Does Medicare Cover Psychological Counseling?

Medicare covers psychological counseling and other mental health services. The extent of this coverage depends on the specific Medicare plan and the types of services received. Understanding these details is important for beneficiaries seeking mental health support.

Understanding Medicare’s Coverage for Psychological Counseling

Medicare covers a wide array of mental health services, including both inpatient and outpatient care. Original Medicare, comprised of Part A (Hospital Insurance) and Part B (Medical Insurance), outlines this coverage. Part B primarily covers outpatient mental health services.

Part B covers services like individual and group psychotherapy, diagnostic tests, and medication management visits. This coverage extends to services provided by licensed mental health professionals who accept Medicare assignment, including psychiatrists, psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, marriage and family therapists, and mental health counselors. Part B also covers one annual depression screening at no cost.

For more intensive needs, Medicare Part A covers inpatient mental health care when a person is admitted to a general or psychiatric hospital. Part A covers the hospital stay, including a semiprivate room, meals, and nursing care. Part B covers services provided by doctors and other healthcare professionals during the inpatient stay. In a psychiatric hospital, Part A coverage is limited to 190 days over a person’s lifetime.

Medicare also covers Partial Hospitalization Programs (PHPs) under Part B. These programs offer intensive outpatient treatment for mental health or substance use conditions, serving as an alternative to full inpatient hospitalization. To qualify, a doctor must certify that the individual would otherwise require inpatient treatment, or needs the program to prevent relapse after a recent inpatient stay, and that less intensive outpatient options are insufficient. These services must be medically necessary and provided by Medicare-approved facilities.

Financial Aspects of Mental Health Care Under Medicare

For outpatient mental health services covered under Medicare Part B, beneficiaries are responsible for a deductible and coinsurance. The annual Part B deductible for 2025 is $257. After meeting this deductible, individuals typically pay 20% of the Medicare-approved amount for most covered mental health services.

For inpatient mental health care covered by Medicare Part A, costs involve a deductible per benefit period. In 2025, the Part A inpatient hospital deductible is $1,676 per benefit period. A benefit period begins the day a person is admitted to a hospital and ends after 60 consecutive days without inpatient care. For hospital stays exceeding 60 days, coinsurance amounts apply: $419 per day for days 61 through 90, and $838 per day for lifetime reserve days (60 days total over a person’s lifetime).

Medicare Advantage Plans (Part C) are offered by private companies and must cover at least the same services as Original Medicare, including mental health care. These plans may have different cost-sharing structures, such as copayments or deductibles, and often operate with specific provider networks. Medicare Advantage plans also have an out-of-pocket spending limit, which can provide financial predictability.

Medicare Supplement Insurance, known as Medigap, can help cover some out-of-pocket costs associated with Original Medicare, such as Part A and Part B deductibles and coinsurance. Medigap plans assist with the 20% coinsurance for Part B outpatient mental health services and contribute to inpatient costs. These plans work alongside Original Medicare and do not have their own provider networks, allowing beneficiaries to see any provider who accepts Medicare.

How to Access Covered Psychological Counseling

A primary way to find Medicare-approved mental health providers is by using the official Medicare website’s provider search tool, often called Physician Compare or Care Compare. This online resource allows individuals to search for doctors, clinicians, and groups enrolled in the Medicare program.

Individuals should confirm a provider’s Medicare enrollment status before receiving services. They can also ask their primary care physician for referrals to mental health specialists. While Original Medicare generally does not require a referral for mental health services, individual providers or Medicare Advantage plans might have specific requirements.

Open communication with mental health providers about Medicare coverage and billing practices is advisable. Providers who accept Medicare assignment agree to accept the Medicare-approved amount as full payment for covered services. This limits the beneficiary’s out-of-pocket costs to the applicable deductible and coinsurance.