How Much Will Medicare Pay for Mental Health Services?

Medicare, the federal health insurance program, provides healthcare coverage for millions of individuals. It offers a structured approach to managing various health needs, including mental well-being. Understanding how Medicare addresses mental health services is important for beneficiaries to access appropriate care.

Original Medicare Mental Health Coverage

Original Medicare, composed of Part A and Part B, provides coverage for a range of mental health services. Part A covers inpatient mental health care. This includes services received when admitted to a general hospital or a psychiatric hospital for treatment. Covered services encompass room and board, nursing care, and medication administered during the inpatient stay.

There is a specific lifetime limit of 190 days for care in a freestanding psychiatric hospital. This limit does not apply if mental health care is received in a psychiatric unit that is part of a general acute care hospital, where services are covered the same way as other inpatient hospital stays.

Medicare Part B covers outpatient mental health services. This includes visits with psychiatrists, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, licensed marriage and family therapists, and mental health counselors. Covered services include individual and group psychotherapy, psychiatric evaluations, diagnostic tests, medication management, and partial hospitalization programs. These programs offer intensive outpatient treatment as an alternative to inpatient care.

Your Costs for Mental Health Services

For inpatient mental health care covered by Part A, a deductible applies for each 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.

For longer inpatient stays, a daily coinsurance applies. From days 61 to 90, the coinsurance is $419 per day in 2025. Beyond 90 days, beneficiaries can use up to 60 lifetime reserve days, each costing $838 per day in 2025. Once lifetime reserve days are exhausted, the beneficiary is responsible for all costs.

For outpatient mental health services covered by Part B, an annual deductible must first be met. In 2025, the Part B deductible is $257. After the deductible is satisfied, beneficiaries pay 20% of the Medicare-approved amount for most covered services, such as doctor visits and therapy sessions. An annual depression screening is covered at no cost if provided by a primary care provider who accepts Medicare assignment. Accepting assignment means the provider agrees to accept Medicare’s approved amount as full payment, resulting in lower out-of-pocket costs for the beneficiary.

Medicare Advantage and Prescription Drug Coverage for Mental Health

Medicare Advantage (Part C) plans offer an alternative to Original Medicare and must cover at least the same mental health services as Part A and Part B. While the scope of covered services is similar, the costs, rules, and restrictions can differ from Original Medicare. These plans may have varying copayments, deductibles, and coinsurance amounts for mental health services.

Medicare Advantage plans often operate with provider networks, meaning beneficiaries might need to see specific doctors or therapists within the plan’s network for services to be covered. Some plans may require referrals for specialists, including mental health professionals. Beneficiaries should review their specific plan details to understand their financial obligations and network requirements. Some Medicare Advantage plans may also include prescription drug coverage for mental health medications.

Medicare Prescription Drug (Part D) plans provide coverage for medications used to treat mental health conditions, such as antidepressants and anti-anxiety drugs. These plans are offered by private insurance companies and have a structured cost-sharing model. This includes a monthly premium, an annual deductible, and copayments or coinsurance for prescriptions.

After the deductible, beneficiaries enter an initial coverage phase where they pay a portion of the drug cost. There is also a coverage gap where beneficiaries pay a higher percentage of drug costs until they reach a certain out-of-pocket spending threshold. Once this threshold is met, catastrophic coverage begins, where beneficiaries pay a small coinsurance or copayment for covered drugs for the remainder of the year. In 2025, the out-of-pocket spending cap for Part D is $2,000.

Accessing Mental Health Services Through Medicare

Beneficiaries can locate Medicare-approved mental health professionals by using Medicare’s Physician Compare website or by calling 1-800-MEDICARE. When searching, use keywords such as “psychiatry,” “clinical psychologist,” or “clinical social worker” to refine results. Verifying that a provider accepts Medicare assignment helps ensure coverage and manage costs.

For individuals enrolled in Medicare Advantage plans, checking the plan’s provider directory is important to find in-network mental health professionals. These plans often have specific network requirements and may necessitate a referral from a primary care physician before seeing a specialist. Telehealth services are also covered by Medicare, providing a convenient way to access mental health support from home.

An initial mental health visit with a primary care provider may include a screening for depression, which is covered at no cost. Understanding the billing process and confirming that providers accept Medicare before receiving services can help prevent unexpected expenses.