Blue Cross Blue Shield Medicare for Therapy | Mental Health Insurance Coverage — Zencare

Blue Cross Blue Shield Medicare for Therapy

Medicare is the federal health insurance program for individuals who are over the age of 65 or have specific health conditions. While you can get coverage directly from the federal Medicare program, you can also find health insurance companies such as Blue Cross Blue Shield that offer Medicare — often with additional perks or benefits. Medicare Blue Cross Blue Shield provides its members with access to its excellent therapist network.

Does Medicare Blue Cross Blue Shield cover therapy?

Yes, Medicare Blue Cross Blue Shield health insurance plans offer mental health coverage. Medicare Blue Cross Blue Shield helps pay for therapy sessions when its members see both in-network and out-of-network therapists. For members, it is typically most cost-effective to see therapists who are in-network with Medicare Blue Cross Blue Shield.

You may need to request preauthorization for mental health services from Medicare Blue Cross Blue Shield before you begin therapy. Depending on your plan, this preauthorization will grant you a specific amount of sessions under a known rate.

How do I check if my Medicare Blue Cross Blue Shield plan covers therapy?

To check if your Medicare Blue Cross Blue Shield provides coverage for mental health services, locate your Summary and Benefits document. This document will detail out the exact coverage rates for specific services, such as therapy. On your Summary and Benefits document (often found on the Medicare Blue Cross Blue Shield website or your online account), look for “outpatient mental health,” “outpatient behavioral health,” or “outpatient individual therapy.”

Example Medicare BCBS Summary of Benefits, with Outpatient Mental Health section highlighted.

Otherwise, try giving the Medicare Blue Cross Blue Shield customer service hotline a call to learn more about your mental health coverage.

How much does therapy cost with my Medicare Blue Cross Blue Shield plan?

Typically, for therapy with a Medicare Blue Cross Blue Shield plan, you may pay a copayment of $20-$50 for each session with an in-network therapist or 20-50% for each session cost with an out-of-network therapist. Medicare Blue Cross Blue Shield offers dozens of health insurance plans across the country, which leads to varying therapy costs, depending on location, plan, and provider type. Be sure to confirm the details of your specific plan before you start therapy.

What types of mental health conditions does Medicare Blue Cross Blue Shield cover?

Medicare Blue Cross Blue Shield covers many mental health conditions, including all mental health conditions under a specific diagnosis. When you start seeing your therapist, they will provide you with a diagnosis under which you’ll receive reimbursement.

Some common mental health conditions covered by Medicare Blue Cross Blue Shield include:

What types of therapy does Medicare Blue Cross Blue Shield cover?

Medicare Blue Cross Blue Shield reimburses for all therapy services provided by a credentialed mental health professional. This could include psychologists, psychiatrists, social workers, licensed professional counselors, nurse practitioners, and more.

Therapists need to provide evidence-based, clinically rigorous treatments that are appropriate for the client’s diagnosis. This includes the following therapeutic modalities:

Many Medicare Blue Cross Blue Shield plans also cover medication management, psychiatric evaluations, partial hospitalizations, and family counseling.

What types of therapy does Medicare Blue Cross Blue Shield NOT cover?

Medicare Blue Cross Blue Shield will not cover any therapies that are not evidence-based or based. Treatment also needs to be based upon a specific mental health diagnosis. For these reasons, Medicare Blue Cross Blue Shield will not cover career counseling, life coaching, holistic therapies, or reiki healing.

Medicare Blue Cross Blue Shield also offers many members access to various online mental health resources and wellness benefits outside of therapy coverage. You might find these tools through your online portal.

Does Medicare Blue Cross Blue Shield cover online therapy?

Yes, Medicare Blue Cross Blue Shield covers online therapy. The same copayment and coinsurance rates apply, whether in-person or online.

While unlikely, this may change in the future. Before beginning to see a therapist online, check to make sure that your plan continues to cover online sessions.

Does Medicare Blue Cross Blue Shield cover couples therapy?

No, in general Medicare Blue Cross Blue Shield does not cover couples therapy. The majority of health insurance companies do not cover this service. However, because there are so many different plans available under Medicare Blue Cross Blue Shield, you may find some mental health benefits for you and your partner or partners, so be sure to learn more about your specific plan.

Do I need to see my primary doctor before starting therapy?

If your Medicare Blue Cross Blue Shield health insurance plan is an HMO plan, then you will need to see your primary care physician before visiting a therapist. HMO plan members need a referral to see a specialist, which includes therapists.

Medicare Blue Cross Blue Shield PPO plan members, however, do not need a referral before they start therapy. So, depending on your plan, you may or may not need to see your primary care doctor before beginning your search for the right therapist.