Does Medicare Cover Psychiatrists and Mental Health Care?

Medicare, the federal health insurance program for individuals aged 65 or older and certain younger people with disabilities, provides coverage for psychiatric care. This includes a range of services to help beneficiaries manage their mental health conditions.

Medicare Coverage for Mental Health Services

Medicare covers mental health services through its different parts, addressing both inpatient and outpatient needs. Understanding how each component functions clarifies the scope of available benefits.

Medicare Part A, known as Hospital Insurance, provides coverage for inpatient mental health care received in a general hospital or a psychiatric hospital. This includes a semi-private room, meals, nursing services, and medications during the inpatient stay. While there is no limit to benefit periods for mental health care in a general hospital, a lifetime limit of 190 days applies to inpatient psychiatric hospital stays.

Medicare Part B, or Medical Insurance, covers outpatient mental health services. This covers visits with psychiatrists, clinical psychologists, clinical social workers, clinical nurse specialists, and other qualified mental health professionals. Services include psychiatric evaluations, individual and group therapy, and medication management. Part B also covers partial hospitalization programs, which offer intensive outpatient treatment as an alternative to full hospitalization, and mental health care in rural health clinics and federally qualified health centers.

Prescription medications for mental health conditions are covered under Medicare Part D, the Prescription Drug Coverage. Offered by private companies approved by Medicare, Part D plans cover certain protected drug classes, including antidepressants, antipsychotics, and anticonvulsants.

Medicare Advantage Plans, also known as Part C, are offered by private companies and combine Part A and Part B benefits, often include Part D. These plans must cover the same mental health services as Original Medicare (Parts A and B). They may offer additional benefits, but their rules, costs, and provider networks can differ from Original Medicare.

Understanding Your Costs for Psychiatric Care

Accessing psychiatric care under Medicare involves various costs, including deductibles, copayments, and coinsurance, which differ based on the type of Medicare coverage. Understanding these financial responsibilities is important for managing healthcare expenses.

Under Original Medicare, costs for inpatient mental health services covered by Part A involve a deductible per benefit period, which is $1,676 in 2025. After meeting this deductible, beneficiaries pay $0 coinsurance for the first 60 days. For days 61 through 90, a daily coinsurance of $419 applies in 2025. Beyond day 90, lifetime reserve days can be used with a daily coinsurance of $838, after which the beneficiary is responsible for all costs.

For outpatient mental health services covered by Part B, beneficiaries must first meet the annual Part B deductible, which is $257 in 2025. After meeting the deductible, Medicare pays 80% of the Medicare-approved amount for most services, leaving the beneficiary responsible for the remaining 20% coinsurance. Services received in a hospital outpatient clinic or department may also incur an additional copayment or coinsurance to the hospital.

Medicare Part D plans have their own cost structure for prescription drugs, including deductibles, copayments, and coinsurance. In 2025, the maximum deductible for a Part D plan is $590, though some plans may have a lower or zero deductible. Once the deductible is met, beneficiaries enter an initial coverage period where they pay 25% of their prescription drug costs. In 2025, the “donut hole” or coverage gap is eliminated, and an annual out-of-pocket spending cap of $2,000 applies for covered drugs. Once this out-of-pocket limit is reached, beneficiaries enter the catastrophic coverage phase and pay nothing for covered Part D drugs for the remainder of the year.

For those enrolled in Medicare Advantage plans, costs like premiums, deductibles, copayments, and coinsurance can vary between plans. These plans also have an annual out-of-pocket maximum, which limits how much beneficiaries will pay for covered services in a year. Medicare Supplement Insurance, also known as Medigap, can help cover out-of-pocket costs that Original Medicare does not pay, such as deductibles, copayments, and coinsurance for mental health services.

Locating Covered Psychiatric Professionals

Finding mental health professionals who accept Medicare is a practical step for beneficiaries seeking psychiatric care. Several resources and considerations can streamline this process.

The official Medicare website, Medicare.gov, offers a “Find & Compare” tool that allows beneficiaries to search for doctors and other healthcare providers, including psychiatrists and mental health professionals, who accept Medicare. It helps identify providers and ensure they participate in Medicare.

An important concept when selecting a provider is “accepting assignment.” This means the provider agrees to accept the Medicare-approved amount as full payment for covered services. Providers who accept assignment cannot charge beneficiaries more than the Medicare deductible and applicable coinsurance or copayment amounts. If a provider does not accept assignment, they may charge up to 15% more than the Medicare-approved amount, known as “excess charges,” which the beneficiary would be responsible for paying.

For individuals with Medicare Advantage plans, finding an in-network mental health professional requires consulting the specific plan’s provider directory or contacting their customer service. Medicare Advantage plans often have network restrictions, and services received outside the network may result in higher out-of-pocket costs or may not be covered at all.

Telehealth services have expanded access to mental health care, and Medicare covers certain mental health telehealth services. Beneficiaries can receive mental health care from their homes using audio and video communication technology. While some temporary flexibilities related to telehealth are set to expire, mental health services delivered via telehealth in a patient’s home are permanently covered.