication management visits with a psychiatrist or other qualified provider to assess, adjust, and manage psychiatric medications.
Family Counseling: Covered if the therapy aims to help with treatment of the patient's condition.
Telehealth Services: Telehealth visits, including mental health therapy and psychiatric services, are covered by Medicare, allowing beneficiaries to access
are from home.
​
Partial Hospitalization Programs (PHPs): Intensive outpatient services provided as part of a structured program of care, typically more intensive than standard outpatient therapy but less restrictive than full inpatient hospitalization. PHPs can include individual therapy, group therapy, and medication management.
Substance Use Disorder
(SUD) Treatment
Outpatient Substance Use Disorder Treatment: Includes therapy, counseling,
and drug screening as part of treatment for addiction, provided by qualified
providers like psychiatrists and licensed social workers.
Medication-Assisted Treatment (MAT): Medicare Part B covers MAT for opioid
use disorder, including methadone (administered through a certified opioid
treatment program) and buprenorphine. The coverage includes counseling and
other related services.
Preventive Services
(Medicare Part B)
Depression Screening: An annual depression screening is covered, provided it is done in a primary care setting where follow-up treatment is available.
Alcohol Misuse Screening and Counseling: Covers screening for alcohol
misuse and up to four brief counseling sessions per year for individuals who misuse alcohol but are not yet alcohol-dependent.
Annual Wellness Visits: These visits include screenings for cognitive impairment and an evaluation of risk factors for behavioral health conditions.
Screening, Brief Intervention, and Referral to Treatment (SBIRT): A preventive service that focuses on identifying individuals at risk for substance abuse.
Partial Coverage for Medications
(Medicare Part D)
Prescription Drugs for Mental Health Conditions: Medicare Part D plans
(prescription drug coverage) typically include medications for treating mental
health conditions like antidepressants, antipsychotics, and anti-anxiety
medications.
Opioid Use Disorder Medications: Part D may also cover medications used for
the treatment of substance use disorders, including those used as part of MAT.
Medicare Advantage Plans
(Medicare Part C)
Enhanced Benefits: Some Medicare Advantage plans may offer additional
behavioral health services beyond what is covered by Original Medicare. These
could include broader access to telehealth, wellness programs, or additional
therapy sessions.
Network Restrictions: Advantage plans may require using in-network providers
for behavioral health services, which can be a limitation compared to Original
Medicare’s broader access.
Medicare coverage of behavioral health services is designed to address the needs of older adults and individuals with disabilities who may experience mental health conditions or substance use disorders. In January 2025, Medicare will see some changes to its coverage for substance use disorder (SUD) treatments, largely aimed at improving access and flexibility for beneficiaries. Key updates include the following:
New Billing Codes and Coverage Adjustments: Medicare plans to incorporate new billing codes for safety planning interventions, specifically designed to support individuals at risk of suicide or overdose. This includes follow-up calls after discharge from a crisis encounter, allowing for better continuity of care during recovery.​
​Expanded Provider Network for SUD and Mental Health Services: Medicare
Advantage plans will include a broader range of providers, such as licensed
mental health counselors and marriage and family therapists, which should
improve access to outpatient mental health and substance use disorder services​.