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This official government booklet has information about mental
health benefits for people with Original Medicare, including:
Who’s eligible
Outpatient & inpatient benefits
Prescription drug coverage
Help for people with limited
income & resources
Where to get the help you need

The information in this booklet describes the Medicare program at the time this booklet was printed. Visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to get the most current information. TTY users can call 1-877-486-2048.
“Medicare & Your Mental Health Benefits” isn’t a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings.

Mental health care & Medicare
Mental health conditions, like depression or anxiety, can happen to
anyone at any time. If you think you may have problems that affect
your mental health, you can get help. Talk to your doctor or other
health care provider if you have:
■ Thoughts of ending your life (like a fixation on death or suicidal
thoughts or attempts)
■ Sad, empty, or hopeless feelings
■ Loss of self-worth (like worries about being a burden, feelings of
worthlessness, or self-loathing)
■ Social withdrawal and isolation (like you don’t want to be with
friends, engage in activities, or leave home)
■ Little interest in things you used to enjoy
■ A lack of energy
■ Trouble concentrating
■ Trouble sleeping (like difficulty falling asleep or staying asleep,
oversleeping, or daytime sleepiness)
■ Weight loss or loss of appetite
■ Increased use of alcohol or other drugs
Mental health care includes services and programs to help diagnose
and treat mental health conditions. These services and programs
may be provided in outpatient and inpatient settings. Medicare
helps cover outpatient and inpatient mental health care, as well as
prescription drugs you may need to treat a mental health condition.
This booklet gives you information about mental health
benefits in Original Medicare. If you get your Medicare benefits
through a Medicare Advantage Plan (like an HMO or PPO)
or other Medicare health plan, check your plan’s membership
materials, and call the plan for details about how to get your
Medicare-covered mental health benefits.

Medicare helps cover mental health services
Medicare Part A (Hospital Insurance) helps cover mental health
care if you’re a hospital inpatient. Part A covers your:
■■ Room
■■ Meals
■■ Nursing care
■■ Therapy or other treatment for your condition
■■ Lab tests
■■ Medications
■■ Other related services and supplies
Medicare Part B (Medical Insurance) helps cover mental health
services that you would get from a doctor and services that you
generally get outside of a hospital, like:
■■ Visits with a psychiatrist or other doctor
■■ Visits with a clinical psychologist or clinical social worker
■■ Lab tests ordered by your doctor
Part B may also pay for partial hospitalization services if you need
intensive coordinated outpatient care.
Medicare prescription drug coverage (Part D) helps cover drugs
you may need to treat a mental health condition.

Medicare may cover partial hospitalization
Part B covers partial hospitalization in some cases. Partial
hospitalization is a structured program of outpatient psychiatric
services provided to patients as an alternative to inpatient
psychiatric care. It’s more intense than the care you get in a doctor’s
or therapist’s office. This type of treatment is provided during the
day and doesn’t require an overnight stay.
Medicare helps cover partial hospitalization services when they’re
provided through a hospital outpatient department or community
mental health center. As part of your partial hospitalization
program, Medicare may cover occupational therapy that’s part of
your mental health treatment and/or individual patient training
and education about your condition.
For Medicare to cover a partial hospitalization program, you must
meet certain requirements, and your doctor must certify that you
would otherwise need inpatient treatment. Your doctor and the
partial hospitalization program must accept Medicare payment.
What you pay
You pay a percentage of the Medicare-approved amount for each
service you get from a doctor or certain other qualified mental
health professionals if your health care professional accepts
assignment. You also pay coinsurance for each day of partial
hospitalization services provided in a hospital outpatient setting or
community mental health center.
What Original Medicare doesn’t cover
■■ Meals.
■■ Transportation to or from mental health care services.
■■ Support groups that bring people together to talk and socialize.
(Note: This is different from group psychotherapy, which is
covered.)
■■ Testing or training for job skills that isn’t part of your mental
health treatment.
Section 1—Outpatient mental health care & professional services

