Therapy and other mental health services are optional Medicaid benefits, which means Medicaid covers therapy in some states, but may not cover it in others.
Medicaid benefits can be lumped into two separate categories:
It is not required for a state Medicaid program to provide any coverage for therapy, but many states choose to do so anyway.
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To learn more about if and how your state Medicaid program covers therapy, check your “Summary of Benefits” document that was mailed to you along with your Medicaid card. If you can’t find that document or need assistance understanding it, contact your state Medicaid program.
It’s common for Medicaid benefits to include coverage of visits with a therapist. There may or may not be a small copayment, and you may be limited to a certain number of covered sessions per year. Medicaid therapy coverage can vary from one state to another.
Medicaid may also often cover virtual visits with a therapist conducted online or over the phone. Coverage of virtual therapy sessions – also referred to as telehealth, telemedicine or teletherapy – was enhanced as a result of the COVID-19 pandemic, so check with your state Medicaid program to see if virtual therapy sessions are still covered where you live.
Medicaid typically does not cover visits with certain types of therapists such as life coaches, career counseling or holistic treatments like massage therapy, acupuncture or aromatherapy.
The mental health and behavioral health treatments that are covered by Medicaid will vary by state, but may include any of the following:
Medicaid benefits can be used to treat a variety of conditions such as depression, anxiety, alcohol and substance abuse, grief and loss, eating disorders, learning disabilities and more.
Like therapy, counseling sessions may or may not require a copayment, and there may be a cap on the number of counseling sessions you may receive in a year. Consult your state’s Medicaid program for more information.
Aside from therapy and counseling sessions, some state Medicaid programs may cover:
Medicaid beneficiaries who are also eligible for Medicare may be able to enroll in a certain type of private Medicare plan called a Medicare Advantage Special Needs Plan. These plans are designed for people with certain health, living or financial circumstances, and one of the available plans is a Dual-eligible Special Needs Plan (D-SNP).
These plans are designed for people on both Medicare and Medicaid and feature a set of benefits that cater to those specific needs. Plan members do not pay a monthly premium.
If you are eligible for Medicare, speak to a licensed insurance agent to find out if Dual-eligible Special Needs Plans are available in your area and how they might cover therapy and other mental health benefits.
Speak with a licensed insurance agent
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
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