What is the payment structure for outpatient treatment of mental illness?

Medicare covers outpatient treatment of mental illness but requires coinsurance, which means that beneficiaries will need to pay a portion of the cost out of their own pockets. This coverage is part of Medicare Part B, which generally includes medically necessary outpatient services, such as therapy and counseling for mental health conditions.

Under Medicare, after a patient has met their deductible, they are typically responsible for around 20% of the Medicare-approved amount for the treatment while Medicare pays the remaining 80%. This coinsurance payment structure is important to encourage the use of necessary mental health services while also sharing some of the financial responsibility with the patient.

Medicare does not pay 100% without coinsurance, nor does it exclude coverage for mental illness entirely. Additionally, partial payment referred to in another choice might mislead one to think that coverage is more limited than it actually is, whereas it’s essential to recognize that while there are out-of-pocket costs involved, the treatment is still covered significantly under Medicare.