Does Medicare Pay for a Therapist?

Medicare, a federal health insurance program, provides coverage for individuals aged 65 and older, along with certain younger people who have specific disabilities or health conditions. Its primary objective is to help manage healthcare costs for eligible beneficiaries. The program broadly covers various medical services, including therapy, supporting both physical and mental well-being. Understanding Medicare’s provisions assists beneficiaries in accessing necessary therapeutic care.

Types of Therapy Covered by Medicare

Medicare covers a range of therapy services when deemed medically necessary and provided by licensed or certified professionals. This includes mental health services like psychotherapy (talk therapy) for individual, group, and family sessions. Psychiatric evaluations and other outpatient mental health care services are also covered.

Beyond mental health, Medicare extends coverage to various rehabilitative therapies. Physical therapy aims to improve or restore physical function for those with injury or illness. Occupational therapy helps individuals regain the ability to perform daily living activities independently. Speech-language pathology services address communication and swallowing disorders.

These therapies require a certification of necessity from a doctor, indicating medical appropriateness. Services must be delivered by qualified healthcare professionals who meet state licensing requirements and accept Medicare.

Medicare Parts and Their Coverage

Medicare is structured into different parts, each covering distinct types of healthcare services, including therapy. Medicare Part A, Hospital Insurance, primarily covers inpatient mental health care. This includes services received when admitted to a general hospital or a psychiatric hospital, covering room, meals, therapy, and other treatments during a hospital stay.

A lifetime limit of 190 days applies for mental health services received in a psychiatric hospital under Part A; there is no such limit for care in a general hospital. Services from doctors during an inpatient stay may fall under Medicare Part B.

Medicare Part B, Medical Insurance, covers outpatient mental health services, physical therapy, occupational therapy, and speech-language pathology services. This includes visits to psychiatrists, psychologists, clinical social workers, and other mental health professionals for psychotherapy. Part B also covers partial hospitalization and intensive outpatient programs.

Medicare Advantage Plans (Part C) are offered by private insurance companies approved by Medicare. These plans must cover at least everything Original Medicare (Parts A and B) covers, but often have different rules, networks, and cost structures. Medicare Advantage plans may also offer additional benefits. Beneficiaries should check their specific plan for coverage details.

Understanding Your Costs for Therapy

Beneficiaries with Original Medicare (Parts A and B) are responsible for certain out-of-pocket costs for therapy services. For outpatient therapy covered under Medicare Part B, an annual deductible applies before Medicare pays. In 2025, the Medicare Part B annual deductible is $257. After this deductible is met, individuals pay 20% of the Medicare-approved amount for most physician services, therapies, and durable medical equipment.

If services are received in a hospital outpatient clinic or department, an additional copayment or coinsurance amount may be due. While there is no longer a hard limit on how much Medicare pays for medically necessary outpatient therapy services, claims exceeding certain thresholds may be subject to targeted medical review to confirm medical necessity.

Medicare Supplement Insurance, or Medigap plans, can help cover some out-of-pocket costs associated with Original Medicare. These plans are sold by private carriers and assist with expenses like copayments, coinsurance, and deductibles. Medicare Advantage plans often have their own cost-sharing structures, which may include fixed copayments for visits rather than a 20% coinsurance.

Finding and Accessing Medicare-Covered Therapists

Locating a therapist who accepts Medicare involves several steps. The official Medicare website offers a Physician Compare tool where beneficiaries can search for doctors and clinicians, including therapists, by entering their zip code or address. This tool allows filtering by provider type, such as psychiatrists, clinical psychologists, or clinical social workers, and can indicate if the provider offers telehealth services.

For those with Medicare Advantage plans, consult the plan’s specific directory or contact them directly to find in-network providers. Medicare Advantage plans often have their own network requirements, which may differ from Original Medicare. While Original Medicare generally does not require a referral for therapy, Medicare Advantage plans, particularly HMOs, may mandate a referral from a primary care doctor.

Once a suitable provider is identified, schedule an initial consultation to confirm Medicare acceptance and discuss the plan of care. Therapists must establish a written plan of care, certified by a physician or other qualified provider, outlining the diagnosis, goals, frequency, and duration of therapy. Telehealth options have expanded, and Medicare Part B and Medicare Advantage plans cover online therapy services, allowing beneficiaries to receive care remotely.