Does Medicare Cover Family Counseling?

Medicare, a federal health insurance program for people aged 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease, provides access to mental health services. Understanding how Medicare addresses mental health is important for eligible individuals. The program recognizes that mental health conditions require diagnosis and treatment to promote overall well-being.

Medicare Mental Health Coverage

Medicare covers a wide array of mental health services. Medicare Part B, Medical Insurance, is the primary source for outpatient mental health care. This includes visits with professionals such as psychiatrists, psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, and, as of 2025, licensed marriage and family therapists and mental health counselors. Part B covers diagnostic tests, individual and group psychotherapy, medication management, and annual depression screenings.

Medicare Part A, Hospital Insurance, covers inpatient mental health care. This includes services received during a stay in a general hospital or a psychiatric hospital. For care in a psychiatric hospital, Part A has a lifetime limit of 190 days. Medicare Advantage Plans (Part C), offered by private companies, must cover at least all services Original Medicare (Parts A and B) covers. These plans may offer additional mental health benefits, but can have different rules, costs, and provider networks.

Family Counseling Under Medicare

Medicare generally covers family counseling services when they are a medically necessary component of a beneficiary’s mental health treatment plan. The counseling must directly relate to the beneficiary’s diagnosed mental health condition and its treatment, not solely for general family or marital therapy. The primary purpose must be to improve the Medicare beneficiary’s mental health, with other family members participating to support that care. For example, counseling might help family members understand the beneficiary’s condition, improve communication, or address family dynamics affecting the beneficiary’s mental health stability.

Services must be provided by a Medicare-approved, licensed mental health professional who can bill Medicare. This includes psychiatrists, psychologists, clinical social workers, or, beginning in 2025, licensed marriage and family therapists and mental health counselors. Medicare coverage for family counseling centers on the beneficiary’s treatment. It typically does not cover individual therapy for other family members unless they are also Medicare beneficiaries with their own medical necessity. The facility must also accept Medicare assignment for coverage to apply.

Costs and Finding Services

For outpatient mental health care covered under Medicare Part B, after meeting the annual Part B deductible, beneficiaries typically pay 20% of the Medicare-approved amount. The standard Part B deductible for 2025 is $257. For example, if a therapy session’s Medicare-approved amount is $100, Medicare pays $80, and the beneficiary pays $20 after the deductible is met.

Medicare Advantage plans may have different cost-sharing arrangements, like copayments or deductibles, and often require using in-network providers. Individuals with Medicare Advantage plans should contact their plan directly to understand specific costs and network requirements. Medigap policies, also known as Medicare Supplement Insurance, can help cover Part B coinsurance and deductibles, reducing out-of-pocket expenses for covered mental health services.

To find Medicare-approved mental health providers, beneficiaries can ask their primary care physician for a referral. The “Physician Compare” tool on Medicare.gov also allows individuals to search for and compare doctors and other clinicians. Always confirm with providers upfront if they accept Medicare assignment and if the specific family counseling service is likely to be covered based on medical necessity.