Does Medicare cover psychologist visits?

6 answers | Last updated: Nov 25, 2016
Ellene asked...

Does Medicare cover psychologist visits? How does seeing a psychologist and Medicare coverage work?

Expert Answers

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 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.

Community Answers

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.

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.

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.

J. m. poirier, ph.d. answered...

When a person is enrolled in Medicare B and elects to have treatment by a Medicare-approved Licensed Psychologist, a Physician's order is not required. The Psychologist can set his/her own fee for the particular service, but will be reimbursed by Medicare according to Medicare's fee schedule for the service performed (Medicare publishes a fee schedule each year). The Psychologist enrolled as a Medicare Provider must accept that reimbursement and may not bill the client any additional amount beyond the 20% co-pay and any residual deductible that has not been met for the year. The Psychologist may forgive the co-pay only if he/she does so for all other clients. The deductible amount, if any, may not be waived. When a client has supplemental coverage for mental health care, that insurance company pays the remaining 20 percent and the client owes nothing further. In most cases, Medicare does an automatic "courtesy" crossover to any supplemental insurer, making it unnecessary in most cases for the Psychologist to bill that insurer. If there is no secondary (supplemental) plan or the supplemental plan doesn't reimburse for mental health coverage, the remaining 20% may be billed to the client. Again, the Psychologist may elect not to bill the remaining portion, but must grant the same favor to all other Medicare clients.

Joh8754 answered...

I'm not up0to-date with the talk about Medicare B payments. What I can tell you about my own circumstances is that: (a) I go to my doctor to get a mental health plan - or reassessment of it - this is bulk billed under Medicare; (b) I don't get charged when I see my psychologist - she bulk bills the lot for me. I haven't paid to see my psychologist during the whole time I've seen her during the past four or five years.