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Does Medicare cover psychologist visits?

4 answers | Last updated: Aug 12, 2014
Q
Ellene asked...
Does Medicare cover psychologist visits? How does seeing a psychologist and Medicare coverage work?
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Answers
Caring.com User - Joseph L.  Matthews
Caring.com Expert
A
Joseph L. Matthews is a Caring.com Expert, an attorney, and the author of Long-Term Care: How to Plan & Pay for It and...
79% helpful
answered...

Yes, it can, but only under certain circumstances, and only for part of the cost. If you are enrolled in Medicare Part B, it can partially cover diagnosis and See also:
Will Medicaid or Medicare pay for indigent health care?
treatment by a psychiatrist, clinical psychologist, clinical social worker or other licensed mental health care practitioner. Approved visits may be in an outpatient mental health clinic, hospital outpatient clinic, adult day care center, or private office. The practitioner must participate in Medicare, meaning that Medicare has approved that practitioner for payment and the practitioner accepts Medicare patients.

Usually, Medicare won't pay for a psychologist's services unless you are referred for psychological care by your doctor. If you go to a psychologist without a doctor's referral, you run a much higher risk that Medicare won't cover your treatment. If Medicare Part B approves your care, it can help pay for:

  • Psychiatric or psychological evaluation, both initial and ongoing
  • Diagnostic testing, including laboratory work
  • Individual and group therapy with Medicare-approved practitioners

Medicare Part B doesn't pay the full cost of this care. First, you have to pay the yearly Medicare Part B deductible ($135) if you haven't already done so. Then, you have to pay what's called the Part B coinsurance amount. For diagnosis, monitoring, and treatment by your doctor, this coinsurance is 20 percent of the amount Medicare approves for that service. For treatment by a psychologist, however, this coinsurance goes way up. For treatment at a psychologist's office or outpatient clinic, you may have to pay 40-50 percent of the Medicare-approved amount. If you have a Medigap supplemental insurance policy, check to see whether it includes coverage of mental health care. If so, it might pay some of this coinsurance amount.

Finally, psychological care often involves taking prescription medication. If so, the drugs may be partly covered by your Medicare Part D prescription drug plan, if you have one.

For more information about Medicare coverage of care by a psychologist, look at Medicare's booklet Medicare and Your Mental Health Benefits.

 

More Answers
50% helpful
ethicaldoc answered...

Our clinic accepts Medicare as full payment if they have a co-Medicare insurance. Medicare pay about the same as other health insurances pay. Other providers of psychological service frequently have the same experience. Medicare has never refused to pay any bill we have submitted in 11 years. If patients are over 66 years old their Medi-gap coverage is set by the federal government and costs are the same. People under 65 who are disabled and have Medicare have higher rates for all services not just psychological services.Medicare patients should be encouraged to seek psychological help from a licensed psychologist who have longer training than many other mental health professionals. Most of the time they have no copays and are allowed significant time for treatment if that is required.

 

20% helpful
Sharon1964 answered...

Both of the answers above contain errors. Regular Medicare NEVER requires a referral for a patient to be covered to see a psychologist, UNLESS the patient is in the hospital.

Making a statement that "our clinic accepts Medicare as full payment" is frowned upon as it could be fraudulent. Patients may have no out-of-pocket costs IF their secondary insurance covers their portion.

 

100% helpful
kenh91 answered...

FRAUD. Here's how innocent psychologists get into trouble: they bill Medicare for the regular Medicare rate, Medicare pays 50% of that rate, and the psychologist, feeling sympathy for the patient, accepts that as payment in full. Medicare then charges him with fraud, on the basis that he billed Medicare for what was not actually his true rate, i.e. they argue that his true rate is that 50%. So, if they have paid him $50, and he accepts it, they say that that is his true rate; they say it was fraud to bill more, and they make him refund half the payments to Medicare. This kind of "fraud" charge is the reason many psychologists do not become Medicare providers.

 

 
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