Illness and changes due to aging bring physical, as well as mental, concerns for seniors. That’s where social workers can help. They counsel seniors with mental health issues and guide them to resources to help with health-related issues. Medicare covers some of these services, but not all of them.
What does a social worker do?
Clinical social workers help diagnose and treat patients with mental illnesses. This can include counseling or therapy for depression or anxiety. Social workers also help people find resources tol help them deal with specific health issues. The idea is that a social worker can help a patient deal with concerns that could hinder their recovery.
When does Medicare pay for a social worker?
Medicare coverage of social worker appointments differs depending on your situation.
Outpatient mental health
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 clinical social worker must accept assignment, meaning they agree to be paid the Medicare-Approved Amount directly by Medicare. And like any treatment, the appointment has to be reasonable and medically necessary.
After meeting your Part B deductible ($233 in 2022), you pay 20 percent of the Medicare-Approved Amount for subsequent visits with a clinical social worker. And there could be an additional copayment or coinsurance amount if you get your services in a hospital outpatient setting.
Remember, Medicare does not pay for clinical social worker services for patients in partial hospitalization programs or skilled nursing facilities.
Both Part A (hospital insurance) and Part B pay for home care, including medical social services like counseling or help with finding resources. Again, the social worker is there to help you deal with issues that could hinder your recovery.
If you’re covered, you won’t pay anything for an appointment with a social worker, but there are rules.
For Medicare to cover any home care services, including those of a social worker, you have to meet all of these conditions:
- You’re under a doctor’s care and getting services according to a plan created and regularly reviewed by a doctor.
- A doctor must certify that you are homebound.
- A doctor must certify 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 oversee your home care services. The agency should tell you what Medicare covers and how much you have to pay for any services Medicare doesn’t cover. Services you have to pay for out-of-pocket should be spelled out in a written Advance Beneficiary Notice before you receive them.
Where can I find a primary care physician who accepts Medicare patients?
Primary care doctors help their patients manage their health and are a doorway to specialized care, such as counseling with a clinical social worker.
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 patients get better.
With a value-based care doctor, you have someone who will take the time to get to know you and your unique needs. 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.