Does Medicare Cover Psychologist Services?

Medicare covers many mental health services, including those offered by licensed psychologists, under specific conditions. Understanding this coverage helps beneficiaries access support for their mental well-being. This overview clarifies how Medicare addresses mental health services, financial aspects, and how to locate providers.

Understanding Medicare’s Mental Health Coverage

Medicare Part B, the medical insurance component, primarily covers outpatient mental health services. These services are received outside a hospital setting, such as in a doctor’s office, clinic, or therapist’s office. Clinical psychologists are among the health professionals whose services are covered under Part B.

Specific types of psychological services typically covered by Medicare Part B include individual and group psychotherapy sessions. Diagnostic tests and evaluations designed to assess mental health conditions are also covered. Family counseling can be included if its primary purpose is to aid in the patient’s treatment.

While psychologists generally do not prescribe medication, medication management services, when provided by a psychiatrist or other prescribing medical doctor, are covered. Additionally, Medicare Part B covers one depression screening annually, provided in a primary care doctor’s office or clinic that offers follow-up treatment.

Medicare Part A (Hospital Insurance) covers inpatient mental health services received in a general or psychiatric hospital. A lifetime limit of 190 days applies to services in a dedicated psychiatric hospital. Services generally not covered include marriage counseling, if not directly related to a treated condition, and personal comfort items.

Costs and Conditions for Psychologist Services

Beneficiaries receiving outpatient mental health services under Medicare Part B have financial responsibilities. After meeting the annual Medicare Part B deductible ($257 in 2025), patients typically pay 20% of the Medicare-approved amount. Medicare pays the remaining 80%.

Seek services from a psychologist who “accepts assignment.” This means the provider agrees to accept the Medicare-approved amount as full payment and bills Medicare directly. This generally results in lower out-of-pocket costs, as they cannot charge more than the deductible and coinsurance.

Covered services must be medically necessary, meaning they are appropriate for diagnosing or treating a mental health condition. The psychologist providing services must also be licensed in their state and enrolled in Medicare.

Under Original Medicare, a referral from a primary care physician is generally not required for outpatient mental health services. A referral can be beneficial for coordinated care, though some Medicare Advantage plans may have specific requirements. There are no specific limits on covered mental health visits, provided they remain medically necessary.

Finding and Utilizing Covered Services

Finding a psychologist who accepts Medicare involves a few steps. Use the “Find a Doctor” tool on the official Medicare website to locate Medicare-enrolled providers in your area. You can also call Medicare directly for assistance or consult your primary care physician for recommendations.

Before your first appointment, it is advisable to confirm that the psychologist is enrolled in Medicare and accepts assignment. This ensures that your services will be covered and helps you understand your potential out-of-pocket costs. Asking the provider’s office about billing procedures and estimated costs beforehand can prevent surprises.

When you receive services, always have your Medicare card ready. After your appointments, Medicare will send an Explanation of Benefits (EOB) detailing the services received, the Medicare-approved amount, what Medicare paid, and what you owe. Reviewing these statements helps you track your deductible and coinsurance obligations.