Mental Health Basics for Medicare Part B

Benefit Qualifiers

Feelings of anxiety, depression or hopelessness, can happen to anyone at any time. Other qualifiers are emptiness, loss of self-worth, worried about being a burden, withdrawn socially, isolation, lack of interest in friends or activities, lack of energy, concentration issues, trouble sleeping, weight loss, loss of appetite, increased use of alcohol or drugs, thoughts of suicide, fixation on death. 

Covered Clinicians

 Licensed Clinical Social Workers

 

Clinical nurse specialist 


Nurse Practitioner 


Physician Assistant 


Psychiatrist or other doctor

Access to Service

   In patient


   Out patient


      In-home setting  

 


Covered Services

Individual, family, group therapy


Psychiatric evaluation


 Medication management


Diagnostic tests 


 “Welcome to Medicare” preventative visit. This is to review for potential risk factors associated with depression. Must be done within the 1st 12 months of receiving Part B.


 “Annual Wellness” visit which is intended to discuss and evaluate mental health changes year to year. 

 


Costs Associated with Services

  Original Medicare Part B - generally, a 20% co-pay applies after the Part B deductible is satisfied.


 Medicare Advantage & Medicare health plans – benefits vary according to individual plan memberships.


 Medicare Supplement Insurance – generally will pay for uncovered, original Medicare expenses like copayments and deductibles. Benefits vary according to plan.


 “Welcome to Medicare” visit – No out of pocket cost if done within the 1st 12 months of having Part B.


 Annual “Wellness” visit – No out of pocket cost if done every 12 months.  

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