What Original Medicare covers
Medicare Part A (Hospital Insurance) helps pay for mental health
services you get in a hospital that require you to be admitted as an
inpatient. You can get these services either in a general hospital
or in a psychiatric hospital that only cares for people with mental
health conditions. No matter which type of hospital you choose,
Part A will help cover inpatient mental health services.
If you’re in a psychiatric hospital (instead of a general hospital),
Part A only pays for up to 190 days of inpatient psychiatric
hospital services during your lifetime.
What you pay
Medicare measures your use of hospital services (including
services you get in a psychiatric hospital) in benefit periods.
A benefit period begins the day you’re admitted as an inpatient in
a general or psychiatric hospital. The benefit period ends after you
haven’t had any inpatient hospital care for 60 days in a row. If you
go into a hospital again after 60 days, a new benefit period begins,
and you must pay a new deductible for any inpatient hospital
services you get.
There’s no limit to the number of benefit periods you can have
when you get mental health care in a general hospital. You can
also have multiple benefit periods when you get care in a
psychiatric hospital, but there’s a lifetime limit of 190 days.
12 Section 2—Inpatient mental health care
As a hospital inpatient, you pay these amounts in 2017:
■■ $1,316 deductible for each benefit period
■■ Days 1–60: $0 coinsurance per day of each benefit period
■■ Days 61–90: $329 coinsurance per day of each benefit period
■■ Days 91 and beyond: $658 coinsurance per each “lifetime reserve day”
after day 90 for each benefit period (up to 60 days over your lifetime)
■■ Beyond lifetime reserve days: all costs
For the most up-to-date costs, visit Medicare.gov, and select “Costs at a
glance” under “Your Medicare Costs.”
Part B also helps cover mental health services provided by doctors and
other health care professionals if you’re admitted as a hospital inpatient.
You pay 20% of the Medicare-approved amount for these mental health
services while you’re a hospital inpatient.
Note: If you have a Medicare Supplement Insurance (Medigap) policy or
other health coverage, tell your doctor or other health care provider so
your bills get paid correctly.
What Original Medicare doesn’t cover
■■ Private duty nursing
■■ A phone or television in your room
■■ Personal items (like toothpaste, socks, or razors)
■■ A private room (unless medically necessary)
13
Words in red
are def ined on
pages 21–24.
Section 3: Medicare prescription
drug coverage (Part D)
To get Medicare prescription drug coverage, you must join a
Medicare Prescription Drug Plan. Medicare drug plans are run
by insurance companies and other private companies approved
by Medicare. Each Medicare drug plan can vary in cost and in the
specific drugs it covers. It’s important to know your plan’s coverage
rules and your rights.
Medicare drug plans have special rules
Will my plan cover the drugs I need?
Most Medicare drug plans have a list of drugs that the plan covers,
called a formulary. Medicare drug plans aren’t required to cover
all drugs, but they’re required to cover all (with limited exceptions)
antidepressant, anticonvulsant, and antipsychotic medications,
which you may need to keep you mentally healthy. Medicare
reviews each plan’s formulary to make sure it contains a wide
range of drugs and that it doesn’t discriminate against certain
groups (like people with disabilities or mental health conditions).
If you take prescription drugs for a mental health condition,
it’s important to find out whether a plan covers your drugs
before you enroll. Visit Medicare.gov/find-a-plan to find out
which plans cover your drugs.
Can my drug plan’s formulary change?
A Medicare drug plan can make some changes to its formulary
during the year within guidelines set by Medicare. If the change
involves a drug you’re currently taking, your plan must do one of
these:
■■ Provide written notice to you at least 60 days prior to the date
the change becomes effective.
■■ At the time you ask for a refill, provide written notice of the
change and a 60-day supply of the drug under the same plan
rules as before the change.
14 Section 3—Medicare prescription drug coverage (Part D)
What if my prescriber thinks I need a certain drug that my plan doesn’t cover?
If you belong to a Medicare drug plan, you have the right to ask for a
coverage determination (including an exception). You can appoint a
representative to help you. Your representative can be a family member,
friend, advocate, attorney, doctor, or someone else you trust who will act
on your behalf. You, your representative, or your doctor or other prescriber
must contact your plan to ask for a coverage determination.
More information about appeals
