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Does Medicare Cover Home Health Care for Mental Health Conditions?
Date Updated: December 13, 2024
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Ashlee Shefer is a freelance copywriter, content writer, and digital marketer who specializes in senior care, mental health, health care, and other wellness-related topics. She has one year of experience writing both short- and long-form content related to senior resources, assisted living, nursing homes, and home care, including blog posts, research-based articles, resource guides, product reviews, facility blurbs, finances, and care costs.
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Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.
Medicare covers home health care for mental health conditions if you require medically necessary part-time or intermittent skilled nursing or rehabilitative services. To qualify for Medicare's home health benefit, you must be homebound due to an illness or injury and require care for less than eight hours per day, 28 hours per week. However, certain Medicare plans cover additional mental health services, depending on your condition and needs.
How to Qualify for Medicare-Covered Home Health Care With a Mental Health Condition
Medicare covers home health care for mental health conditions if you need skilled nursing or rehabilitative care, such as:
- Physical, speech or occupational therapy
- Wound care
- Nutrition or intravenous therapy
- Medical social services
- Medical monitoring for a serious illness or an unstable health status
- Injections
Medicare doesn't cover full-time or 24-hour care, home meal delivery or personal care when it's the only service you need. Additionally, you must receive care through a Medicare-certified agency. If a doctor deems intermittent home health care necessary for your condition, your individualized care plan can include mental health services, such as medication management and monitoring of psychiatric symptoms. However, if you only need mental health care, other Medicare benefits better serve your needs.
What Mental Health Services Does Medicare Cover?
Medicare covers a range of mental health, substance use and prescription drug services, depending on your plan. Under Medicare Part A, coverage includes inpatient care at a general or psychiatric hospital as ordered by a doctor. Meanwhile, Medicare Part B expands access to care in inpatient, outpatient or partial hospitalization settings, offering more flexibility in living arrangements. Covered outpatient services include:
- Mental health screenings
- Individual and group therapy
- Family counseling
- Medication management
- Psychiatric evaluations
- Intensive outpatient programs
- Ongoing testing to confirm treatment success
- A yearly wellness visit with a doctor or other health care provider
Additionally, Medicare Part D offers prescription drug coverage, which includes medications for mental health conditions. Depending on the plan, you may need to pay a deductible, copay or coinsurance fees.