Mental health is as important as physical health, and it should never be overlooked. If you know someone having mental problems, they should ideally go see a doctor who can refer them to a mental health specialist as soon as possible.
There are a number of treatments available for those struggling with their mental health. One common mental health therapy for people with suicidal thoughts is DBT, or dialectical behavior therapy.
If this is a treatment you or a loved one could benefit from, a common question you likely have is “does Medicare cover DBT therapy?” In this article, we answer that question in clear, plain English. You will also find the average costs of DBT therapy for those who have to pay out of pocket.
Does Medicare Cover DBT Therapy?
The short answer is yes. Medicare will cover the cost of DBT therapy. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your DBT therapy. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for DBT therapy. Parts A and/or B provide coverage for your DBT therapy if it is considered medically necessary. The treatment must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
Original Medicare provides coverage for certain mental health therapy including DBT therapy as long as the service is provided by a licensed psychiatrist, clinical psychologist, or other mental health professionals who accept Medicare assignment.
DBT therapy is a type of psychotherapy. It is usually for patients suffering from PTSD, suicidal thoughts, and certain personality disorders.
Original Medicare also provides other psychotherapy mental health services including:
- Family counseling
- Group psychotherapy
- Individual psychotherapy
- Psychiatric evaluation
- Partial hospitalization
- Medication management
- Annual depression screenings
- Alcohol and substance abuse therapy
Coverage for DBT is provided by Medicare Part A if it takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days. After that, you will have a considerable co-pay for each day you are in the hospital.
On the other hand, Medicare Part B provides coverage for mental health services that take place in an outpatient setting. DBT therapy is usually an outpatient procedure.
Medicare Part B also has a program called yearly wellness visits which includes depression screenings. Medicare Part B covers 100 percent of the costs of yearly wellness visits if your healthcare provider accepts Medicare assignment.
Part C and Part D Coverage for DBT Therapy
Medicare Advantage plans (Medicare Part C) also provide coverage for DBT therapy. They cover everything Original Medicare covers (in fact, they have to by law). But they also offer additional coverage for things Original Medicare does not. What is covered under a Part C plan will vary depending on the plan you sign up for.
Medicare Part C plans that include prescription drug plans will also provide coverage for medications that your healthcare provider will prescribe to you such as antidepressants. Medicare Part D plans also provide coverage for mental health medications.
How Much Does DBT Therapy Cost?
An DBT therapy can cost from $150 to $300 per week if you have to pay for it yourself. This cost depends on the provider.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare Cover Deviated Septum Surgery?