Everyone experiences grief at some point in life. In its deepest form, it’s related to the loss of someone you deeply loved. Grief can easily become so consuming; you need help to recover and go on living—you need a professional to help you manage your emotions.
Seniors are particularly susceptible to the effects of grief: Older people more frequently suffer the loss of a friend or family member. If that family member happens to be a spouse, grief can be all-consuming. If you’re weighed down by grief as the result of loss, Medicare can help. Medicare provides benefits for people dealing with grief; here’s what you need to know about Medicare and grief counseling.
Medicare coverage for mental health care
Mental health care and selective services are covered for Medicare beneficiaries under Part B. Medicare Part B provides coverage for outpatient services, including counseling and psychotherapy. Part B covers access to many mental health care services.
Yearly depression screening
Medicare beneficiaries are entitled to one annual depression screening at no cost with qualifying providers. These screenings can detect if you are at risk for depression or showing signs of the disorder. In order to be covered, the screening must be done in a primary care setting. You pay nothing out of pocket if the provider who screens you accepts Medicare assignment. If you see someone who doesn’t participate with Medicare, you may be on the hook for a lot of out-of-pocket expenses.
Medicare Part B also covers individual psychotherapy, including grief counseling. Part B even covers family counseling for family members if a loved one is under hospice care. Psychotherapy typically takes place on a one-to-one basis, but Medicare also covers group and individual therapy.
Medicare coverage rules
Medicare covers other mental health care services under Part B. Those services include diagnostic tests, psychiatric evaluations and prescription drug management. In order for Medicare to cover these services, the provider must be a nurse practitioner, clinical social worker, clinical psychologist, psychiatrist or physician assistant.
Medicare beneficiaries can receive these benefits in a hospital outpatient setting, mental health center, or a doctor’s office. Your provider must accept Medicare assignment.
As with other outpatient services, there is a 20% cost-sharing expense under Part B. However, the annual depression screening is covered at no cost to you under Part B.
Cost-sharing for mental health care services
In 2019, the Part B deductible is $185. Once this annual deductible is met, Part B will pay 80 percent of the bill – leaving the beneficiary responsible for paying 20 percent for each Part B covered service.
Fortunately, Medicare beneficiaries have the option to enroll in a Medicare Supplement plan (also known as a Medigap plan) to help cover cost-sharing expenses. Medigap plans A, B, C, D, F, G, M, and N all cover 100 percent of the 20 percent Part B coinsurance. However, Plan N beneficiaries may be required to pay up to a $20 copay for counseling sessions. Beneficiaries who are enrolled in a Medigap Plan G only pay the Part B deductible for covered mental health care services.
One common misconception is that the Part B premium is also covered when they enroll in a Medigap plan. Unfortunately, this isn’t true. When a beneficiary is enrolled in a Medigap plan, they are still required to pay the Part B premium. The Part B premium is $135.50 per month, as of 2019.
Grief counseling and other mental health care services are covered by Medicare depending on the service and setting where the service is received. If you or a loved one is seeking help or guidance in finding the right Medigap plan, contact a professional such as a Medicare insurance broker.
Written by: Danielle Kunkle Roberts, founding partner and senior executive at Boomer Benefits