Medicare covers mental health therapy, but the amount you pay and which therapists you can see depend on which type of Medicare you have and whether you meet certain conditions.

Original Medicare (Parts A and B) covers outpatient mental health services at the same rate as physical health services — you pay 20 percent of the approved amount after you meet your Part B deductible. Medicare Advantage plans (Part C) set their own rules for mental health coverage, so what you pay varies by plan. In-network therapists, psychiatrists, and licensed counselors are covered; out-of-network providers may not be, depending on your plan.

The catch is that Medicare requires a diagnosis code before it will pay. You cannot walk in for general counseling or preventive therapy without a documented mental health condition. The therapist must note a diagnosis like depression, anxiety, PTSD, or another recognized condition in your medical record for each visit to be covered.

Key Takeaways

  • Original Medicare covers 80 percent of the cost of outpatient mental health therapy after you meet your Part B deductible; you pay 20 percent.
  • Medicare Advantage plans cover mental health services but set their own copays and deductibles, which can range from zero to several hundred dollars per visit.
  • Your therapist must be enrolled in Medicare and must document a mental health diagnosis for each visit in order for Medicare to pay.
  • Inpatient psychiatric hospital stays are covered under Medicare Part A, but the length of stay and your out-of-pocket costs depend on how many days you stay.
  • Substance use disorder treatment, including medication-assisted therapy, is covered under the same rules as other mental health services.

How Original Medicare Covers Outpatient Mental Health Therapy

If you have Original Medicare, you pay 20 percent of the Medicare-approved amount for each outpatient mental health visit after you meet your Part B deductible (which is $240 in 2024, though this changes yearly). The therapist or psychiatrist must be enrolled in Medicare and must accept Medicare assignment — meaning they agree to bill Medicare directly and accept Medicare's approved amount as full payment for the service.

The type of provider matters. Medicare covers psychiatrists, psychologists, licensed clinical social workers, licensed professional counselors, and marriage and family therapists. Unlicensed counselors, life coaches, and peer support specialists are not covered, even if they provide therapy-like services. The provider's state license determines whether Medicare will pay.

There is no limit on the number of mental health visits Medicare will cover in a year, as long as the treatment is deemed medically necessary. However, your doctor or psychiatrist may need to document why ongoing therapy is necessary, especially if you have been seeing the same therapist for a long time.

Medicare Advantage Plans and Mental Health Coverage

Medicare Advantage plans must cover at least the same mental health services as Original Medicare, but they can charge different copays, coinsurance, or deductibles. Some plans charge $0 per visit; others charge $30 to $50 or more. Some plans have a separate deductible for mental health services that you must meet before coverage begins.

Most Medicare Advantage plans require you to use in-network providers. If you see an out-of-network therapist, you may pay significantly more or the plan may not cover the visit at all. Before you start therapy, call your plan's customer service number (on the back of your card) and ask: what is the copay for outpatient mental health visits, is there a deductible, and do you need a referral from your primary care doctor.

Some Medicare Advantage plans also cover telehealth mental health visits, which may have a lower copay than in-person visits. This varies by plan, so ask when you call.

What Happens During Your First Mental Health Visit

At your first appointment, the therapist or psychiatrist will ask about your symptoms, medical history, and what brought you in. They will document a diagnosis in your medical record — this is required for Medicare to pay. Common diagnoses include major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder, bipolar disorder, and adjustment disorders.

The provider will also verify your Medicare coverage before or during the visit. If you have Original Medicare, they will confirm that you have met your Part B deductible and explain that you will owe 20 percent of the approved amount. If you have Medicare Advantage, they will check your plan's copay and whether you need a referral.

If the therapist is not enrolled in Medicare or does not accept Medicare assignment, you may have to pay the full cost out of pocket and then submit a claim yourself — though Medicare may not reimburse you if the provider is not enrolled. Always ask whether the provider accepts Medicare before your first visit.

Inpatient Psychiatric Hospital Stays

If you need to be admitted to a psychiatric hospital, Medicare Part A covers the cost after you meet your inpatient deductible (which is $1,632 per benefit period in 2024). You pay nothing for days 1 through 60 of your stay; you pay a copay for days 61 through 90; and you pay the full daily cost for days beyond 90 in a single benefit period.

A benefit period begins the day you are admitted to the hospital and ends 60 days after you are discharged. If you are readmitted within 60 days, it counts as the same benefit period. If you are readmitted after 60 days have passed, a new benefit period begins and your deductible resets.

The hospital must be a Medicare-certified psychiatric facility. Most general hospitals have psychiatric units that are certified; some standalone psychiatric hospitals are also certified. Ask your doctor or the hospital whether they accept Medicare before admission if possible.

Medication-Assisted Treatment and Substance Use Disorder

Medicare covers treatment for substance use disorders, including medication-assisted treatment (such as methadone or buprenorphine) and counseling. Outpatient visits are covered under the same rules as other mental health services — you pay 20 percent of the approved amount under Original Medicare after meeting your deductible.

Inpatient treatment for substance use disorder is covered under Part A. Residential rehabilitation programs are also covered if they are Medicare-certified and medically necessary. The length of stay and your out-of-pocket costs follow the same rules as psychiatric hospital stays.

Some Medicare Advantage plans have additional restrictions on substance use disorder treatment, such as requiring prior authorization before you start treatment or limiting the number of visits. Check your plan's coverage details or call customer service before you begin treatment.

Finding a Medicare-Enrolled Mental Health Provider

The Medicare provider search tool at Medicare.gov allows you to search for psychiatrists, psychologists, clinical social workers, and other mental health providers in your area. You can filter by location, type of provider, and whether they are accepting new patients. The tool shows whether each provider accepts Medicare assignment.

You can also call your state's mental health department or a local community mental health center to ask for a list of Medicare-enrolled providers. Many community health centers offer sliding-scale fees based on income and accept Medicare. If you have Medicare Advantage, your plan's website or customer service line can provide a list of in-network mental health providers.

If you cannot find a provider in your area, ask your primary care doctor for a referral. Your doctor may know of providers who are accepting new patients or who specialize in your condition.

Frequently Asked Questions

Does Medicare cover therapy for anxiety or depression without a diagnosis?

No. Medicare requires a documented diagnosis before it will cover mental health services. You cannot receive coverage for general counseling or preventive therapy. The therapist must note a specific diagnosis like generalized anxiety disorder or major depressive disorder in your medical record for each visit.

Do I need a referral from my doctor to see a therapist?

Original Medicare does not require a referral. You can see any Medicare-enrolled mental health provider directly. Some Medicare Advantage plans do require a referral from your primary care doctor, so check your plan's rules before you schedule an appointment.

What if my therapist is not enrolled in Medicare?

You can still see them, but you will likely pay the full cost out of pocket. Medicare may not reimburse you if the provider is not enrolled. Always ask whether a provider accepts Medicare and is enrolled before your first visit to avoid unexpected bills.

Does Medicare cover online therapy or telehealth mental health visits?

Original Medicare covers telehealth mental health visits at the same rate as in-person visits. Medicare Advantage plans may cover telehealth, but copays and coverage rules vary by plan. Call your plan to ask whether telehealth mental health visits are covered and what you will pay.

Is there a limit to how many therapy sessions Medicare will cover?

Medicare does not set an annual limit on the number of mental health visits. However, your provider must document that ongoing treatment is medically necessary. If you have been seeing the same therapist for a long time, your doctor or therapist may need to justify why continued treatment is still needed.