How Does Medicare Cover Psychiatry Services?

Medicare, a federal health insurance program, provides coverage for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease. Understanding how Medicare covers mental health services, particularly psychiatry, is a frequent concern for many beneficiaries.

Outpatient Mental Health Coverage Under Original Medicare

Original Medicare Part B, which is medical insurance, broadly covers outpatient mental health services. This includes care from professionals such as psychiatrists, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician assistants. Licensed marriage and family therapists and mental health counselors also receive reimbursement for their services.

Part B covers a variety of medically necessary services, including individual and group psychotherapy, psychiatric evaluations, and diagnostic tests. Medication management, partial hospitalization programs (PHPs), and intensive outpatient program services are also covered. A yearly depression screening is provided at no cost if the healthcare provider accepts assignment. For most outpatient mental health services, beneficiaries pay 20% of the Medicare-approved amount after meeting the annual Part B deductible.

Inpatient Mental Health Coverage Under Original Medicare

Original Medicare Part A, which is hospital insurance, covers inpatient mental health care when received in a general hospital or a psychiatric hospital. This coverage includes a semi-private room, meals, nursing care, medications, and other hospital services and supplies that are part of inpatient treatment. Part A coverage is measured in “benefit periods,” which begin the day a beneficiary is admitted as an inpatient and end after they have been out of a hospital or skilled nursing facility for 60 consecutive days.

For care received in a freestanding psychiatric hospital, Medicare Part A has a lifetime limit of 190 days. This limit does not apply to mental health care received in a psychiatric unit within a general acute care hospital. Beneficiaries are responsible for a deductible at the start of each benefit period, and daily coinsurance amounts apply for longer inpatient stays.

Medicare Advantage Plans and Prescription Drug Coverage

Medicare Advantage (Part C) plans are offered by private companies approved by Medicare and are an alternative to Original Medicare. These plans cover all services Original Medicare (Parts A and B) covers, including mental health services. Medicare Advantage plans may offer additional benefits not covered by Original Medicare and often have different cost-sharing structures, such as copayments instead of coinsurance, and may have network restrictions.

Medicare Part D plans provide prescription drug coverage, either as stand-alone plans or as part of a Medicare Advantage plan with prescription drug coverage. These plans cover prescription medications, including those used to treat mental health conditions like antidepressants and anti-anxiety drugs. Each Part D plan maintains a formulary, and costs can vary based on drug tiers within the formulary.

Understanding Your Costs and Finding Providers

Under Original Medicare Part B, after the annual deductible of $257 for 2025 is met, beneficiaries are responsible for 20% of the Medicare-approved amount for most outpatient mental health services. For inpatient mental health care covered by Original Medicare Part A, the deductible per benefit period is $1,676 in 2025. Coinsurance amounts apply for longer inpatient stays, such as $419 per day for days 61-90 and $838 per day for lifetime reserve days in 2025. Supplemental insurance, known as Medigap, can help cover some of these out-of-pocket costs for Original Medicare beneficiaries.

For those with Medicare Advantage or Part D plans, costs such as copays, deductibles, and coinsurance can vary significantly, requiring review of specific plan details. When seeking providers, beneficiaries can use the “Find a Doctor” tool available on Medicare’s official website. It is advisable to confirm that a mental health professional accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment for covered services, which helps limit out-of-pocket expenses.