Does Medicare Pay for a Psychiatrist?

Medicare offers coverage for psychiatric services, providing financial assistance for various mental health treatments. The specific coverage and associated costs depend on an individual’s Medicare plan.

Medicare Coverage for Psychiatric Services

Medicare Part B covers a range of outpatient mental health services. These services include visits with psychiatrists, psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician assistants. Beginning January 1, 2024, marriage and family therapists and mental health counselors are also covered. Part B covers individual and group therapy, psychiatric evaluations, diagnostic tests, and medication management.

An annual depression screening is available at no cost if the healthcare provider accepts Medicare assignment. Part B also covers intensive outpatient programs, sometimes referred to as partial hospitalization programs, which offer structured treatment as an alternative to inpatient care. For coverage to apply, all services must be medically necessary and provided by a healthcare professional enrolled in Medicare.

Medicare Part A covers inpatient mental health care. This includes stays in a general hospital or a psychiatric hospital, which is a facility specifically for mental health treatment. Part A covers the costs of the room, meals, nursing care, laboratory tests, and medications received during an inpatient stay. There is a lifetime limit of 190 days for inpatient care received in a freestanding psychiatric hospital. However, there is no lifetime limit for inpatient mental health care received in a general hospital.

Medicare Advantage Plans, also known as Part C, are offered by private companies approved by Medicare. These plans must provide at least the same coverage as Original Medicare (Parts A and B). Many Medicare Advantage plans may offer additional benefits, such as expanded telehealth services for mental health care. Beneficiaries enrolled in a Medicare Advantage plan typically receive services from providers within the plan’s network.

Outpatient prescription drugs for mental health conditions are generally covered under Medicare Part D. This includes medications like antidepressants, antipsychotics, and anti-anxiety drugs. The specific drugs covered and the associated costs can vary widely among different Part D plans.

Understanding Your Financial Responsibility

Beneficiaries with Original Medicare (Parts A and B) have specific financial obligations for psychiatric services. For outpatient mental health care covered under Part B, individuals must first meet an annual deductible, which is $257 in 2025. After the deductible is satisfied, Medicare typically pays 80% of the Medicare-approved amount for most outpatient services, leaving the individual responsible for the remaining 20% coinsurance.

For inpatient mental health care covered under Part A, a deductible applies per benefit period. In 2025, this deductible is $1,676. After meeting this deductible, there is no coinsurance for the first 60 days of an inpatient stay within a benefit period. For longer stays, a daily coinsurance applies: $419 per day for days 61 through 90, and $838 per day for lifetime reserve days. Individuals are responsible for all costs once their lifetime reserve days are depleted.

Medicare Advantage plans (Part C) have different cost-sharing structures, which can include varying deductibles, copayments, and coinsurance amounts for mental health services. These plans also have an annual out-of-pocket limit for Part A and Part B services. In 2024, the average out-of-pocket limit for in-network services was $4,882, and $8,707 for combined in-network and out-of-network services in PPO plans.

Costs associated with prescription drugs under Part D include deductibles, copayments, and coinsurance, which vary based on the specific plan chosen. Some beneficiaries may also encounter a coverage gap, often referred to as the “donut hole,” where they pay a higher percentage for their medications until they reach a certain spending threshold.

Supplemental insurance, known as Medigap policies, can help cover some of the out-of-pocket costs associated with Original Medicare. These policies are sold by private companies and can assist with deductibles, copayments, and coinsurance for Part A and Part B services. The specific expenses covered by a Medigap policy depend on the plan selected.

Finding a Medicare-Accepting Psychiatrist

One primary resource is the official Medicare Physician Compare tool, which allows individuals to search for healthcare providers who accept Medicare. If enrolled in a Medicare Advantage plan, beneficiaries should consult their plan’s specific provider directory to find in-network psychiatrists.

A participating provider agrees to accept the Medicare-approved amount as full payment for services, meaning they accept Medicare assignment. Non-participating providers can still treat Medicare beneficiaries but are permitted to charge up to 15% more than the Medicare-approved amount, known as an “excess charge.”

When scheduling an appointment with a psychiatrist, it is advisable to confirm their Medicare acceptance and whether they are a participating provider to understand potential out-of-pocket costs. For those with Medicare Advantage plans, it is also important to inquire about any referral requirements. While Original Medicare generally does not require referrals for mental health services, Medicare Advantage plans may have specific rules regarding referrals for specialty care.