Does Medicare Cover Psychiatric Hospitalization?

Mental health hospitalization is just as crucial as other inpatient services. Inpatient mental health facilities have helped many people experiencing personal problems and mental illnesses.

If you or a loved one could benefit from help like this, you probably have the question, “does Medicare cover psychiatric hospitalization”?

This is a common question many people have. And below, you’ll find the answer this question in clear, plain English.

Does Medicare Cover Psychiatric Hospitalization?

The short answer is yes; Medicare will cover the cost of psychiatric hospitalization. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your psychiatric hospitalization. Below we look at what these are so you know what to expect.

Original Medicare Coverage of Psychiatric Hospitalization

Original Medicare (Medicare Part A and Part B) provides coverage for psychiatric hospitalization. Such inpatient mental health services are covered if it is considered medically necessary.

Coverage is provided for mental health therapy as long as the service is provided by a licensed psychiatrist, clinical psychologist, or other mental health professionals who accept Medicare assignments.

Examples of Essential Mental Health Services

So what are some common essential mental health services? Below we list a few common ones, that you can expect Medicare to cover:

Family counseling
Group psychotherapy
Individual psychotherapy
Lab tests
Psychiatric evaluation
Partial hospitalization
Medication management
Annual depression screenings
Alcohol and substance abuse therapy

When is Coverage Provided by Part A?

Mental health services are covered by Medicare Part A if it takes place in an inpatient setting. So, psychiatric hospitalization falls under Part A, rather than Part B.

Coverage for mental health is provided by Medicare Part A if your mental health takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.

Starting from the 61st day up to 90 days, Medicare Part A will still provide coverage. However, you will pay a copayment each day you are hospitalized. After 90 days, Medicare Part A will no longer provide coverage.

Medicare Part A, however, does provides 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days, but you will have to cover a copayment.

Medicare Advantage Coverage of Psychiatric Hospitalization

Medicare Advantage plans (Medicare Part C) also provide coverage for psychiatric hospitalization. They must cover everything Original Medicare covers, though they will offer additional benefits.

Exactly what Plan C covers and how much the out-of-pocket costs will vary depending on the plan you sign up for.

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.

Commonly, it is Medicare Part D plans that provide coverage for mental health medications such as antidepressants. And these are provided by private insurance companies.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.