Does Medicare Cover Grief Counseling
by Danielle Kunkle Roberts
Grief is a normal part of life that most people experience. The loss of a loved one is the most common cause of grief. For older adults, losing a loved one, such as a spouse, causes many health issues, such as depression, insomnia, anxiety, and more.
According to the National Institute of Health, the widowhood effect is when the surviving spouse passes away within the first three months of grieving the loss of a spouse. People often refer to this as dying from a broken heart.
The Centers for Medicare and Medicaid Services recognizes the effects grief can have on its beneficiaries. Therefore, Medicare does offer some covered options for grief counseling.
Mental health services Medicare covers
Grief counseling is a form of psychotherapy used to help someone cope with the loss of a loved one. Because mental health services are provided by a doctor or other licensed medical professional, Part B provides coverage for these services.
Mental health services covered by Part B are as follows:
- Psychotherapy in an individual or group setting
- Psychiatric evaluations
- Family counseling if medically necessary
- An annual depression screening
- Diagnostic tests
- Medicare prescription drug management
Part B covers psychotherapy and other mental health services as long as they are medically necessary. Medicare sometimes covers grief counseling for family members of beneficiaries who are on hospice as well.
Rules for coverage
Medicare has rules and requirements for covered services. Medicare requires specific medical professionals to provide grief counseling and other mental health services. Medicare allows the following medical professional to provide mental health services:
- Clinical nurse specialists
- Clinical psychologists
- Clinical social workers
- Nurse practitioners
- Physician assistants
Medicare also requires the medical professional to accept Medicare assignment for mental health visits to be covered. If the provider doesn’t accept Medicare assignment, the visit won’t be covered. Accepting Medicare assignment means the provider agrees to charge no more than Medicare’s approved price for the service.
Medicare covers mental health services provided in a:
- Community mental health center
- Doctor’s office
- Hospital outpatient department
Medicare’s costs for mental health services
Each part of Medicare has its form of cost-sharing. Medicare Part B has an 80/20 split as well as an annual deductible. As of 2019, the Part B annual deductible is $185. Once the deductible is met, the 80/20 split kicks in. The patient pays 20% of the bill, while Part B pays 80%.
For example, if a grief counseling session costs $200, the patient owes $185 to meet the deductible. The remainder is split by the patient and Part B. For the next session, Part B pays $160, while the patient pays $40.
If you have already met your deductible on another outpatient service earlier in the year, then the counseling service will be covered at 80%.
If the service is provided in a hospital outpatient department, there may be a copay as well.
Help with costs
Medicare beneficiaries can enroll in a Medigap plan or Medicare Advantage plan. Medigap plans pick up all or some of the cost-sharing expenses Medicare leaves for the patient to pay. With Medigap Plan G, the patient in the scenario above would only be responsible for the $185 deductible. Medicare pays 80% and Plan G covers the 20% coinsurance Part B requires beneficiaries to pay.
Medicare Advantage plans pay instead of Original Medicare (Part A and Part B). With a Medicare Advantage plan, the cost-sharing is unique to each plan. Some Medicare Advantage plans include additional mental health services otherwise not covered by Medicare.
Both Medigap plans and Medicare Advantage plans can lower out-of-pocket costs for mental health services.
While grieving is a normal part of life, severe grief has repercussions. After the loss of a loved one, reach out to a doctor or other medical professional for grief counseling. Grief counseling provides the necessary treatment to get back to normal life.
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