Does Medicare Pay for Psychotherapy?

Mental well-being is a fundamental aspect of overall health. Medicare, the federal health insurance program for people aged 65 or older and certain younger people with disabilities, covers various mental health services, including psychotherapy. Understanding this coverage helps beneficiaries navigate their options and seek needed support.

Medicare Coverage for Mental Health Services

Medicare provides coverage for mental health services across different parts of its program, supporting both inpatient and outpatient care. Medicare Part A, also known as Hospital Insurance, covers inpatient mental health care received in a general hospital or a psychiatric hospital. This includes psychotherapy sessions conducted while a patient is admitted for mental health treatment, along with other services like nursing care, meals, and semi-private rooms.

Medicare Part B, or Medical Insurance, focuses on outpatient mental health services. Part B covers individual and group psychotherapy sessions provided by qualified mental health professionals, including psychiatrists, psychologists, and clinical social workers. It also covers diagnostic tests to assess a patient’s mental health condition, helping to establish a treatment plan. Family counseling sessions are covered if the primary purpose is to help with the patient’s specific treatment.

Medicare Part C, known as Medicare Advantage Plans, are offered by private companies approved by Medicare and must cover everything Original Medicare (Parts A and B) covers. While these plans provide the same mental health benefits, they may have different rules, costs, and provider networks for accessing services, including psychotherapy. Beneficiaries should review their specific plan details to understand their mental health benefits. Medicare Part D provides prescription drug coverage for mental health conditions, but does not cover psychotherapy. For any mental health service to be covered, it must be “medically necessary,” meaning a provider determines the services are needed to diagnose or treat a medical condition.

Understanding Your Out-of-Pocket Costs

For outpatient mental health services under Medicare Part B, an annual deductible applies before Medicare pays. In 2025, the standard Part B deductible is $240. Once met, Medicare pays 80% of the Medicare-approved amount for most outpatient mental health services, with the beneficiary responsible for the remaining 20% coinsurance.

This 20% coinsurance applies to services from psychiatrists, psychologists, and clinical social workers. Certain services or settings may also involve specific copayments, which are fixed amounts paid for a service. For instance, an initial psychiatric evaluation may have a copayment, and subsequent therapy sessions will incur the 20% coinsurance.

Costs differ with Medicare Advantage (Part C) plans, as these plans establish their own cost-sharing rules. A Medicare Advantage plan might have specific copayments for each therapy session (e.g., $20-$50 per visit) or a different deductible structure than Original Medicare. These plans often have preferred provider networks, and receiving care outside the network could result in higher out-of-pocket costs or no coverage.

Medigap, or Medicare Supplement Insurance, can help cover some of the out-of-pocket costs associated with Original Medicare, such as the Part B coinsurance and deductible. Beneficiaries should always ask their mental health provider if they “accept assignment,” meaning the provider agrees to accept the Medicare-approved amount as full payment. Providers who do not accept assignment can charge up to 15% more than the Medicare-approved amount, known as the “excess charge,” which the beneficiary is responsible for.

Navigating Covered Psychotherapy Services

Accessing Medicare-covered psychotherapy involves several practical steps. Finding a qualified mental health professional who accepts Medicare is a primary consideration. Beneficiaries can use the “Physician Compare” tool on Medicare.gov, which allows searches for doctors and other healthcare providers who accept Medicare. Primary care doctors can also provide referrals to mental health specialists. Local mental health organizations and community clinics may also offer resources or lists of Medicare-participating providers.

For outpatient mental health services under Original Medicare Part B, a referral from a primary care physician is not required to see a mental health professional. However, some Medicare Advantage plans may require a referral, especially for specialists or specific types of services. Always check with your Medicare Advantage plan, as their rules can vary. The initial visit with a mental health professional involves an intake and assessment of your mental health needs. During this visit, the provider will gather information about your history, symptoms, and goals to develop a personalized treatment plan.

Before receiving any psychotherapy services, confirm coverage and participation with the provider’s office. Beneficiaries should verify that the mental health professional accepts Medicare and, if applicable, participates in their specific Medicare Advantage plan. This step helps prevent unexpected costs and ensures services will be covered according to Medicare’s guidelines. Understanding these aspects helps beneficiaries utilize their Medicare benefits.

References

Medicare.gov. (n.d.). Mental health care (outpatient). Retrieved August 3, 2025, from https://www.medicare.gov/coverage/mental-health-care-outpatient
Medicare.gov. (n.d.). Find & compare doctors, hospitals & other providers. Retrieved August 3, 2025, from https://www.medicare.gov/care-compare/
Centers for Medicare & Medicaid Services. (2024, November 13). CMS announces 2025 Medicare premiums, deductibles, and coinsurance amounts. Retrieved August 3, 2025, from https://www.cms.gov/newsroom/press-releases/cms-announces-2025-medic…