Depression Screenings and Medicare
This article was updated on: 10/16/2017
One of the preventive care services covered by Medicare is an annual depression screening. According to the Centers for Medicaid and Medicare Services (CMS), one in six people over the age of 65 suffers from depression. As a Medicare beneficiary, remember that caring for your mental health is just as important as caring for your physical health.
If you’ve been showing symptoms of depression and aren’t used to people talking openly about mental health, you may feel ashamed or embarrassed about getting help. It may help to think of depression the way you would think of any other health condition. Just like you wouldn’t think twice about seeking medical attention for diabetes or a broken hip, getting treatment for depression can help you feel better in the long run. Talking to a doctor will help you get on the right track to caring for your mental health.
Here’s more information about this important screening and what Medicare covers for the depression screening.
How does the Medicare depression screening benefit work?
If you have Medicare coverage, you’re covered for one annual depression screening per year. This is covered through Medicare Part B, which covers outpatient medical and mental health services.
Medicare covers a “Welcome to Medicare” preventive care exam for new enrollees and an annual “Wellness” visit after your first year as a Medicare beneficiary. During your initial “Welcome to Medicare” visit, your doctor should review your risk for depression and refer you for follow-up care if needed. After your first visit, your annual preventive care visits may be a good time to ask your doctor about being screened for depression.
If you are concerned that you may be showing signs of depression, you can also schedule a depression screening outside of your annual “Wellness” check-ups; just make sure to get the screening done in a primary care setting and with a doctor that accepts assignment (see below for more information on costs).
During the screening, your primary care doctor may use a tool called the patient health questionnaire to assess your mental health. The questionnaire may ask you to describe how frequently during the past two weeks you’ve felt sad or hopeless, or whether you’ve become less interested in doing things you used to enjoy. The questions may feel personal, but it’s important to answer these questions honestly so your health-care team can accurately determine how to help you and whether treatment is needed.
Typically, the questionnaire should only take a few minutes to fill out. Afterwards, your doctor or another clinician in the primary care practice will assess your responses and then discuss follow-up care with you, if needed. If your responses suggest you could benefit from treatment for depression, your doctor may refer you to a mental health specialist.
Your doctor or other health-care provider may recommend additional treatment following your depression screening. It is important that you ask questions so you understand why a particular service is being recommended and what your costs may be. Remember, your doctor may sometimes recommend services that go beyond what Medicare covers.
How much does the Medicare depression screening cost?
The depression screening is offered at no cost to you as long as your doctor or health-care provider accepts Medicare assignment, meaning that he or she agrees to accept the amount Medicare pays for the service as full payment.
In addition, as mentioned, you’ll need to get the screening in a primary care environment, such as a clinic or doctor’s office, in order to be covered. Primary care doctors and nurses routinely provide a wide range of primary care services, including depression screenings and preliminary physical and mental health assessments. If you’re diagnosed with depression, they can make referrals, if necessary, to doctors and counselors who are qualified to work with you to treat depression.
Make sure to follow these rules for coverage, or you could end up with unexpected costs for this screening.
Do Medicare Advantage plans cover depression screenings?
Depression screenings are also covered under Medicare Advantage (Medicare Part C). Medicare Advantage plans are offered by Medicare-approved private insurance companies and must provide at least the same amount as coverage as Part A and Part B. So if you’ve opted to get your Medicare benefits through a Medicare Advantage plan, annual depression screenings are also covered. Check with your specific Medicare Advantage plan for details and whether you need to use certain providers. Some types of plans, such as HMOs, may require you to use in-network providers to be covered.
Does Medicare offer coverage for other mental health services?
Medicare covers other mental health services, in addition to yearly depression screenings. Mental health coverage is available under Part A (inpatient hospital care) and Part B (outpatient services).
Medicare Part A covers mental health-care services in an inpatient hospital setting if you are admitted to a general hospital or a psychiatric hospital that accepts Medicare assignment. For psychiatric hospital stays, Part A pays for no more than 190 days of care during your lifetime. After you’ve reached your deductible, you’re responsible for a coinsurance for each day of each benefit period; the coinsurance amount may change depending on the length of your hospital stay. You may also owe a 20% coinsurance for mental health services you get while as an inpatient, and the Part B deductible applies.
Medicare Part B covers outpatient mental care from a psychiatrist or other mental health-care provider who accepts Medicare assignment. Covered services are usually provided outside a hospital, such as at a doctor’s office, clinic, or a hospital’s outpatient mental health department. You typically owe 20% of the Medicare-approved amount for outpatient mental health services, after meeting the Part B deductible.
Part B coverage of mental health services includes:
- Mental health counseling or psychotherapy
- Family counseling when the main goal is to help with your treatment
- Psychiatric assessments
- Diagnostic exams
- Help with managing your prescription drugs
- Partial hospitalization
If medically necessary, Medicare Part D prescription drug coverage may help pay for the cost of medications used in the treatment of depression. Medicare-approved private insurance companies provide Medicare Part D prescription drug coverage through either a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.
As mentioned, you may be responsible for paying applicable Medicare deductibles and coinsurance or copayments for covered mental health services.
How can I get more information on Medicare preventive screenings?
As mentioned, Medicare Part B and Medicare Advantage cover a variety of annual preventive services. Many Medicare Advantage plans also offer additional benefits to keep you healthy, including routine vision or dental benefits, wellness programs, and more. If you’re worried about paying for your health-care costs, a Medicare Supplement plan may help with certain out-of-pocket costs in Original Medicare, including deductibles, copayments, or coinsurance.
If you’d like to discuss Medicare’s preventive services or your Medicare coverage options, please feel free to contact me. You can use the links below to schedule a phone appointment or get an email with personalized information. If you want to look at Medicare plan options right now, click the Compare Plans button to get started. Feel free to call and speak with a licensed insurance agent with your questions at 1-844-847-2660, or 711 for TTY users; Monday through Friday, 8AM to 8PM ET.
For resources on Medicare’s coverage of depression screenings, see:
Medicare.gov, “Depression screenings,” https://www.medicare.gov/coverage/depression-screenings.html
Medicare.gov, “Medicare & Your Mental Health Benefits,” https://www.medicare.gov/Pubs/pdf/10184-Medicare-Mental-Health-Bene.pdf
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