Good news! In 2024 marriage and family therapists will eligible to become Medicare providers.
Psychiatrists (MDs), psychologists (PhDs) and social workers (LCSWs) are currently the only licensed mental health professionals recognized by Medicare and that will remain in effect for 2023.
Background: Medicare was created in 1965 to provide health insurance to Americans, starting at age 65 and earlier for those with long term physical or emotional disabilities. The idea was and is to provide health insurance to those no longer in the workforce and without the benefit of employer-provided health insurance.
Medicare coverage includes mental health services but Medicare has not recognized all licensed mental health professionals. The Mental Health Access Improvement Act, passed in December of 2022, will allow licensed marriage and family therapists (MFTs) and licensed mental health counselors (LMHCs) to be recognized by Medicare, effective January of 2024 .
In the meantime if you have Medicare are, considering therapy with me, and wondering if your insurance will cover services. It all comes down to what type of Medicare you have. Here is what you need to know.
- Original Medicare without a supplement—not covered but you can still see me. You can use of a Health Saving Account and therapy is a tax-deductible medical expense.
- Original Medicare with a supplemental plan—the supplemental may pay depending on the specifics of your plan. If therapy with a LCSW or PhD is covered by the supplemental insurance then they should cover the same services when provided by an MFT. You may need a Medicare denial and may have a separate deductible. Medicare insurance is considered “primary” for all who have it. Your secondary insurance may want a denial from Medicare before paying on a claim and Medicare will not issue a denial directly to an MFT. Partnership MediCal does not require a denial from Medicare. For all other supplemental insurance, call the behavioral health number on the back of your secondary insurance card and inquire about out-of-network benefits including: deductible, what services are covered, whether than need a denial for therapy with an MFT and how to get reimbursed for out-of-network services
- A Medicare Advantage plan typically works like an HMO and only covers “in-network” providers. Double check this with them but it might leave me out as an covered option. Ask them is you can see a therapist who is not in-network. If not, you can still see but would have to pay out of pocket.
If you need help figuring out whether your insurance will cover sessions with me, contact me.