Does Medicare Cover Therapy for Depression?

Medicare, a federal health insurance program, provides coverage for millions of Americans, primarily those aged 65 or older, along with certain younger individuals with disabilities. Understanding healthcare coverage for mental health conditions like depression is a common concern for many beneficiaries. The program recognizes the importance of mental well-being and offers various options for accessing therapy and related services. This article explores how Medicare covers therapy for depression, detailing core benefits, the role of supplemental plans, and guidance on finding appropriate care.

Medicare’s Core Coverage for Mental Health

Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), provides a foundation for mental health coverage. Part A primarily covers inpatient mental health care during a hospital stay. This includes care in a general hospital, a psychiatric hospital, or another medical facility, encompassing room and board, nursing services, and diagnostic tests within the hospital setting.

For 2025, the Part A deductible for each benefit period is $1,676. After meeting this deductible, beneficiaries typically pay $0 coinsurance for days 1-60, $419 per day for days 61-90, and $838 per day for lifetime reserve days (up to 60 days). A benefit period begins the day a patient is admitted as an inpatient and ends when they have been out of the hospital for 60 consecutive days. Psychiatric hospital stays have a lifetime limit of 190 days under Part A.

Medicare Part B is the primary component for outpatient mental health services, often utilized for depression therapy. This includes individual and group therapy sessions, family counseling if it benefits the patient’s treatment, diagnostic tests, and medication management. Services from a range of mental health professionals are covered, including:
Psychiatrists
Psychologists
Clinical social workers
Clinical nurse specialists
Physician assistants
Mental health counselors
Marriage and family therapists

These providers must be enrolled in Medicare and accept Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment.

Costs associated with Part B mental health services include an annual deductible and coinsurance. For 2025, the annual Part B deductible is $257. After this deductible is met, beneficiaries typically pay 20% of the Medicare-approved amount for most outpatient mental health services. If services are received in a hospital outpatient clinic, an additional copayment or coinsurance may apply. An annual depression screening is covered at 100% under Part B, with no cost-sharing, if performed by a primary care provider who accepts assignment.

How Medicare Advantage and Medigap Affect Coverage

Beyond Original Medicare, beneficiaries can choose alternative and supplemental plans that influence their mental health coverage and out-of-pocket costs. Medicare Advantage (MA) plans, also known as Medicare Part C, are offered by private companies approved by Medicare. These plans must cover at least the same services as Original Medicare Parts A and B, including mental health care. MA plans often have different cost-sharing structures compared to Original Medicare, such as copayments for visits rather than a 20% coinsurance, and they include an annual out-of-pocket maximum.

Understanding the specific rules of a Medicare Advantage plan is important, as they can vary significantly. Many plans operate with network restrictions, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), which may require beneficiaries to see providers within the plan’s network for the lowest costs. Some plans may also require referrals from a primary care physician to see a mental health specialist. Medicare Advantage plans often bundle prescription drug coverage (Part D) and may offer extra benefits not covered by Original Medicare, such as telehealth services for mental health.

Medigap, or Medicare Supplement Insurance, provides another option for managing out-of-pocket costs. These policies are sold by private companies and help cover some of the expenses that Original Medicare does not, such as deductibles, copayments, and coinsurance. A Medigap plan can help pay the 20% coinsurance for Part B mental health services, thereby reducing a beneficiary’s out-of-pocket expenses for therapy. Medigap policies work in conjunction with Original Medicare; once Medicare pays its share, the Medigap policy pays its portion. However, Medigap plans do not cover prescription drugs (under Medicare Part D) or offer additional benefits beyond supplementing Original Medicare.

Finding Mental Health Care Providers Under Medicare

Locating mental health professionals who accept Medicare and understanding specific coverage details is a practical step for beneficiaries. Official Medicare resources, such as the “Care Compare” tool on Medicare.gov, allow individuals to search for doctors and other health professionals who accept Medicare. If enrolled in a Medicare Advantage plan, beneficiaries should also consult their plan’s specific provider directory to ensure the provider is in-network.

Before an appointment, confirm directly with the provider’s office that they accept Medicare. It is also important to verify if the provider “accepts assignment,” which signifies their agreement to accept the Medicare-approved amount as full payment for services. If a provider does not accept assignment, they may charge more than the Medicare-approved amount, and the beneficiary would be responsible for the difference, known as an “excess charge.”

Understanding potential out-of-pocket costs, including deductibles, copayments, or coinsurance, is another important discussion to have with the provider’s billing office or the Medicare Advantage plan before beginning therapy. Some Medicare Advantage plans, particularly HMOs, may require a referral from a primary care physician before seeing a mental health specialist. Confirming these logistical details in advance can help ensure a smooth process for accessing needed mental health care.