Will Medicare cover grief counselling?


Grief can be a result of many different forms of loss. However, the most common cause of grief is the loss of a loved one. According to Statista, there were over 15 million widows and widowers in the United States in 2018. While not all the people Statista surveyed were seniors, we can assume that the majority of them who claimed to be widowed were seniors.

Severe grief in seniors can cause the widowhood effect. The widowhood effect is the increased likelihood of the surviving spouse dying shortly after the loss of her spouse. Usually, the death of the elderly surviving spouse occurs within the first three months of losing her spouse. It's commonly called dying of a broken heart.

Medicare has even assisted in the research of the widowhood effect with the National Center for Biotechnology Information. Because the widowhood effect was found to be most common among seniors, Medicare covers medically necessary grief counseling and other mental health services for its beneficiaries.

Grief and other mental health services covered by Medicare

There are several outpatient mental health services covered by Medicare Part B, including individual psychotherapy for grief counseling. Depending on the type of treatment needed, Medicare may cover other services, such as family counseling, medication management, a psychiatric evaluation, and partial hospitalization.

Medicare Part B also covers a few related preventive services. Part B covers an annual depression screening for anyone enrolled in Part B. These annual screenings are 100% covered when delivered by a primary care physician.

Costs for mental health services covered by Medicare

The non-preventive services, such as psychotherapy, counseling, and evaluations, are subject to the Part B deductible and coinsurance. At the beginning of each calendar year, Medicare applies an annual deductible to Part B services.

As of 2019, the Part B deductible is $185. Some people satisfy the deductible within one Part B service. Once that deductible is satisfied, Part B covers 80% of covered services.

Medicare beneficiaries do not need to pay the Part B deductible upfront at the time of service. If they do, Medicare has no way of knowing the deductible has already been satisfied if it is paid upfront.

The doctor’s office should bill Medicare first. Medicare will see the Part B deductible is unsatisfied and will pay for 80% of the bill minus the deductible. Then, Medicare will return the bill to the doctor’s office. Then, and only then, should the doctor’s office bill the patient for the deductible and 20% coinsurance.

Medicare’s approved cost of service

One rule Medicare has for mental health services is regarding the medical professional performing the service must accept Medicare assignment rates. If the medical professional doesn’t accept assignment, Medicare won’t cover any part of the mental health service.

Medicare has an approved price that they will pay for each covered service. When a professional agrees to accept Medicare assignment, they agree to not charge to the patient any more than the approved price.

For example, if a provider accepts Medicare assignment, and they bill Medicare $400 for a service, but Medicare’s approved price for that service is $300, the doctor must accept $300 as the full price of service. If a provider doesn’t accept Medicare assignment, they can charge the patient up to 15% more than the Medicare-approved price.

Other requirements for mental health services covered by Medicare

 In addition to the requirement that mental health providers accept Medicare’s assigned rates, Medicare also requires that mental health services be delivered by certain types of medical professionals.

Medicare covers mental health services provided by psychiatrists, clinical psychologists, clinical nurse specialists, nurse practitioners, physician assistants, and clinical social workers.

Medicare also requires mental health services to be provided in specific settings, such as a doctor’s office, a hospital outpatient center, or a community mental health center. Medicare will cover the service if all of the above requirements are met. The service must also be deemed medically necessary for Medicare to cover it.

Tips to overcoming grief

Overcoming grief is not a one-person job. Usually, family, professionals, and the individual all play a part in helping an individual overcome grief. However, there are some things the individual can do to get the ball rolling.

  • Get grief counseling
  • Spend time with family
  • Meditate
  • Pick up a hobby
  • Move to a community where other widowed individuals may also live

The last tip is proven to lower the likelihood of the widowhood effect and overcome grief quicker. According to the research done by Medicare and the National Center for Biotechnology Information, when surviving spouses moved to a neighborhood with a higher concentration of other surviving spouses, the likelihood of death decreased from 22% to 17% for men, and from 17% to 15% for women.

All of these tips are actionable things a grieving individual can do to start the healing process today.


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About the Author

Danielle is a Medicare expert who writes regularly for many online publications, including daniellekroberts.com and Forbes, where she is a member of the Finance Council. A TCU journalism graduate and former magazine editor, she enjoys sharing her knowledge about Medicare and other topics effecting seniors.