Does Medicare Pay for Mental Health Services?

Medicare provides substantial coverage for mental health services. This support extends across various treatment settings, from outpatient therapy to inpatient hospital stays. Understanding how Medicare structures its benefits can help individuals access the care they need.

Understanding Medicare’s Coverage Framework

Medicare’s framework for mental health coverage is divided among its different parts. Medicare Part A, Hospital Insurance, primarily covers inpatient mental health care. This includes services received during a stay in a psychiatric hospital or a general hospital for a mental health condition, encompassing room, meals, nursing care, and other services. Part A coverage is structured around benefit periods, which begin on admission and end after 60 consecutive days out of the hospital. A deductible applies per benefit period. Part A also includes 60 lifetime reserve days, usable after a 90-day benefit period is exhausted.

Medicare Part B, Medical Insurance, covers outpatient mental health services. These services include visits to mental health professionals, diagnostic tests, and certain therapy programs. Part B also covers partial hospitalization programs, which offer intensive treatment in an outpatient setting.

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), including mental health benefits. Medicare Advantage plans may offer additional benefits and often have different cost-sharing rules and network restrictions.

Medicare Part D provides prescription drug coverage. This part helps cover the cost of medications prescribed to treat conditions. Part D plans are offered by private companies and have their own formularies, deductibles, copayments, and coinsurance structures.

Specific Mental Health Services Covered

Medicare covers a broad array of mental health services. Outpatient services, covered under Medicare Part B, include individual and group psychotherapy sessions. These can be provided by licensed psychiatrists, psychologists, clinical social workers, and psychiatric nurse practitioners. Psychiatric evaluations and medication management are covered. Diagnostic tests, such as psychological testing, are also included.

Inpatient mental health services are covered by Medicare Part A when care is received in a psychiatric hospital or a general hospital. This coverage includes the costs of a semi-private room, meals, nursing services, and other hospital supplies or services during the stay. Stays in freestanding psychiatric hospitals are limited to 190 days in a person’s lifetime.

Partial Hospitalization Programs (PHPs) offer a structured, intensive treatment option for individuals who need more care than typical outpatient therapy but do not require full hospitalization. These programs, covered under Medicare Part B, provide a comprehensive set of services including group therapy, individual therapy, and medication management across several hours a day, multiple days a week.

Medicare also covers crisis intervention services. Medicare covers certain preventive screenings, such as an annual depression screening and alcohol misuse screenings. These screenings are fully covered under Part B when performed by a Medicare-approved provider.

Your Costs for Mental Health Services

Costs for mental health services under Medicare vary. For Original Medicare Part A, an inpatient mental health stay involves a deductible per benefit period. In 2025, this deductible is approximately $1,700, covering the first 60 days. After 60 days, a daily coinsurance applies, increasing after 90 days. Lifetime reserve days have their own daily coinsurance.

Medicare Part B covers outpatient mental health services. After meeting the annual Part B deductible (approximately $240 in 2025), beneficiaries pay 20% of the Medicare-approved amount for most services. This 20% coinsurance applies to visits with psychiatrists, psychologists, clinical social workers, and partial hospitalization programs. Preventive mental health services, like annual depression screenings, are covered at 100% if provided by a Medicare-approved provider.

Medicare Part D costs for prescription medications vary depending on the specific plan. Part D plans have an annual deductible, which beneficiaries must pay before the plan begins to cover costs. After the deductible, beneficiaries pay a copayment or coinsurance for their medications until they reach the initial coverage limit. Once this limit is reached, beneficiaries enter the coverage gap, often called the “donut hole,” where they may pay a higher percentage of drug costs until they reach the catastrophic coverage phase, where out-of-pocket costs are significantly reduced.

Medicare Advantage (Part C) plans have their own cost-sharing structures, including different deductibles, copayments, and coinsurance amounts for mental health services and prescription drugs. While these plans must cover at least the same benefits as Original Medicare, their out-of-pocket costs can differ. Medicare Advantage plans have an annual out-of-pocket maximum, which limits how much a beneficiary will pay for covered services in a year.

Medigap policies, also known as Medicare Supplement Insurance, help cover some of the out-of-pocket costs not paid by Original Medicare. These policies assist with deductibles, copayments, and coinsurance amounts for both Part A and Part B mental health services. Medigap plans pay some or all of the remaining costs after Original Medicare has paid its share.

Finding Providers and Getting Care

Finding Medicare-approved mental health providers is a crucial step. Beneficiaries can use Medicare’s “Physician Compare” website to find Medicare-approved doctors and healthcare professionals. Confirm a provider accepts Medicare assignment, meaning they accept the Medicare-approved amount as full payment. Contacting the provider’s office or your Medicare Advantage plan is advisable to ensure they are in-network.

For Original Medicare, a referral from a primary care doctor is not required to see a mental health professional, as long as the professional is Medicare-approved. However, some Medicare Advantage plans require a referral before you can see a specialist, including mental health providers.

Initial evaluations and screenings can be integrated into existing Medicare benefits. The “Welcome to Medicare” preventive visit, available within the first 12 months of enrolling in Part B, and the annual “Wellness” visit are opportunities for a doctor to assess your mental health and discuss concerns.

Telehealth services are an accessible way to receive mental health care, and Medicare covers many of these services. Beneficiaries can receive individual and group psychotherapy, as well as other mental health counseling, via video or phone calls. This expanded coverage makes it easier for individuals to connect with mental health professionals.

Integrated care means that mental and physical health services are coordinated. Some primary care practices now offer mental health services directly or work closely with mental health specialists to provide comprehensive care. This approach addresses a person’s overall health needs.