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January 16, 2020 Danielle Kunkle Roberts

Does Medicare Cover Grief Counseling?

It's important — but is it covered?

Does Medicare Cover Grief Counseling?
Grief counseling can help a mourner understand their loss, but it can also give context to life and death through the eyes of a professional. (Shutterstock)

Grief is commonly experienced after the loss of a loved one. A lot of seniors fall victim to the "the widowhood effect" as a result of severe grief. The increased likelihood of a person dying shortly after losing a significant other, generally within the first three months, is what defines the widowhood effect. 

In 2018, approximately 15 million people in America claimed to be widowed, according to Statista. Although not every survey participant classified as a senior, there's no doubt that a lot of the widowed participants were seniors.

Medicare is a complicated program to navigate, especially when you're dealing with grief from the loss of a loved one. Many of America's baby boomers aging into Medicare don't understand their benefits, costs and coverage. 

Grief counseling is an often misunderstood benefit. Fortunately, Medicare does cover grief counseling,  however, there are some limitations and circumstances that must be met. Medicare does provide coverage to beneficiaries for grief counseling if they are medically necessary as determined by your healthcare provider. 

Medicare Coverage of Grief and Mental Health Services

Mental health services are covered by Medicare Part B in several outpatient settings. For example, individual psychotherapy for grief is a covered service. Family counseling, psychiatric evaluation, medication management and even partial hospitalization may also be covered.  

Under Part B, you may qualify for several associated preventive services for mental health. For example, annual depression screenings are covered for beneficiaries enrolled in Medicare Part B. The annual depression screening is covered at 100 percent if performed by your primary care physician.

Requirements for Medicare Coverage of Mental Health Services

Medicare requires that mental health services be provided by specific types of medical professionals. Medicare will cover mental health services with clinical psychologists, psychiatrists, clinical nurse specialists, physician assistants, clinical social workers and nurse practitioners who accept Medicare.

Mental health services must also be provided in specific settings such as a hospital outpatient center, doctor's office or a community mental health center in order for Medicare to approve coverage. 

Cost of Medicare-covered Mental Health Services

Every January 1st, your Part B deductible starts over. Currently, in 2019, the deductible is $185 but will increase to $198 in 2020. In some cases, beneficiaries will meet the deductible after just one eligible Part B service. 

Once you've met the deductible, 80 percent of Medicare-approved services are covered by your Part B benefits. All non-preventive services such as counseling, psychotherapy and evaluations are subject to the Part B deductible and coinsurance.

Beneficiaries are not required to immediately pay the Part B deductible when they receive grief counseling. The doctor's office should first bill Medicare before sending you a bill. Medicare will note if the deductible applies and pay its portion of 80 percent after the deductible is met. The patient is then billed for 20% coinsurance plus any portion of the deductible that may be due. 

Everyone grieves at some point in life. Dealing with it doesn't have to leave you feeling alone and without support. If you or a loved one ever have questions about what Medicare will and will not cover for mental health services, contact your carrier or a Medicare insurance broker. 

This article was contributed by Danielle Kunkle Roberts of Boomer Benefits

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