Medicare covers psychotherapy, but the amount you pay and which therapists you can see depend on which Medicare plan you have and whether you meet certain conditions.

Original Medicare (Part A and Part B) covers outpatient mental health treatment, including psychotherapy with a psychiatrist, psychologist, clinical social worker, or licensed counselor. You pay 20% of the cost after you meet your Part B deductible, which is $240 in 2024. Medicare Part B also covers psychiatric evaluation and management visits with a doctor.

If you have a Medicare Advantage plan (Part C), coverage works differently. Each plan sets its own rules about which therapists are in-network, how many visits you can have, and what you pay per visit. Some plans cover more therapy sessions than Original Medicare does; others cover fewer. You need to check your specific plan's details.

Key Takeaways

  • Original Medicare covers psychotherapy at 20% coinsurance after your Part B deductible, with no visit limit set by Medicare itself.
  • The therapist must be a psychiatrist, psychologist, clinical social worker, or licensed professional counselor — not all counselors are covered.
  • Medicare Advantage plans cover mental health services but each plan decides how many visits, which providers, and what you pay out of pocket.
  • You should ask your therapist's office whether they accept Medicare and what your cost will be before your first appointment.

How Original Medicare Covers Psychotherapy

Under Original Medicare Part B, you can see a mental health professional for psychotherapy without a referral from your primary care doctor. The therapist must be enrolled in Medicare and meet specific credential requirements. Psychiatrists (medical doctors who specialize in mental health), psychologists with a doctoral degree, clinical social workers with a master's degree or higher, and licensed professional counselors can all bill Medicare for therapy.

You pay 20% of what Medicare approves as the cost, after you have paid your Part B deductible ($240 in 2024). If your therapist charges more than Medicare's approved amount, you may owe the difference — but only if they are not a "participating provider" who has agreed to accept Medicare's approved amount as full payment. Always ask whether your therapist participates in Medicare before you start.

Original Medicare does not set a limit on how many psychotherapy sessions you can have in a year. However, your therapist must document that the treatment is medically necessary, and Medicare can review whether sessions continue to meet that standard.

Medicare Advantage Plans and Mental Health Coverage

If you are enrolled in a Medicare Advantage plan, that plan covers your mental health services instead of Original Medicare. Each plan decides which therapists are in-network, how many visits per year you can have, and what you pay for each visit. Some plans cover 30 or more therapy sessions per year; others cover 20 or fewer. Some charge a copay per visit (often $0 to $50); others use coinsurance.

To find out what your plan covers, call the member services number on your insurance card or log into your plan's website. Ask specifically: How many mental health visits does my plan cover per year? Which therapists are in-network in my area? What is my copay or coinsurance? Do I need a referral from my primary care doctor? Some plans require a referral; others do not.

If your preferred therapist is not in-network, you can ask your plan whether they will cover out-of-network care. Some plans do, but you will usually pay more out of pocket.

What Types of Mental Health Providers Medicare Covers

Medicare covers therapy from psychiatrists, psychologists, clinical social workers, and licensed professional counselors. A psychiatrist is a medical doctor (MD or DO) who specializes in mental health and can prescribe medication. A psychologist typically has a doctoral degree (PhD or PsyD) in psychology. A clinical social worker has at least a master's degree and is licensed by their state. A licensed professional counselor (LPC) also has a master's degree and state licensure.

Medicare does not cover therapy from unlicensed counselors, life coaches, or therapists who do not meet these credential requirements, even if they are skilled and helpful. Before you schedule an appointment, ask the therapist's office what their credentials are and confirm they are enrolled in Medicare.

Psychiatrists can also provide medication management visits, where they evaluate your symptoms and prescribe or adjust psychiatric medications. These visits are covered under Medicare Part B as well.

Inpatient Mental Health Treatment and Hospital Care

If you need to stay in a hospital for mental health treatment, Original Medicare Part A covers inpatient psychiatric care. You pay your Part A deductible ($1,632 in 2024) and then nothing for the first 60 days of a hospital stay in a benefit period. Days 61 through 90 cost you $408 per day in 2024. After 90 days, you enter your lifetime reserve days, which have higher costs.

Medicare Advantage plans cover inpatient mental health stays as well, but the cost-sharing rules vary by plan. Check your plan documents or call member services to understand what you would pay.

Substance Use Disorder Treatment

Medicare covers treatment for alcohol and drug use disorders, including outpatient counseling, medication-assisted treatment (such as methadone or buprenorphine), and inpatient rehabilitation. The same rules explore: Original Medicare covers 80% of approved costs after your deductible, and Medicare Advantage plans set their own coverage rules.

If you are looking for a substance use treatment program, you can search for Medicare-enrolled providers through the SAMHSA National Helpline at 1-800-662-4357 (free, confidential, 24 hours a day). They can also refer you to local programs.

Questions to Ask Your Doctor or Therapist

Before you start psychotherapy, ask these questions to understand what you will pay and whether the provider accepts your Medicare coverage:

  • Are you enrolled in Medicare and do you accept my specific Medicare plan?
  • What is the cost per session, and what will I owe out of pocket?
  • Do I need a referral from my primary care doctor, or can I schedule directly?
  • How often do you typically recommend sessions, and does my plan cover that frequency?
  • If my plan has a visit limit, what happens if I need more sessions?
  • Do you bill Medicare directly, or do I need to pay and then submit for reimbursement?

When to Seek Mental Health Care

You should reach out to a mental health professional if you are experiencing persistent sadness, anxiety, difficulty sleeping, loss of interest in activities you normally enjoy, thoughts of harming yourself, or substance use that is affecting your daily life. You do not need to wait for a crisis to seek help.

If you are having thoughts of suicide, call or text 988 (the Suicide and Crisis Lifeline) any time, day or night. If you are in when ready danger, call 911 or go to your nearest emergency room.

Your primary care doctor can also screen for depression and anxiety and can refer you to a mental health professional. Many primary care offices have mental health providers on staff or can connect you with someone in your area.

Frequently Asked Questions

Does Medicare cover therapy for marriage or family counseling?

Medicare covers individual psychotherapy but not marriage or family counseling as a separate service. However, if you are seeing a therapist for your own mental health condition and family issues come up in that context, the therapy is still covered. Some therapists may see couples or families, but Medicare would cover only the individual's treatment for their diagnosed condition.

Can I see a therapist without a referral from my doctor?

Under Original Medicare, you do not need a referral. You can contact a mental health provider directly and schedule an appointment. With Medicare Advantage, the rules vary by plan — some require a referral and others do not. Check your plan documents or call member services to confirm.

What if my therapist charges more than Medicare approves?

If your therapist is a participating provider, they have agreed to accept Medicare's approved amount as full payment, and you owe only your coinsurance (20% under Original Medicare). If they are a non-participating provider, they can charge up to 15% more than Medicare's approved amount, and you owe that difference plus your coinsurance. Always ask in advance.

Does Medicare cover online or telehealth therapy?

Yes. Medicare covers psychotherapy delivered by video or phone, and many therapists now offer these options. The coverage and cost-sharing rules are the same as in-person therapy. Ask your therapist whether they offer telehealth and whether it is covered under your specific plan.

What should I do if my Medicare Advantage plan denies coverage for therapy?

You have the right to appeal. Contact your plan's member services and ask for the reason for the denial in writing. You can then file a formal appeal, and if you disagree with the appeal decision, you can request an independent external review. Your state's health insurance counseling program (find it through your State Health Insurance information Program, or SHIP) can help you understand your appeal rights.