Medicare, Medicaid, & Mental Health: Eligibility, Services & Benefits

The Phoenix Recovery and Counseling Centers

When it comes to getting mental health care for yourself or a loved one, you deserve a mental health center that provides the services and resources best suited to meet your treatment needs. One of the most common ways to pay for mental health treatments is by using Medicare or Medicaid, but many people still ask “Does Medicare cover mental health services?” Learn more about the qualifications for Medicaid and Medicare mental health coverage and if you can use these types of insurance to cover services at The Phoenix. 

What Counseling Services Do We Offer?

The Phoenix Recovery and Counseling Centers provide mental health care services for various mental illnesses. The following behavioral health disorders are just some of those treated at The Phoenix:

It is important to note that we do NOT provide residential treatment for psychiatric stabilization. The Phoenix is partnered with some of the best counseling centers on the Wasatch Front, so we make sure that you are taken care of if, upon assessment, it is determined that residential treatment is needed. 

Medicare, Medicaid, and Counseling Services

Medicare is federally funded insurance that covers medical bills for qualifying individuals, and similarly, Medicaid is state and federal funded insurance that can cover treatment for those individuals that qualify. While many think first of Medicare and Medicaid insurance as coverage for drug prescription costs, hospital or doctor visits, mental health insurance coverage may be provided if you’re eligible. Let’s take a closer look at what it means to be eligible for coverage with each insurance.

Medicaid Mental Health Coverage Eligibility

How do you know if you qualify for this mental health insurance coverage? Medicaid may cover all or some of the associated expenses for therapy for those who are eligible. Coverage can be used in conjunction with one of our addiction recovery programs, one-on-one therapy, or group therapy for treatment. Since Medicaid is determined by the state, these are the requirements to qualify for coverage in the state of Utah:

  • People age 19-64
  • U.S. citizen or qualified alien
  • Resident of the state of Utah 
  • Household income up to 5% federal poverty level
  • Ineligible for any other Medicaid program (with the exception of Medically Needy or Refugee Medicaid)
  • Meet one of three targeted categories:
    • Group 1: Chronically homeless.
    • Group 2: Involved in the justice system and needing substance use or mental health treatment.
    • Group 3: Needing substance use or mental health treatment

If you are still not sure if you fit these requirements, please call The Phoenix to verify your coverage. We are more than happy to work with your situation to find a solution that works.

Medicare Mental Health Coverage Eligibility

Medicare is broken down into different parts (A. B, C, and D), so it’s important to know which part of Medicare is needed to receive mental health services coverage. Original Medicare, the federally funded health insurance program for those who are 65 or older or have a qualifying disability, is made up of part A (hospital insurance) and part B (outpatient/medical insurance). Thanks to part B, mental health services are often covered under the original Medicare as long as it is accepted by that facility. Additionally, if you are enrolled in a Medicare part C program, also known as a Medicare advantage program, you will have the same benefits as those who only have parts A and B. This means you will still be eligible to receive mental health care coverage. However, please do note that Medicare advantage programs may have different rules, restrictions, and costs when compared to original Medicare. It’s important to always call to verify your eligibility and benefits prior to making an appointment.

What health services are covered by Medicaid and Medicare?

Both types of insurance can cover part of or all of the following: 

  • Family counseling
  • Addiction recovery services (if applicable)
  • Inpatient care
  • Long-term residential treatment
  • Maintenance medications
  • Medical screenings
  • Outpatient mental health visits

Am I Eligible for Medicare or Medicaid Mental Health Services?

Certain conditions apply, but Medicaid and Medicare do cover counseling at The Phoenix. Though not every insurance provider covers counseling and there are some qualifications and eligibility requirements, many mental health patients use Medicare or Medicaid to cover their expenses for therapy. The best way to determine if your individual case will be covered by Medicare or Medicaid is to contact the representatives directly

Medicaid and Medicare Mental Health Services Benefits

While Medicare and Medicaid both provide a wide range of health services, you might still be wondering what mental care services are covered under the two insurances. Under certain conditions, Medicaid or Medicare will cover the following mental health services: 

  • Psychosocial Rehabilitation Services
  • Evaluations
  • Individual and Group Therapy
  • Inpatient mental health services
  • Medication Management
  • Personal Services
  • Psycho-educational Services

Feel free to call us to verify your benefits coverage or work with your health insurance provider to enroll in a plan or find out what services are included in your plan. We believe that mental health is a priority, so when you’re ready to take the next step, call The Phoenix to verify coverage and set up an appointment.