Will Medicare cover Grief Counseling?
by Danielle K. Roberts
Grief stems from experiencing a loss. People experience grief after a loved one passes away, when they lose a job, or even after they sell their first home. Some experts say there are four stages of grief: Separation distress, traumatic distress, guilt, and social withdrawal.
Many people set up grief counseling to help them cope with a loss. Grief counselors walk their patients through each stage of grief and help them learn how to overcome them. Grief counseling allows the patient to be able to mourn the loss of a loved one in a healthy and stable manner.
Older adults who experience the loss of a spouse or other traumatic event can get the care they need with Medicare. Medicare covers several forms of mental health care services, including grief counseling. Beneficiaries need to make sure they follow Medicare’s guidelines for coverage, though.
What Medicare covers for mental health care
Medicare covers mental health care services under Part B. Part B is the designated part of Medicare for outpatient doctor services. Part B beneficiaries have access to several mental health care services.
Psychotherapy
Part B covers individual psychotherapy for those who need it. Grief counseling consists mainly of this type of therapy. Beneficiaries also get the option of therapy in a group setting. Part B even covers family counseling for family members of a beneficiary who is in hospice care to help them prepare for the loss of their loved one.
Rules for coverage
Other services Part B covers include psychiatric evaluations, diagnostic tests, and drug management. Medicare requires these services to be performed by one of the following medical professionals: clinical nurse specialists, clinical psychologists, clinical social workers, nurse practitioners, physician assistants, and psychiatrists.
Beneficiaries can receive these benefits in a mental health center, doctor’s office, or hospital outpatient setting. Medicare also requires beneficiaries to use medical professionals who accept Medicare assignment in order for their services to be covered.
Each of these services has cost-sharing expenses you pay out-of-pocket. However, there is one mental health care service that Part B covers at 100%.
Annual depression screening
Once a year, Part B covers a depression screening. The screening is to detect whether or not the beneficiary is as a risk for depression. The screening must be done in a primary care setting. Also, beneficiaries should get their depression screenings done by doctors who accept Medicare assignment to get 100% coverage.
Cost-sharing for mental health care services
When beneficiaries access Part B services, an annual deductible is usually applied. Currently, the Part B deductible is $185. Once this is met, Part B pays 80% of the bill, and the beneficiary pays 20% for each Part B covered service.
Medicare beneficiaries have the choice to enroll in a Medigap plan to help cover cost-sharing expenses. Medigap plans A, B, C, D, F, G, and M all cover 100% of the 20% Part B coinsurance. Another plan that covers the Part B coinsurance is Plan N.
However, beneficiaries with Plan N may have an up to $20 copay for counseling sessions. Beneficiaries who are enrolled in a Medicare Supplement Plan G only pay the Part B deductible for covered mental health care services.
One misconception among Medicare beneficiaries is the Part B premium is also covered when they enroll in a Medigap plan. This isn’t true. When a beneficiary is enrolled in a Medigap plan, he is still required to pay the Part B premium. As of 2019, the Part B premium is $135.50 per month.
Medicare offers substantial coverage for grief counseling and other mental health care services. With the right Medigap plan, beneficiaries can experience little to no out-of-pocket costs.
Danielle Kunkle Roberts is a founding partner at Boomer Benefits and a Medicare Supplement Accredited Advisor. She and her team help thousands of baby boomers learn the ropes regarding Medicare every year.
