Does Medicare Pay for Mental Health?

Medicare is a federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease. Medicare provides coverage for a range of mental health services. Understanding this coverage helps beneficiaries access needed support.

Medicare Parts and Mental Health Coverage

Medicare’s structure involves different parts, each contributing to mental health coverage in distinct ways.

Medicare Part A, Hospital Insurance, covers inpatient mental health care services. This includes stays in a general hospital or a psychiatric hospital. Part A has a lifetime limit of 190 days for inpatient psychiatric hospital services. A benefit period begins the day of inpatient admittance and ends after 60 consecutive days without inpatient hospital care.

Medicare Part B addresses outpatient mental health services. This includes visits with mental health professionals like psychiatrists, psychologists, clinical social workers, and nurse practitioners. Part B also covers partial hospitalization programs, which offer intensive outpatient treatment as an alternative to inpatient care. Additionally, Part B covers diagnostic tests and preventive services like annual depression screenings.

Medicare Part C, Medicare Advantage Plans, are offered by private companies approved by Medicare. These plans must cover at least the same services as Original Medicare (Parts A and B). Medicare Advantage plans often include additional benefits beyond Original Medicare. However, these plans may have different cost-sharing rules and provider networks than Original Medicare.

Medicare Part D provides prescription drug coverage. These plans cover medications used to treat mental health conditions, such as antidepressants, antipsychotics, and anti-anxiety medications. Each Part D plan has its own list of covered drugs, known as a formulary, but Medicare mandates coverage for certain categories of psychiatric medications.

Specific Mental Health Services Covered

Medicare covers a broad spectrum of mental health services to address various needs.

Under Part B, outpatient services include individual and group psychotherapy sessions provided by qualified professionals. Psychiatric evaluations and medication management are also covered. Family counseling is covered if its primary purpose is to help treat the beneficiary’s mental health condition.

Diagnostic tests and certain screenings, such as an annual depression screening, are covered under Part B. Part B also covers services for substance use disorders, including counseling and therapy.

Inpatient mental health services, covered by Part A, include a semiprivate room, meals, general nursing care, therapy sessions, and medications administered in the hospital. This care can be provided in either a general hospital or a specialized psychiatric hospital.

Partial Hospitalization Programs (PHPs) offer a structured outpatient treatment option for individuals who require intensive mental health care but do not need 24-hour inpatient supervision. These programs typically involve several hours of treatment per day, multiple days a week, in a hospital outpatient department or community mental health center.

Costs for Mental Health Care

Beneficiaries incur various out-of-pocket costs for mental health services under Medicare, which vary depending on the Medicare part and the specific services received.

For inpatient mental health care under Part A, beneficiaries are responsible for a deductible per benefit period. In 2025, this deductible is $1,676. After meeting the deductible, there is no coinsurance for the first 60 days of an inpatient stay within a benefit period. A daily coinsurance applies for days 61-90, which is $419 per day in 2025, and higher daily coinsurance for lifetime reserve days beyond 90 days.

For outpatient mental health services under Part B, beneficiaries pay a deductible before Medicare covers costs. The Part B deductible for 2025 is $257. After the deductible is met, Medicare pays 80% of the Medicare-approved amount for most outpatient mental health services, with the beneficiary responsible for the remaining 20% coinsurance. Certain preventive services, such as the annual depression screening, are covered at 100% if the provider accepts assignment. If services are received in a hospital outpatient clinic, an additional copayment or coinsurance may be required by the hospital.

Costs for mental health care under Medicare Part C vary significantly by plan. These plans may have different premiums, deductibles, copayments, and coinsurance amounts for mental health visits. All Medicare Advantage plans include an annual out-of-pocket maximum, which limits how much a beneficiary must pay for covered services in a year.

Medicare Part D costs for prescription drugs used in mental health treatment vary by plan and the specific drug’s tier on the plan’s formulary. Beneficiaries may pay a deductible, copayments, or coinsurance for their medications. Some plans may have different cost-sharing for generic versus brand-name drugs.

Accessing Mental Health Care

Finding and accessing mental health care under Medicare involves several practical considerations.

Beneficiaries can locate mental health professionals who accept Medicare by using Medicare’s online provider search tool. Asking current doctors for referrals can also be a helpful way to find qualified providers. Mental health organizations often provide resources for finding local services that accept Medicare.

For Original Medicare Part B, a referral from a primary care doctor is not required to see a mental health professional. However, some Medicare Advantage plans or specific services might require a referral. Many providers are now offering integrated care, which combines physical and mental health services in one setting, facilitating a more holistic approach to health.

Telehealth services have expanded under Medicare, improving access to mental health care, especially for those in rural areas or with mobility challenges. Medicare covers many mental health services provided via telehealth, allowing beneficiaries to receive care from their home through video or phone calls.