When you’ve experienced a loss and are feeling many emotions, the last thing you want to do is verify whether your insurance will cover grief counseling. Grief counseling can be just what you need to help you recover from a traumatic loss.
Medicare covers several mental health services, including grief counseling. Medicare covers things like individual and group psychotherapy, family counseling, psychiatric evaluations, partial hospitalization, annual depression screenings, and medication management.
However, Medicare covers each service slightly different. Be sure to read on to learn which part of Medicare covers mental health services and the costs you can expect to pay.
Which part of Medicare covers grief counseling?
There are two main parts of Medicare you receive your coverage from – Part A and Part B. Part A covers inpatient type services, such as inpatient stays in hospitals and skilled nursing facilities, meals while admitted, and some medications administered to you while admitted.
Part B covers the bulk of your medical services. Part B covers outpatient type services, such as doctor visits, mental health services, therapy, durable medical equipment, lab work, and x-rays.
Hospital status (inpatient versus outpatient) is a tricky thing to understand when it comes to Medicare. If your therapist recommends partial hospitalization as part of your treatment, you’ll live at home while commuting to the hospital for treatment.
In this scenario, because you are never considered an inpatient, Part A doesn’t cover any of your treatment. Even though you’re receiving treatment at a hospital, Part B is in charge of your coverage because you’re receiving treatment on an outpatient basis.
Generally, grief counseling is an outpatient service. Therefore, Part B is in charge of coverage. As long as the counseling is medically necessary, Part B will cover it for as long as you need it.
Part B also covers some preventive services, such as depression screenings and wellness checks. You can receive a depression screening once every year at no charge to you. You can also get a wellness check once a year that includes an evaluation of your risk for depression. These visits are covered at 100% as long as you see a doctor who accepts Medicare assignment.
Medicare’s Requirements for Grief Counseling
Mental health services, including grief counseling, have a few requirements you must follow for Medicare to cover them. First, only certain types of medical professionals can administer your counseling. Medicare covers mental health services with the following type of professionals:
- Physician assistants
- Nurse practitioners
- Nurse specialists
- Social workers
When deciding which type of provider you want to seek counseling from, be sure to choose one who accepts Medicare assignment. Medicare only covers mental health services performed by professionals who accept Medicare assignment.
What is Medicare assignment?
There is a maximum price that Medicare will pay for any service, also called the Medicare assignment rate. When a doctor accepts Medicare assignment, they agree to accept Medicare’s rate as the full cost for the service they provide.
If a doctor accepts Medicare but doesn’t accept Medicare assignment, they can charge you, the patient, up to 15% more than Medicare’s approved rate.
Always ask doctors if they accept Medicare first. Then ask them if they accept Medicare assignment.
Other Requirements for Grief Counseling
In addition to provider requirements, Medicare requires you to receive your counseling in particular settings. Part B covers grief counseling in a provider’s office, an outpatient department in a hospital, and a community mental health center.
What does grief counseling cost under Medicare?
The federal government regulates Medicare costs. Premiums and deductibles are adjusted each year to account for inflation and other factors. Most Americans earn premium-free Part A by working and paying Medicare taxes. However, Part B costs $135.50 per month for most beneficiaries.
Like most other insurance programs, Part A and Part B have deductibles you must meet before the insurance pays anything. Part A’s deductible is per benefit period, while Part B’s deductible is per year.
Part A deductible
A benefit period starts the first day you are considered an inpatient. As soon as you are an inpatient, you owe the Part A deductible of $1,364 (in 2019). The benefit period ends once you have stayed out of the hospital for 60 consecutive days.
For example, if you’re admitted to a hospital or mental health facility and stay for 14 days, your deductible is still in effect for the next 60 days. If you are admitted back into the hospital within those 60 days for the same reason, you won’t owe the deductible again. However, if you go 60 days without being readmitted to the hospital, you’ll owe the deductible again.
Part B Deductible and Coinsurance
The Part B deductible is much smaller and is only paid once per year. The Part B deductible is $185 as of 2019.
Once you have your first Part B service of the year, you’ll owe $185, and Part B will cover 80% of the remaining bill. You’ll also owe the remaining 20%, which is called your coinsurance.
Never pay your deductible upfront. The provider should first bill Medicare. Medicare will see you still owe your Part B deductible and will subtract that from the total bill. Part B will pay 80% of whatever is left over after the deductible. Medicare will return the bill to the provider, showing you owe the $185 deductible plus the 20% coinsurance.
Let’s say your first Part B service of the year is a grief counseling session that costs $200. You owe $185 for your deductible plus $3 (your 20% coinsurance). Part B will pay the other $12. However, for your next grief counseling session, Medicare will immediately pay $160, leaving you with only $40 to pay.
Medicare Supplement Plans that Cover Grief Counseling Costs
Medicare Supplement (Medigap) plans pay after Medicare and cover Part A and Part B costs, such as deductibles and coinsurance. There are 10 different plans to choose from.
Medigap Plan B, C, D, F, and G all cover the Part A deductible and coinsurance, as well as the Part B coinsurance at 100%.
So for example, if you enroll in Plan G, you would pay the Part B deductible once per year but nothing thereafter. Plan G would pick up all of the the Part B coinsurance, so you would pay nothing for your counseling.
You still have to pay your Part B premium when you have a Medigap plan. Therefore, you’ll have your Part B premium and a Medigap premium. Medigap premiums can be $100/month or more depending on where you live and the cost of healthcare in that area. If a Medigap plan doesn’t fit your monthly budget, consider a Medicare Advantage plan instead.
Medicare Advantage plans
Medicare Advantage plans are private insurance plans that fall under Part C of Medicare. You must be enrolled in both Medicare Parts A and B to enrol in either a Medigap plan or a Medicare Advantage plan.
However, because Medicare Advantage plan premiums are usually inexpensive, they’re easier to afford each month.
On the other hand, you tend to have more costs on the back end with Medicare Advantage plans than you do with Medigap plans. You will owe a copay or coinsurance each time you receive a covered service. However, having a Medicare Advantage plan is usually more cost-effective than having just Original Medicare (Part A and Part B).
This is because Medicare Advantage plans have out-of-pocket maximums, whereas Original Medicare does not. There is no cap to how much you can spend out-of-pocket with just Original Medicare. With a Medicare Advantage plan, you will never pay more than $6,700 (in 2019) on deductibles, copays, or coinsurance for medical services.
Prepare for Grief Counseling
If you’re dealing with grief and are looking into grief counseling, follow these steps:
- Research which Medicare covered mental health service fits your needs best.
- Research providers and clinics.
- Confirm how the provider participates in Medicare.
- Estimate your costs with your Medicare plan.
Follow these steps to create an easier process for getting the help you need. If you have your Medicare plan through Boomer Benefits and receive a bill from a provider that you’re unsure of, contact our client service team at 855-732-9055. Our client service team will help you figure out whether you owe the bill or not.