Does Medicare Pay for Psychologist?
Demystify Medicare's coverage for psychologist services. Learn about your benefits, financial responsibilities, and how to find care.
Medicare, a federal health insurance program, provides coverage for individuals aged 65 or older, along with certain younger people who have disabilities or specific medical conditions. This program helps manage healthcare expenses. Mental health services are an important component of overall well-being, and Medicare aims to ensure beneficiaries can access necessary support for these needs.
Understanding Medicare Mental Health Coverage
Medicare offers coverage for mental health services through different parts of the program, depending on where care is received. Outpatient mental health services, including visits to a psychologist, are primarily covered under Medicare Part B, which is Medical Insurance. Part B assists with costs for services typically obtained outside of a hospital, such as in a doctor’s office, therapist’s office, hospital outpatient department, or community mental health center. This component of Medicare broadly covers various medical services and supplies deemed medically necessary.
Inpatient mental health care falls under Medicare Part A, or Hospital Insurance. Part A covers services received when an individual is admitted to a hospital, whether general or psychiatric. While Part A addresses costs associated with hospital stays, including room, meals, and nursing care, seeking assistance from a psychologist for ongoing therapy or evaluation usually involves outpatient settings, making Part B the relevant coverage area.
Conditions for Coverage and Covered Services
For Medicare to cover mental health services from a psychologist, services must be medically necessary for the diagnosis or treatment of a mental health condition. Medicare covers services from various licensed professionals, including clinical psychologists, psychiatrists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician assistants. As of January 1, 2024, licensed marriage and family therapists and mental health counselors can also enroll in Medicare and be reimbursed for their services.
A referral from a primary care doctor is generally not required for outpatient mental health services under Original Medicare. However, if a beneficiary has a Medicare Advantage (Part C) plan, that plan might have its own rules regarding referrals or prior authorizations. Medicare Part B covers a range of specific services provided by a psychologist, including:
Individual and group psychotherapy
Diagnostic tests to assess mental health conditions
Psychiatric evaluations
Family counseling, if its primary purpose is to help with the beneficiary’s treatment
One annual depression screening at no cost if received in a primary care doctor’s office or clinic that can provide follow-up care
Out-of-Pocket Costs for Mental Healthcare
Beneficiaries utilizing Medicare Part B for mental health services are responsible for certain out-of-pocket costs. Before Medicare begins to pay for covered services, an annual Part B deductible must be met. For 2025, this deductible is $257. Once this deductible has been satisfied, beneficiaries typically pay a coinsurance amount, which is a percentage of the Medicare-approved amount. For most outpatient mental health services, this coinsurance is 20% of the Medicare-approved amount.
The cost can also be influenced by whether the psychologist accepts “assignment.” Accepting assignment means the provider agrees to accept the Medicare-approved amount as full payment for the service and will not bill the beneficiary for more than the deductible and coinsurance. Almost all doctors and hospitals in the U.S. accept Original Medicare, and providers who participate in Part B must accept assignment. If a psychologist does not accept assignment, they may charge more than the Medicare-approved amount, though there are limits to how much extra they can charge.
For mental health services requiring an inpatient hospital stay, different costs apply. The Part A deductible for 2025 is $1,676 per benefit period. A benefit period begins when admitted to a hospital and ends after 60 consecutive days out of the hospital. For stays longer than 60 days within a benefit period, a daily coinsurance applies, such as $419 per day for days 61-90 in 2025. Medicare Part A also has a lifetime limit of 190 days for inpatient care in a freestanding psychiatric hospital.
Finding Medicare-Approved Psychologists
Locating a psychologist who accepts Medicare involves several practical steps to ensure coverage for services. A primary resource for finding Medicare-enrolled healthcare providers is the official Medicare.gov website. The “Physician Compare” tool on this site allows users to search for and compare clinicians and groups who participate in Medicare. This tool can help identify psychologists in a specific geographic area.
It is always advisable to directly contact the psychologist’s office to confirm their participation in Medicare and inquire if they accept assignment. Confirming this information upfront can prevent unexpected costs and ensure that Medicare benefits will apply to the services rendered. Additionally, an individual’s primary care physician can be a valuable resource for referrals to mental health professionals within the Medicare network. These steps help beneficiaries navigate their options and connect with appropriate mental health support.