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

Original Medicare (Part A and Part B) covers outpatient mental health services at the same rate it covers other medical services — you pay 20% of the cost after you meet your Part B deductible. Medicare Advantage plans (Part C) set their own rules for mental health coverage, so your costs and which therapists are in-network vary by plan. Both types of Medicare require that a doctor refer you or that a mental health professional work within a clinic setting; you cannot straightforward call a therapist on your own and have Medicare pay.

The therapy itself must be provided by a licensed professional — a psychiatrist, psychologist, clinical social worker, or counselor with the right credentials. Medicare does not cover life coaching, peer support groups, or therapy from unlicensed practitioners, even if you pay out of pocket and ask for reimbursement.

Key Takeaways

  • Original Medicare covers 80% of outpatient mental health therapy after you meet your Part B deductible, but you must have a referral or receive care through a clinic.
  • Medicare Advantage plans cover mental health services but set their own copays, deductibles, and in-network provider lists, so you need to check your specific plan.
  • The therapist must be licensed and enrolled in Medicare; you cannot see any counselor you choose and expect Medicare to pay.
  • Inpatient psychiatric hospital stays are covered under Part A, but the length of stay and your costs depend on your specific situation and plan.

How Original Medicare Covers Outpatient Mental Health Therapy

If you have Original Medicare, outpatient mental health services are covered at 80% after you pay your Part B deductible (which is $240 in 2024, though this amount changes yearly). This means you pay 20% coinsurance for each visit. The therapist must be enrolled in Medicare and accept Medicare payment.

You do not need a referral from your primary care doctor in the way you might for other specialists, but the mental health professional must be working in an outpatient clinic, hospital department, or federally may have access to health center. Private practice therapists who are enrolled in Medicare can also bill Medicare directly. The key is that the provider must be set up to bill Medicare — if they do not accept Medicare, you would pay out of pocket.

There is no limit on the number of visits Medicare will cover in a year, as long as the treatment is deemed medically necessary. What counts as medically necessary is determined by your doctor and the mental health professional, not by Medicare in advance. If Medicare later denies a claim, you have the right to appeal.

Medicare Advantage Plans and Mental Health Coverage

Medicare Advantage plans must cover at least the same mental health services that Original Medicare covers, but they can charge different copays, set different deductibles, and maintain their own networks of in-network providers. One plan might charge $30 per therapy visit; another might charge $50. One plan might cover 30 visits per year; another might not limit visits at all.

Before you start therapy, call your Medicare Advantage plan and ask: What is the copay for outpatient mental health visits? Do I need a referral? Which therapists are in-network? If you see an out-of-network therapist, you will likely pay much more or the plan may not cover the visit at all. Some Medicare Advantage plans also offer telehealth mental health services, which may have a different copay than in-person visits.

Your plan's coverage details are in your Summary of Benefits and Coverage document, which you receive each year. You can also find this document on your plan's website or call the plan directly.

Inpatient Psychiatric Hospital Care

If you need to stay in a psychiatric hospital or a psychiatric unit within a general hospital, Medicare Part A covers this as an inpatient stay. You pay your Part A deductible (which is $1,632 per benefit period in 2024) and then Medicare covers the full cost for days 1 through 60. For days 61 through 90, you pay a daily coinsurance amount. After day 90, you enter your lifetime reserve days, which have a higher daily cost.

A psychiatric hospital stay is different from a regular hospital stay in that it is specifically for mental health treatment. The hospital must be Medicare-certified. Your doctor and the hospital will work together to determine how long your stay should be; Medicare does not set a limit in advance, but the hospital must document that each day of care is medically necessary.

What Medicare Does Not Cover for Mental Health

Medicare does not cover therapy from unlicensed counselors, life coaches, or peer support specialists, even if they call themselves therapists. It does not cover group therapy sessions unless they are run by a licensed mental health professional in a clinical setting. It does not cover online therapy platforms that are not connected to a Medicare-enrolled provider.

Medicare also does not cover substance use disorder treatment in a residential rehab facility unless it is a hospital-based program. Outpatient substance use counseling is covered if provided by a licensed professional, but inpatient rehab in a non-hospital setting is not. Some Medicare Advantage plans may offer additional coverage for these services, so check your plan documents.

Medications prescribed by a psychiatrist or other doctor are covered under Part D (prescription drug coverage) if you have it, not under the mental health therapy benefit itself.

How to Find a Medicare-Enrolled Mental Health Provider

The easiest way to find a therapist who accepts Medicare is to use the Medicare Provider Search tool on Medicare.gov. You can search by location and type of provider (psychiatrist, psychologist, clinical social worker, or counselor). The search will show you which providers are enrolled in Medicare in your area.

You can also call your doctor's office and ask for a referral to a mental health professional who accepts Medicare. Your primary care doctor may have a list of providers they work with regularly. If you have a Medicare Advantage plan, call your plan first to get a list of in-network providers, because using an in-network provider will cost you less.

When you call a therapist's office, ask directly: "Do you accept Medicare?" and "Are you currently taking new patients?" Some practices have long wait lists or have stopped accepting new Medicare patients even though they are still enrolled in the program.

What to Ask Your Doctor or Mental Health Provider

Before you start therapy, ask your doctor or the mental health professional these questions: Will Medicare cover this treatment? What will my out-of-pocket cost be? How many visits does Medicare cover? Do I need prior approval from Medicare or my insurance plan before starting? What happens if Medicare denies a claim?

If you have a Medicare Advantage plan, also ask: Is this provider in-network? What is my copay? Do I need a referral from my primary care doctor? If the therapist is out-of-network, ask what your cost would be and whether the plan will cover any of it.

Write down the answers and keep them with your insurance information. If a claim is denied later, you will have a record of what you were told.

Frequently Asked Questions

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

No formal referral is required for Original Medicare, but the therapist must be enrolled in Medicare and working in a clinic or hospital setting. For Medicare Advantage plans, check your plan documents — some require a referral, others do not. Call your plan to be sure before you schedule an appointment.

Will Medicare cover therapy for anxiety or depression?

Yes, if a doctor diagnoses you with anxiety, depression, or another mental health condition and refers you to a licensed therapist, Medicare will cover outpatient therapy. The therapist must document that the treatment is medically necessary, which is standard practice.

What if my therapist is not in-network for my Medicare Advantage plan?

You can still see an out-of-network therapist, but you will likely pay more. Call your plan first to find out what your out-of-network cost would be. Some plans cover out-of-network mental health services at a higher copay; others do not cover them at all.

Does Medicare cover online therapy?

Medicare covers telehealth mental health visits if the provider is Medicare-enrolled and the visit meets Medicare's telehealth rules. Not all therapists offer telehealth, and some Medicare Advantage plans may have different copays for telehealth than for in-person visits. Ask your provider or plan whether telehealth is available and what you would pay.

What should I do if Medicare denies my mental health therapy claim?

You have the right to appeal. Ask your therapist's office for a copy of the denial notice, which will explain why the claim was denied. You can file an appeal with Medicare within 180 days. If you need help with the appeal, you can contact your State Health Insurance information Program (SHIP), which offers free counseling about Medicare issues.