Medicare covers both inpatient mental health care and substance abuse treatment under Medicare Part A, as well as outpatient services under Medicare Part B.
While the majority of physicians (both primary care physicians and specialists) report that they take new Medicare patients in their practices, psychiatrists are less likely than other specialists to accept new patients, whether covered by Medicare or private insurance.
According to a Kaiser Family Foundation analysis, 60% of psychiatrists are accepting new Medicare patients, which is 21 percentage points lower than the share of physicians in general/family practice accepting new patients (81%). In addition, the wait for new patient appointments can be several weeks to several months long.
Psychiatrists are also more likely than other specialists to “opt-out” of Medicare altogether. The relatively high rate of psychiatrists not taking new Medicare patients, combined with high opt-out rates, has posed accessibility issues for Medicare beneficiaries who need mental health services.
For individuals transitioning to Medicare from individual or employer-based coverage where their mental health providers participated with their pre-Medicare plan, confirming provider participation status with Medicare before the transition is recommended to ensure the continuation of care. Establishing a new relationship can support a smooth transition if a provider change is necessary to optimize Medicare benefits.
To explore provider participation with Medicare, follow these steps:
- Go to www.medicare.gov/care-compare.
- Click on "find doctors & clinicians."
- Enter your zip code and search for a specific provider name. If the provider’s name is returned it will advise on their Medicare participation status. If no name is returned this means the provider doesn’t participate in Medicare.
When a provider doesn’t participate in Medicare, they cannot bill Medicare. Therefore, you will be responsible for the full amount if you still choose to go to that provider. Some individuals prefer to remain with their current provider and negotiate payment arrangements directly. If you itemize your taxes, these expenses are deductible as unreimbursed medical expenses. Be sure to log these on your planner.caribouadvisors.com portal.
Medicare does not have limits on outpatient mental health visits, and covers mental healthcare at 80% — just as it does for other healthcare services. If you have a Medicare supplemental plan and the provider participates with Medicare, your supplemental plan will pick up the remaining 20%. If you have a Medicare Advantage plan, your visits may be subject to copays or coinsurance up to your out-of-pocket maximum.
Medicare has made some permanent changes to telehealth coverage related to mental health services, which has made mental health services more accessible for many individuals. Medicare has permanently removed geographic restrictions for telehealth mental health services and allows beneficiaries to receive those services at home.
Many mental health providers offer telehealth visits to established patients; Caribou does not endorse particular providers, but one national telehealth provider, Talkiatry, notes that they participate with Original Medicare. Many Medicare Advantage plans also offer telehealth services with in-network providers.
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Last updated on February 21st, 2023