For more information on your appeal rights, how to file an appeal, and how
to appoint a representative to help you:
■■ Visit Medicare.gov/appeals.
■■ Visit Medicare.gov/publications to view or print the booklet “Medicare
Appeals.”
■■ Call 1-800-MEDICARE (1-800-633-4227). TTY users can call
1-877-486-2048.
Section 3—Medicare prescription drug coverage (Part D) 15
Learn more about Medicare prescription drug coverage
To find out more about Medicare prescription drug coverage:
■■ Visit Medicare.gov/part-d.
■■ Visit Medicare.gov/publications to view or print “Your Guide to
Medicare’s Prescription Drug Coverage.”
■■ Visit Medicare.gov/find-a-plan to find and compare plans in
your area. Have your Medicare card, a list of your drugs and
their dosages, and the name of the pharmacy you use available.
■■ Call 1-800-MEDICARE (1-800-633-4227). TTY users can call
1-877-486-2048.
■■ Call your State Health Insurance Assistance Program (SHIP)
to get personalized help. Visit shiptacenter.org, or call
1-800-MEDICARE to get the phone number.
16 Section 3—Medicare prescription drug coverage (Part D)
Notes
17
Words in red
are def ined on
pages 21–24.
Section 4: Get the help you need
Help if you have limited income & resources
Extra Help paying your Medicare prescription drug costs
If you meet certain income and resource limits, you may qualify
for Extra Help from Medicare to help pay the costs of Medicare
prescription drug coverage. You should apply even if you aren’t
sure if you qualify.
Visit socialsecurity.gov/i1020 to apply for Extra Help online.
For more information:
■■ Visit Medicare.gov, and select “Get help paying costs” under
“Your Medicare Costs.”
■■ Visit socialsecurity.gov, and select “Medicare” under “Benefits.”
■■ Call Social Security at 1-800-772-1213. TTY users can call
1-800-325-0778. You can apply for Extra Help by phone or ask
for a paper application.
■■ Contact your State Medical Assistance (Medicaid) office.
Visit Medicare.gov/contacts, or call 1-800-MEDICARE
(1-800-633-4227) to get the phone number. TTY users can call
1-877-486-2048.
18 Section 4—Get the help you need
State Pharmacy Assistance Programs (SPAPs)
Many states have SPAPs that help certain people pay for
prescription drugs. Each SPAP makes its own rules on how to help
its members. To find out if there’s an SPAP in your state and how it
works:
■■ Visit Medicare.gov/pharmaceutical-assistance-program/
state-programs.aspx.
■■ Call your State Health Insurance Assistance Program
(SHIP). Visit shiptacenter.org, or call 1-800-MEDICARE
(1-800-633-4227) to get the phone number. TTY users can call
1-877-486-2048.
Medicare Savings Programs
If you have limited income and resources, you may be able to get
help from your state to pay your Medicare costs (like premiums,
deductibles, and coinsurance) if you meet certain conditions.
For more information:
■■ Visit Medicare.gov, and select “Get help paying costs” under
“Your Medicare Costs.”
■■ Contact your State Medical Assistance (Medicaid) office, and ask
for information on Medicare Savings Programs. Call even if you
aren’t sure if you qualify. To get the phone number for your state,
visit Medicare.gov/contacts, or call 1-800-MEDICARE.
■■ Visit Medicare.gov/publications to view or print the brochure
“Get Help With Your Medicare Costs: Getting Started.”
■■ Call your State Health Insurance Assistance Program (SHIP).
Visit shiptacenter.org, or call 1-800-MEDICARE to get the phone
number.
Medicaid
Medicaid is a joint federal and state program that helps with
medical costs for some people with limited income and resources.
Medicaid also offers some benefits not normally covered by
Medicare, like custodial nursing home care and personal care
services. Each state has different rules about eligibility and applying
for Medicaid.
Section 4—Get the help you need 19
For more information:
■■ Visit Medicare.gov, and select “Get help paying costs” under “Your
Medicare Costs.”
■■ To see if you qualify, call your State Medical Assistance (Medicaid)
office. Visit Medicare.gov/contacts, or call 1-800-MEDICARE
(1-800-633-4227) to get the phone number. TTY users can call
1-877-486-2048.
■■ To learn about the Medicaid program, visit Medicare.gov/publications
to view or print the brochure “Medicaid: Getting Started.”
Your Medicare rights
No matter how you get Medicare, you generally have certain rights and
protections. All people with Medicare have the right to:
■■ Be treated with dignity and respect at all times.
■■ Be protected from discrimination.
■■ Have their personal and health information kept private.
■■ Get a decision about health care payment, coverage of services, or
prescription drug coverage.
To learn more about your Medicare rights:
■■ Visit Medicare.gov, and select “Your Medicare rights” under “Claims &
Appeals.”
■■ Visit Medicare.gov/publications to view or print the booklet
“Medicare Rights & Protections.”