Does Medicare Pay for a Therapist?

Mental health support is an important aspect of overall well-being, and many individuals seek therapy to address various emotional and psychological needs. For those enrolled in Medicare, understanding the scope of benefits for mental health care is key to accessing needed support without unexpected financial burdens.

Medicare Part B Coverage for Mental Health Services

Medicare Part B, which is medical insurance, provides coverage for a wide range of outpatient mental health services. These services are typically received outside of a hospital setting, such as in a doctor’s office, clinic, or community mental health center. Part B covers medically necessary diagnostic evaluations and therapeutic services to treat mental health conditions.

The covered services include individual, group, and family psychotherapy sessions, where the family counseling’s primary purpose is to help with the beneficiary’s treatment. Psychiatric evaluations and medication management are also covered, along with testing to determine if current treatment is effective. Medicare Part B also covers partial hospitalization programs and intensive outpatient programs, which offer structured treatment between traditional outpatient and inpatient care.

A variety of licensed professionals can provide these services, including psychiatrists, psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician assistants. Beginning January 1, 2024, Medicare Part B expanded its coverage to include services provided by licensed marriage and family therapists and mental health counselors. For coverage, services must be deemed medically necessary to diagnose or treat a medical condition and must meet accepted standards of medical practice.

Medicare also covers certain preventive mental health services. This includes a one-time “Welcome to Medicare” preventive visit, which assesses potential risk factors for depression. An annual depression screening is also covered, provided by a primary care doctor or clinic.

Understanding Your Costs

While Medicare Part B covers many mental health services, beneficiaries are responsible for certain out-of-pocket costs. The annual Part B deductible must be met before Medicare begins to pay its share for covered services. For 2025, the Part B deductible is $257.

Once the deductible is satisfied, Medicare typically pays 80% of the Medicare-approved amount for most outpatient mental health services. The beneficiary is then responsible for the remaining 20% coinsurance. Original Medicare does not have an annual limit on out-of-pocket expenses, meaning the 20% coinsurance can accumulate without a cap.

Additional costs, known as excess charges, may apply if a healthcare provider does not accept Medicare assignment. This means the provider has not agreed to accept Medicare’s approved amount as full payment and can charge up to 15% above that amount. While rare overall, over 40% of providers who may charge excess fees are in the mental health industry.

Certain preventive services, such as the annual depression screening, are typically covered at 100% with no cost-sharing if provided by a qualified professional.

Finding a Covered Provider and Accessing Care

Finding a mental health therapist who accepts Medicare involves a few practical steps to ensure coverage and manage costs. Medicare provides an official online tool called “Physician Compare” that allows beneficiaries to search for doctors and other healthcare professionals who accept Medicare. This tool helps confirm if a provider accepts Medicare assignment, which is crucial for predictable costs.

It is generally not necessary to obtain a referral from a primary care doctor for outpatient mental health services covered by Original Medicare. However, for some specific services or if seeing a specialist outside of a primary care setting, a referral might be beneficial or required by the provider’s office. Before initiating care, confirming the provider’s billing practices and understanding the treatment plan, including its medical necessity, is advisable.

Telehealth has become an increasingly common method for accessing mental health services, and Medicare covers certain online therapy options. Through September 30, 2025, Medicare beneficiaries can receive telehealth services from any location, including their home. After this date, while some telehealth services will require beneficiaries to be in a rural medical facility, mental health services for diagnosis, treatment, or evaluation of a mental or behavioral health disorder will continue to be covered from a beneficiary’s home.

Medicare Advantage Plans and Therapy Coverage

Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare and provide an alternative way to receive Medicare benefits. These plans are legally required to cover at least the same services as Original Medicare Part A and Part B, including mental health services. This ensures that beneficiaries in Medicare Advantage plans have access to comprehensive mental health care.

A primary difference from Original Medicare is that Medicare Advantage plans often operate with provider networks, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Beneficiaries typically need to see therapists and other providers within the plan’s network to receive the lowest cost-sharing. Seeing an out-of-network provider, if allowed by the plan, usually results in higher out-of-pocket expenses.

The cost-sharing structure for mental health services can vary significantly among Medicare Advantage plans, with different copayments, deductibles, and out-of-pocket maximums compared to Original Medicare. Some plans may offer additional mental health benefits beyond what Original Medicare covers, such as wellness programs or a broader range of therapy types.

To understand specific coverage details and costs, beneficiaries should contact their Medicare Advantage plan directly or review their plan’s Evidence of Coverage document.