Original Medicare vs. Medicare Advantage for Online Psychiatric Care

Medicare has two main paths. Original Medicare is run by the federal government. Medicare Advantage plans are sold by private companies approved by Medicare. Both can cover outpatient mental health care, including psychiatric evaluations and medication management, and nurse practitioners are among the clinicians Medicare lists for this care.

At SteadyMind, Medicare visits are with Alexeis Menendez-Suarez, PMHNP-BC. He is enrolled with Medicare and welcomes eligible adults, in English or Spanish.

Original Medicare (Part B)

• Who you can see: any provider who accepts Medicare, anywhere in the U.S.
• What you usually pay: after you meet the yearly Part B deductible, you usually pay 20% of the Medicare-approved amount for each visit.
• Help with the 20%: a Medicare Supplement Insurance (Medigap) policy may pay some or all of it.

Medicare Advantage (Part C)

• Who you can see: in many plans, only clinicians in the plan's network. A clinician who is enrolled with Medicare is not automatically in network with every Medicare Advantage plan.
• What you usually pay: a copay or coinsurance set by your plan. Amounts differ from plan to plan.
• Extra steps: some plans require a referral or prior authorization before mental health visits.
• What is covered: Medicare Advantage plans must cover the medically necessary services that Original Medicare covers, but their rules and costs can be different.

Video visits from home

Medicare permanently covers mental health visits by telehealth while you are at home. A separate rule would require an in-person visit within six months before you start telehealth mental health care, and then once a year. According to the U.S. Department of Health and Human Services, that in-person visit is not required through December 31, 2027. Rules like this can change, so we will tell you if anything applies to you.

For SteadyMind visits, you must be physically located in Florida during each video visit.

How SteadyMind checks your plan

1. Email or text us the name of your plan, as it appears on your card. Please do not send your Medicare number by email or text.
2. We check whether Alexeis can see you with that plan, and whether a referral or authorization is needed.
3. We explain how to book and what your plan may charge. Please do not assume a visit costs $0.

Questions to ask your plan

• Is Alexeis Menendez-Suarez, PMHNP-BC, in network for my plan?
• Do I need a referral or prior authorization for outpatient mental health visits?
• What is my copay or coinsurance for a psychiatric evaluation and for follow-up visits by video?
• Have I met my deductible this year?

Learn more about Medicare care with Alexeis and how deductibles, copays and coinsurance work.