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Hi there!

Coverage for Medicare Outpatient Mental Health/Individual Therapy.

Aetna clients - Benefits and Resource Information (recent communication).

Keep reading!

Theresa Cangemi CSA, CLTC
"The Medicare Lady™" 
Medicare Covered Outpatient Mental Health/Individual Therapy?
I thought this would be a good topic to cover, about Medicare, since we all might need a little help from 2020 and the world-wide COVID19 epidemic we are all in; and has carried over to 2021.

Well, what about therapy and mental health? When needing therapy sessions, make sure the provider(s) are in the network.

When needing OUTPATIENT mental health, services covered (falls under Part B) with Medicare Advantage are:
  • Individual and group therapy 
  • Substance use disorder treatment 
  • Tests to make sure you are getting the right care 
  • Occupational therapy 
  • Activity therapies, such as art, dance, or music therapy 
  • Training and education (such as training on how to inject a needed medication or education about your condition) 
  • Family counseling to help with your treatment 
  • Laboratory tests 
  • Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you 
  • An annual depression screening (speak to your primary care provider for more information)

For Medicare Advantage plans, see the SUMMARY OF BENEFITS to understand how that Part C (Medicare Advantage) plan will cover outpatient mental health. If you see an out-of-network provider you will most likely pay a percentage instead of a flat copay; and no medical deductible for my Medicare Advantage plan clients.

For outpatient hospital mental health program, this coverage would apply to doctor’s office, therapist office, or at a clinic. Providers would include:
  • General practitioners 
  • Nurse practitioners 
  • Physicians’ assistants 
  • Psychiatrists 
  • Clinical psychologists 
  • Clinical social workers 
  • Clinical nurse specialists 

For Medicare Advantage Plan, call your plan directly for a list of mental health care providers in your plan’s network. This Customer Service number can be found on the back of your Medicare Advantage plan card for help and information.

You can also go directly to your Medicare Advantage plan’s website for a list of providers.

Here is another resource: Substance Abuse and Mental Health Services Administration (SAMHSA) at 800-662-4357. 
Virtual member meetings
Aetna is hosting virtual MA/MAPD member meetings in select markets throughout the first quarter of this year. If there is an event available in your market, I encourage you to attend! During the virtual meetings, members will learn more about their 2021 plan and benefits. Plus, we'll be there to help answer questions. Members can visit AetnaRSVP.com to register. After registering, they’ll receive an email with event details.
Check out the Aetna MA/MAPD member handbook
The 2021 Aetna MAPD member handbook, available in English and Spanish, is filled with tips and information to help members make the most of their Medicare plan. It can also help you answer member FAQs during the year. This year, the handbook is available online only.
COVID-19 vaccine information
We’re committed to providing members with the tools and support they need as the COVID-19 vaccine becomes more widely available. Members can visit our vaccine support website to check vaccine eligibility, schedule an appointment, get answers to questions about coverage and more.
Helping members schedule their COVID-19 vaccine
This week, we began calling Aetna Medicare members who may be eligible for the COVID-19 vaccine to help them find and schedule a vaccine appointment at their local CVS Pharmacy or another available location. During the call, members will also get information about the vaccine, an opportunity to ask questions and a reminder to bring their red, white and blue Medicare card to their vaccine appointment.

CMS will cover the full cost of the COVID-19 vaccine for Medicare beneficiaries, including those in a Medicare Advantage plan. Aetna members won’t have to pay for any out-of-pocket costs for the vaccine. Members just need to bring their red, white and blue Medicare card with them to their vaccination appointment. Learn more.
We'll continue to waive Individual MA/MAPD member cost shares for:
  • COVID-19 screening, testing and provider visit to diagnose COVID-19, including provider office visit, telemedicine visits, urgent care and emergency room visits until further notice.
  • Inpatient admissions due to a COVID-19 diagnosis until February 28, 2021.
  • PCP and behavioral health telehealth visits through March 31, 2021.
  • In-office PCP visits to in-network providers through March 31, 2021.
* This article is for information purposes only. I don’t recommend, support, or diagnose any featured writer or article. I am not a doctor. Your health is one of a kind. What works for one person may not for another, so the information in these articles should not take the place of an expert opinion. Before making significant lifestyle or diet changes, please consult your primary care physician or nutritionist. Your doctor will know your own health best.