The Mental Health Parity and Addiction Equity Act is a federal statute that requires health insurance plans to provide coverage for mental health and substance use disorder treatment that is comparable to coverage for physical health and surgical services. State Medicare programs must follow this statute, which has requirements that apply to copayments, visit limits, and medical necessity criteria.
Medicare Part B does cover certain telehealth services, though this will depend on your specific plan. The Medicare Advantage plan and the Medicare Platinum plan both offer telehealth coverage for a variety of services, including mental health specialty services, psychiatric services and outpatient substance abuse services.
It depends. For instance, the Medicare Platinum plan and Medicare Advantage plan require preauthorization for inpatient opioid treatment program services and inpatient mental health services. Check your benefits summary to learn about any required preauthorizations.
No, as long as your provider certifies that the services are medically necessary for your condition, there is no limit on the number of mental health visits or therapy sessions covered per year. Inpatient mental health services coverage may be limited depending on your plan.
Typically, Medicare does not cover services from out-of-network providers except for in emergency or urgent care situations. To find a provider whose services are covered by your plan, use our Find A Doctor tool.
Psychologists, therapists and counselors typically cannot prescribe medication. If you or your therapist believes you need mental health medication, you’ll have to arrange an appointment with your primary care provider or a psychiatrist. Primary care providers often handle medications for diagnoses like anxiety and depression If you have more complicated or severe conditions, they may refer you to a psychiatric office. There, psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants can all diagnose, treat and prescribe medications for mental health conditions.
First, check your insurance plan to determine if a referral is required. If you do need one, you’ll have to meet with your primary care doctor. You’ll discuss your symptoms and concerns with them and ask them to provide you with a referral for a specialist.