Mental health conditions like depression can surface at any age, but often become prevalent in people diagnosed with health conditions that commonly occur later in life, like Alzheimer’s disease, Parkinson’s disease, arthritis, heart disease and cancer. If you live with depression, you’re not alone. It’s estimated that more than 2 million adults aged 65 and older experience some form of depression.1
There are many resources out there that can help you manage depression, and it can help to understand what Medicare covers and doesn’t cover when it comes to screenings and treatment. Medicare Part B does cover depression screenings and treatments, but the amount of coverage can vary from plan to plan. In this article, we’ll walk you through the details of what Medicare will and won’t cover for depression treatment, so you can get the care you need.
What is depression?
Depression, also known as major depressive disorder or clinical depression, is a mood disorder that affects how a person feels, thinks and works. It causes persistent sadness and loss of interest, and can lead to various mental and physical problems. To be officially diagnosed with depression, symptoms must be present for at least two weeks, which include:
- Feelings of sadness, emptiness or hopelessness
- Loss of interest or pleasure in normal activities
- Sleep disturbances, including insomnia or sleeping too much
- Tiredness and lack of energy
- Reduced appetite and weight loss or increased cravings for food and weight gain
- Anxiety, agitation or restlessness
- Feelings of worthlessness or guilt
- Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide2
Medicare Coverage of Depression Screenings
Depression screenings can help you find the right course of action to manage your symptoms or risk of developing depression. A depression screening is typically a questionnaire that you complete on your own or with the help of your doctor to indicate if you are at risk for or are currently showing symptoms of depression.3 Medicare Part B will cover one depression screening per year and you do not need to show signs or symptoms to qualify for the screening. However, the screening must be performed in a primary care setting, like a doctor’s office, that can provide follow-up treatment and referrals for Medicare coverage. Medicare will not cover the screening if it takes place in an emergency setting, skilled nursing facility or hospital.
Medicare Coverage of Depression Treatments
If you are diagnosed with depression, Medicare Part B may cover certain services and treatments to help you manage it. It typically covers mental health visits with a doctor and services you generally get in an outpatient setting3, such as:
- Individual and group psychotherapy with doctors or certain other licensed professionals
- Family counseling
- Diagnostic testing
- Psychiatric evaluation
- Medication management
- Certain prescription drugs that aren’t self-administered, like injections
- Partial hospitalization
Doctors and psychiatrists who participate in Part B must accept assignments, which you should make sure of before you schedule your appointment. Deductibles and coinsurance may also apply.
Medicare Part A4 helps cover inpatient mental health services that you receive in a general or psychiatric hospital. Part A will typically cover:
- Nursing care
- Therapy or other treatment for your condition
- Lab tests
- Other related services and supplies
If you’re admitted to a psychiatric hospital, Part A will only pay for up to 190 days of inpatient psychiatric hospital services during your lifetime.
What Medicare Doesn’t Cover
There are a few mental health treatments and services that Medicare doesn’t cover, including:
- Transportation to or from mental health care services
- Activity therapy that’s for recreation or to divert attention from other issues
- Support groups that bring people together to talk and socialize (This is different from group psychotherapy, which is covered)
- Testing or training for job skills that isn’t part of your mental health treatment
It’s important to note, however, that although Original Medicare (Parts A and B) does not cover everything related to mental health treatments and services, there are alternative forms of coverage and community resources that you may be eligible for.
Medicare Advantage plans are an alternative to Original Medicare. These plans are legally required to include the same coverage as Parts A and B, but often include additional coverages. Based on your needs, the plans available in your area, and the coverage you qualify for, this could include mental health benefits
You may also be eligible for resources in your area that could continue to help fill gaps in your healthcare coverage. SelectQuote’s partner, Population Health, offers a free membership service that can help you discover and access the healthcare services available to you.
SelectQuote Can Help You Get the Most Out of Your Medicare Advantage Coverage
Taking care of your mental health is just as important as your physical health. Utilizing the services covered by Medicare and your Medicare plan is an easy way to stay on top of it all. At SelectQuote, we can help you understand what is and isn’t covered by your Medicare plan and connect you to resources to help you get the most out of your Medicare coverage.