Illness and aging can bring on anxiety, depression, feelings of loneliness and other mental or behavioral health concerns. If you’re 65 or older and have Medicare, you can get counseling and support from a Medicare social worker to help you cope with these challenges. But what does a social worker do, who can they help and where can you find a social worker who accepts Medicare patients? Let’s find out.
What do Medicare social workers do?
Medicare covers services provided by clinical social workers who diagnose, treat and prevent mental illness and emotional or behavioral disturbances.
Treatment can include individual, group and family counseling for a range of issues, including depression or anxiety. Social workers also help patients find resources to address health issues that could hinder their recovery from illness or injury.
To practice as a clinical social worker, these professionals must have a social work master’s or doctoral degree, at least two years of supervised clinical experience and a state license.
Can social workers bill Medicare?
Yes, clinical social workers can bill Medicare for some services, but other kinds of social workers can’t.
Outpatient mental health services
Medicare Part B (health insurance) covers counseling or therapy appointments with a clinical social worker in a doctor’s office, a hospital outpatient department or a community mental health center.
For Medicare to cover the visit, the treatment must be reasonable and medically necessary. Also, the clinical social worker must accept assignment, meaning they agree to be paid the Medicare-Approved Amount directly by Medicare. If they don’t accept assignment, you have to pay the entire cost of the appointment.
These are some of the outpatient mental health services covered by Part B:
- One depression screening a year
- Individual and group psychotherapy
- Family counseling, if the aim is to help with your treatment
- Evaluation of your treatment plan
- Psychiatric evaluation
- Diagnostic tests
Home care services
Medicare Part A (hospital insurance) and Part B pay for home care, which can include medical social services. In this scenario, the social worker can provide counseling, assessments or resource finding to help you recover from an injury or illness.
For Medicare to cover home care services, including those of a social worker, you must meet the following conditions:
- You’re under a doctor’s care and getting services according to a plan created and regularly reviewed by a doctor.
- A doctor has certified that you are homebound.
- A doctor has certified that you need intermittent skilled nursing care, physical therapy, speech-language pathology or occupational therapy services that qualify under the home care benefit.
A home health agency will manage your services, including visits with a social worker. Before you get any services, the agency should give you a written Advance Beneficiary Notice explaining the services covered by Medicare pays and the cost of services for which you pay out-of-pocket.
Why would a patient need a social worker?
Aging, illness and related issues cause stress that can lead to anxiety, depression, loneliness and other mental or behavioral health concerns. A social worker can help a patient cope with these challenges, and help the patient to navigate a potentially confusing maze of services.
How do I contact a social worker?
Clinical social workers see patients in a variety of settings. Some have a private practice. Others work in community mental health centers, hospitals and primary care centers or come to you as part of a home-care service.
Before making an appointment with a clinical social worker, ask if they accept assignment. If they don’t accept assignment, Medicare won’t cover the services they provide, and you’ll have to pay the full amount yourself.
You can use the provider finder at Medicare.gov/care-compare to find Medicare clinical social workers in your area. Your primary care doctor also can help.
A primary care physician can help me connect with a social worker?
Yes, your primary care doctor can be a great way to connect with a social worker. Primary care doctors help their patients manage their health and are a doorway to specialized care, such as counseling with a clinical social worker. Some primary care providers even have a clinical social worker on site.
Where can I find a primary care physician who accepts Medicare patients?
NewPrimaryCare.com™ can help you find a quality primary care doctor near you. Our partner providers practice value-based care, meaning Medicare rewards them for helping their patients get better.
With a value-based care doctor, you have someone who will take the time to get to know you and your circumstances, including your mental health concerns. You can expect quicker appointment scheduling, shorter waits at the doctor’s office and a meaningful connection with your physician.
Use our Find Your Doctor tool to search for and compare value-based care providers near you.
