What Seniors Need to Know About Medicare and Mental Health

For seniors who are on Original Medicare, chances are high that you’re familiar with the basics of what Medicare covers. However, did you know mental health is included in your coverage? This is great news when you consider the fact that so many seniors are underdiagnosed. Why? According to U.S. News & World Report, “Many older adults and their family members may incorrectly believe that depression is normal with aging.” However, this isn’t true.


If you’re dealing with a mental health issue, therapist Sophie L. Robinson-Matthews wants to help you learn to put your Medicare coverage to good use.

What Are Some Common Senior Mental Health Disorders?

The most common mental health disorders in seniors are anxiety and depression, and they are often co-occurring. Keep in mind that anxiety isn’t a single diagnosis; in fact, it comes in many forms including generalized anxiety disorder (GAD), social phobias, panic disorder, as well as PTSD. While PTSD might often be associated with those who have served in the military, it can happen to anyone — especially seniors — whether it is the result of past combat or other traumatic events such as the loss of a spouse or child; medical issues that resulted in hospitalizations such as a fall, stroke, or heart attack; or a car accident.


The bottom line is that mental health isn’t just one disorder, and no matter what you may hear to the contrary, declining mental health is in no way a natural or normal part of the natural aging process.

So What Does Medicare Cover?

When it comes to mental health, you have a good bit of coverage. Medicare Part A covers inpatient mental health (room, food, therapy, testing, medication), while Part B covers outpatient mental health received by a psychiatrist, psychologist, social worker, or nurse practitioner. Part B also covers one depression screening per year, as well as psychiatric evaluations, medication management, individual and group psychotherapy, family counseling, and even testing to determine if the services and treatment you are receiving are helping.

A Medicare Advantage plan expands your coverage and may even offer additional benefits. For example, Medicare Advantage plans cover counseling and therapy services too since they are required to cover at least the minimum of what you would receive with Original Medicare (Part A and B). In addition, Medicare Advantage plans give you additional benefits including prescription coverage as well as dental, hearing, and vision.

How Do You Find a Provider That Accepts Medicare?

The easiest way to find a doctor that accepts Medicare is by using the Physician Compare tool offered by Medicare.gov. There you can easily search for nearby doctors and filter by specialty, condition, or body part to quickly find a doctor who provides the mental health services you need. So, what are your options if you find a doctor you like and they don’t accept Medicare? According to Investopedia, “your doctor may take Medicare patients but doesn’t agree to the program’s reimbursement rates,” meaning they can still see you but you’ll have to pay the difference that results from the fees and reimbursement.

If you’re an established patient, you may be able to get a discount. Talk with your provider and let them know that you’d prefer to stay with them. Your doctor may be what’s called an “opt-out provider,” meaning they will see Medicare patients but want to be paid their regular (full) fee. Your doctor may be willing, however, to lower the price for you. If not, you can ask for a referral to a doctor who does accept Medicare.

Medicare is a helpful tool to have in your healthcare arsenal. It not only covers your traditional health needs, but mental health is covered too. However, it only works if you seek the help you need. Talk with your primary care doctor about any concerns you have so that you can be pointed in the direction of the right mental health tools and resources.


For more information on counseling and therapy services through Sophie Wild Robin, please don’t hesitate to reach out today!


By Sheila Olson

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