Does Medicare cover psychologist visits?

Ellene asked...

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

Expert Answer

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.