Does Medicare Cover Counseling?

Original Medicare (Medicare Part A and Part B) does cover a wide range of qualified counseling services. Medicare coverage extends to certain counseling and therapy services that focus on either your physical or your mental health and well-being.

Medicare Advantage (Part C) plans can also cover counseling. Most Medicare Advantage plans also cover prescription drugs, which Original Medicare doesn't typically cover.

Man receives counseling from his therapist

Medicare covers several different types of counseling and therapy

Medicare coverage for counseling falls under Medicare Part B (medical insurance).

Your doctor may recommend services for you that are not covered by Medicare, or you may be recommended to receive counseling more frequently than Medicare covers. You may have to pay some or all of the costs if this happens.

Be sure to check with your doctor to confirm whether or not Medicare will pay for your recommended counseling.

The types of counseling services that are covered by Medicare can include the following.

Alcohol misuse

Medicare covers one alcohol misuse screening per year if you consume alcohol regularly but don’t meet the designated criteria for alcohol dependency. If your primary care doctor determines that you’re misusing alcohol, you can receive up to four face-to-face therapy and counseling sessions per year.

Your cost: You pay nothing if your primary care doctor accepts Medicare assignment.

Obesity

Medicare covers behavioral counseling if you have a body mass index (BMI) of 30 or more. The counseling includes discussion of weight loss with a focus on diet and exercise.  

Your cost: You pay nothing if your primary care doctor accepts Medicare assignment and if you receive the counseling in a primary care setting.

Sexually transmitted infections

Medicare covers up to two face-to-face counseling sessions for sexually active people at increased risk for sexually transmitted infections (STI). These sessions typically last for 20 to 30 minutes.

Your cost: You pay nothing if your doctor accepts Medicare assignment.

Smoking and tobacco use cessation

Medicare may cover up to eight counseling sessions during a 12-month period that are geared toward helping you quit smoking and using tobacco.

Your cost: You pay nothing if your doctor accepts Medicare assignment.

Cardiac rehabilitation

Medicare may cover exercise, education and counseling for beneficiaries who have experienced one or more of the following:

  • A heart attack in the past twelve months
  • Coronary artery bypass surgery
  • Heart valve replacements or repairs
  • A coronary angioplasty
  • A coronary stent
  • A heart transplant
  • Stable chronic heart failure.

Your cost: Your Medicare Part B deductible applies, which is $185 per year in 2018. Once you meet your Part B deductible for the year, you will then be responsible for paying 20 percent of the Medicare-approved amount for cardiac rehab services you receive in a doctor’s office.

Hospice

A hospice team will create a plan for your care depending on your illness, conditions and circumstances. Your care plan may include dietary counseling, as well as grief and loss counseling for you and your loved ones, all of which may be covered by Medicare.

Your cost: You pay nothing for counseling services received during hospice care.

Mental health

Family counseling is available for beneficiaries suffering from depression and can be covered by Medicare. Medicare also covers one depression screening per year with your primary care doctor, some partial hospitalizations, diagnostic tests and psychiatric evaluations, medication management and your yearly Medicare Wellness visit.

Your cost: Your Medicare Part B deductible applies, which – as mentioned above – is $185 per year in 2018. Once you meet your Part B deductible for the year, you will then be responsible for paying 20 percent of the Medicare-approved amount for doctor’s office visits to diagnose and treat your mental health condition.

You may also be required to pay an additional copay or coinsurance if you receive mental health therapy services in a hospital outpatient clinic.

Nutrition therapy

Dietary counseling and nutrition therapy services may be covered by Medicare for beneficiaries who receive skilled nursing care and for beneficiaries who have diabetes, kidney disease or have had a kidney transplant in the past three years.

The nutrition therapy can include an initial lifestyle assessment, help managing the factors that affect your nutritional health and follow up individual or group therapy sessions.

Your cost: If counseling services are received while you are admitted to a skilled nursing facility, they are included as part of your overall skilled nursing facility costs. The cost of the stay is covered by Medicare, while you may pay some coinsurance costs beginning with the 21st day of your stay in the skilled nursing facility.

You won’t pay anything for preventive nutrition therapy and dietary counseling if you receive these services due to your kidney health or diabetes.

Medicare Advantage plans also cover counseling

Medicare Advantage plans (Medicare Part C) are required to provide at least the same minimum coverage as Medicare Part A and Part B (except for hospice care, which you continue to receive through Medicare Part A).

This means that a Medicare Advantage plan will cover your Medicare-eligible counseling and therapy services in the same way that Original Medicare would.

Many Medicare Advantage plans also offer additional benefits not covered by Original Medicare. These benefits can include prescription drug coverage, vision and hearing coverage and other potential benefits that support your counseling and therapy needs.

Call today to speak with a licensed insurance agent and learn more about Medicare Advantage plans that may be available where you live.

 

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