To our Medicare population, please review your Medicare benefits carefully and if possible call the member services number on the back of your card to ask about your coverage for outpatient mental health. Medicare covers therapy with a clinical psychologist, psychiatrist, or Licensed Clinical Social Worker as long as the provider accepts Medicare assignment.
If you are Medicare eligible and have not delayed opted out of Medicare Part B, then Part B becomes your primary coverage for Mental Health.
Medicare Part B covers counseling and psychotherapy services to treat mental health issues, including:
- Individual counseling.
- Family Counseling (Medicare covers family counseling when the goal of the therapy is related to your treatment).
Medicare doesn’t cover some types of therapy, however, such as marriage counseling or pastoral counseling.
We accept the following types of Medicare plans:
- Straight Medicare
- Medicare Advantage or Complete Plans: Medicare Advantage plans cover everything original Medicare covers and generally offers extra benefits (Part B – for mental health).
- Medicare Supplemental or (Medigap) Plans: Medicare Supplemental Insurance is a plan that you buy from a private insurance company that pays for some of the cost sharing in Medicare. Medicare sends claims directly to them for processing if the client has coordinated their benefits.
Medicare Advantage/Complete Plans:
- AARP® MedicareComplete HMO® Managed through United Health Care/OPTUM
- HMO Plans require a prior auth members call 1.800.547.5514.
- Kaiser Permanente Medicare Advantage HMO*
*HMO plans require a prior auth member call 1.800.446.8882.
- Premera Blue Cross Medicare Advantage PPO & HMO*
o Managed through UnitedHealthcare (UHC) – HMO Plans require a prior auth members call 1.855.339.8125. Make sure therapist is in network on that plan.
- Regence Medicare Advantage PPO
- Fax Outpatient Reviews: 866.702.9028
- NOT REGENCE HMO or REGENCE BLUE ADVANTAGE PLAN HMO
- Soundpath Medicare Advantage HMO*
o Managed through Optum Behavioral Health
- *HMO Plans require a prior auth Emmaus calls 888.873.6769.
- UnitedHealthcare Medicare Advantage HMO*
o HMO Plans require a prior auth. members call 1.855.339.8128.
Medicare Supplemental Plans:
- State Farm Medicare Supplemental Health Ins.
- Sterling Medicare Supplemental (CIGNA Network)
- USAA Insurance Plan
- United of Omaha Life Insurance Company
*Please note, we do not participate with any state-sponsored plans such as Medicaid, Molina or Apple Health.
Meet our Medicare Providers
|Harvey LeSure, MSW, LICSW, GMHS||Fran Regdos, MSW, LICSW||Bea Roskopf, MSW, LICSW||Shannon Tait, MA, LMFT, GMHS|
|Dr. Dan Tomczyk, Ph.D.||Dr. Richard Wemhoff, Ph.D.||Dr. David C. Wiesner, Ph.D.|
Note: If you are 65+ and work for a company that has 20+ employees, your group health plan generally pays first and if you have you have coordinated your benefits then Medicare can be billed for your remainder (you would still need to be seen by a medicare provider to use this benefit). That said, you’ll have to pay any costs Medicare or the group health plan doesn’t cover.
Helpful Medicare Tools:
- Learn about the different Medicare Plans.
- Top Ten Medicare Insurance Tips – A Helpful Video.
- How to Understand Medicare – a Helpful Video.
- Understanding Medicare Advantage Plans – A Helpful Video.
- Learn About MediGap Plans – A Helpful Video.
If you have questions about Medicare coverage, please call them directly at 1-800-633-4227 or visit www.medicare.gov.