Does Medicare Cover Mental Health Benefits?

Medicare is a federal health insurance program for individuals aged 65 or older, younger people with certain disabilities, and those with End-Stage Renal Disease. It covers various mental health services. Understanding this support is important for beneficiaries seeking care for conditions like depression, anxiety, or other behavioral health needs.

Understanding Medicare Mental Health Coverage

Medicare provides comprehensive coverage for mental health services across its different parts, ensuring support for both inpatient and outpatient care.

Part A (Hospital Insurance)

Part A, Hospital Insurance, covers mental health services received during an inpatient stay in a general hospital or a psychiatric hospital. Part A coverage for inpatient psychiatric hospital services has a lifetime limit of 190 days.

Part B (Medical Insurance)

Part B, Medical Insurance, covers outpatient mental health services including psychotherapy, counseling, psychiatric evaluations, medication management, diagnostic tests, partial hospitalization programs, and substance use disorder treatment. These services must be provided by Medicare-approved professionals. As of January 1, 2024, covered providers include psychiatrists, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, licensed professional counselors, and marriage and family therapists.

Medicare Advantage Plans (Part C)

Medicare Advantage Plans (Part C) are offered by private companies and must cover at least all services provided by Original Medicare (Parts A and B). Many plans offer additional mental health benefits. However, they may have different rules for accessing care, such as network requirements or referrals, so beneficiaries should review their specific plan details.

Part D (Prescription Drug Coverage)

Part D, Prescription Drug Coverage, helps cover prescription drugs for mental health conditions. These plans are offered by private companies and are generally required to cover most antidepressants, anticonvulsants, and antipsychotics. Specific drugs covered can vary by plan formulary.

Telehealth Services

Medicare covers mental health services delivered via telehealth, expanding access to care. Patients can receive behavioral and mental health services from their homes, regardless of geographic location, including via audio-only communication. The previous in-person visit requirement before an initial telehealth service has been postponed until at least September 30, 2025.

Medicare Costs for Mental Health Services

Part A Costs

Under Medicare Part A for inpatient mental health care, costs are structured around benefit periods. For 2025, the deductible for each benefit period is $1,676. After the deductible, there is no coinsurance for the first 60 days. A daily coinsurance of $419 applies for days 61 through 90, and $838 per day for each “lifetime reserve day” used after day 90, up to 60 lifetime reserve days.

Part B Costs

For outpatient mental health services covered by Medicare Part B, the 2025 annual deductible is $257. After meeting this, beneficiaries generally pay 20% of the Medicare-approved amount. Certain preventive services, such as an annual depression screening, are covered at 100% with no deductible or coinsurance if the provider accepts assignment. Additional copayments or coinsurance may apply if services are received in a hospital outpatient clinic or department.

Part C Costs

Costs for Medicare Advantage Plans (Part C) vary significantly by plan. These plans often have their own copayments, deductibles, and out-of-pocket maximums for mental health services. Beneficiaries should consult their plan documents or contact their provider to understand exact costs, as these can differ from Original Medicare. Some plans may also require prior authorizations or referrals, which can impact costs if not followed.

Part D Costs

For prescription drugs covered under Medicare Part D, costs include monthly premiums, annual deductibles, and copayments or coinsurance. The maximum annual deductible for Part D plans in 2025 is $590. After the deductible, beneficiaries typically pay a portion of the drug cost. For 2025, a $2,000 out-of-pocket spending limit for covered prescription drugs means beneficiaries pay nothing further once this amount is reached.

Medigap Policies

Medicare Supplement Insurance (Medigap policies) can help cover some out-of-pocket costs associated with Original Medicare (Parts A and B). These policies assist with deductibles, coinsurance, and copayments, including those for mental health services. Medigap policies work with Original Medicare and do not apply to Medicare Advantage Plans.

Finding Mental Health Care with Medicare

Provider Search

The official Medicare.gov website provides a “Physician Compare” tool to search for mental health professionals who accept Medicare, including psychiatrists, psychologists, and clinical social workers. Confirm that a provider accepts “Medicare assignment,” meaning they accept the Medicare-approved amount as full payment, limiting your out-of-pocket costs to the deductible and coinsurance.

Referrals and Authorizations

Beneficiaries with Original Medicare generally do not need referrals for behavioral health services. However, Medicare Advantage Plans may require referrals or prior authorizations for certain services or specialists. Contact your Medicare Advantage plan directly to understand specific requirements before receiving services, as not obtaining authorization could result in higher costs. Emergency behavioral health services are typically not subject to prior authorization.

Scheduling Appointments

Schedule an appointment with an approved provider and bring your Medicare card. Confirming coverage with the provider’s office beforehand can help prevent unexpected charges and ensure services are covered under your specific Medicare plan.

Emergency Mental Health Care

Medicare covers emergency mental health care. If experiencing a mental health crisis, seek immediate help from an emergency room or crisis center. Medicare Part B typically covers services received in a hospital’s outpatient department, including emergency psychiatric evaluations and crisis intervention. For urgent or life-threatening situations, call 911 or the 988 Suicide & Crisis Lifeline for immediate assistance.