Medicare covers some therapy services, but not all types, and the amount you pay depends on which part of Medicare you have and what kind of therapy you need.

Medicare Part B covers outpatient mental health treatment — which includes therapy with a licensed therapist, psychologist, or clinical social worker — at 80% of the approved amount after you meet your annual deductible. You pay the remaining 20%. Medicare does not cover therapy that happens in your home unless it is part of a skilled nursing or home health service. Therapy through a hospital outpatient department or community mental health center may have different cost-sharing rules.

The therapist must be enrolled in Medicare and must be licensed in your state. Not all therapists accept Medicare, and some who do may charge more than Medicare's approved amount — in which case you could owe the difference. Before you schedule, confirm that your therapist takes Medicare and ask what you will owe out of pocket.

Key Takeaways

  • Medicare Part B covers individual therapy sessions at 80% of the approved amount after your deductible, meaning you typically pay 20% per visit.
  • The therapist must be licensed and enrolled in Medicare; not all therapists accept Medicare, so you need to check before booking.
  • Medicare does not cover therapy in your home unless it is part of a skilled nursing or home health service ordered by a doctor.
  • Group therapy and couples therapy may be covered, but the rules and your cost-sharing can differ from individual therapy.
  • If your therapist charges more than Medicare's approved amount, you may owe the difference on top of your 20% coinsurance.

What Types of Therapy Medicare Part B Covers

Medicare Part B covers therapy provided by a licensed clinical social worker, psychologist, psychiatrist, psychiatric nurse specialist, or marriage and family therapist — as long as they are enrolled in Medicare and the therapy is medically necessary. This includes individual therapy, group therapy, and family therapy. The therapist does not need to refer you to another doctor first; you can schedule directly.

Therapy must address a mental health condition that a doctor has documented. Medicare will not cover therapy for general life coaching, stress management classes, or counseling that is not tied to a diagnosed condition. If you are seeing a therapist for the first time, the therapist will likely ask you to sign a form confirming that you have a mental health condition that warrants treatment.

Some therapists work in private practice; others work through a hospital, clinic, or community mental health center. The setting does not change whether Medicare covers the service, but it can change how much you pay. A hospital outpatient department, for example, may charge a facility fee in addition to the therapist's fee.

How Much You Pay for Therapy Under Medicare Part B

You pay 20% of the Medicare-approved amount for each therapy session after you have met your Part B deductible for the year. The deductible is the same amount whether you use it for therapy, doctor visits, or lab work. Once you reach the deductible, you pay coinsurance (20%) for the rest of the calendar year.

The Medicare-approved amount varies by location and by the type of provider. A psychiatrist's session may have a higher approved amount than a social worker's session for the same type of therapy. You can look up the approved amount for your area on the Medicare website or by calling your therapist's office and asking what Medicare allows for their specific credential and location.

If your therapist does not accept Medicare assignment — meaning they do not agree to charge only the Medicare-approved amount — you could owe up to 15% more than the approved amount on top of your 20% coinsurance. This is called balance billing. Before you start therapy, ask your provider whether they accept Medicare assignment.

Therapy Covered Under Medicare Part A (Hospital and Skilled Nursing)

If you are admitted to a hospital or skilled nursing facility, mental health therapy provided as part of your inpatient or post-acute care is covered under Part A, not Part B. You pay your Part A deductible and coinsurance, which are different from Part B amounts. Therapy in this setting is considered part of your overall care and is billed differently.

Home health therapy is also covered under Part A if a doctor orders it as part of a skilled nursing or rehabilitation plan after a hospital stay or may have access to event. The therapist must work for a Medicare-certified home health agency. This is different from private therapy in your home, which Medicare does not cover.

What Medicare Does Not Cover

Medicare does not cover therapy in your private home unless it is ordered by a doctor as part of a skilled nursing or home health service. If you want a therapist to come to your house for a regular weekly session, Medicare will not pay for it. You would need to pay out of pocket or use another insurance plan.

Medicare also does not cover therapy that is not medically necessary — for example, life coaching, career counseling, or general wellness counseling. Therapy for substance use disorder is covered, but only if it is provided by a Medicare-enrolled provider and is documented as treatment for a diagnosed condition.

Telehealth therapy is covered by Medicare Part B, but only if the therapist is enrolled in Medicare and you meet certain requirements (such as being in a rural area or already established as a patient). Not all therapists offer telehealth, and not all telehealth platforms are Medicare-approved.

How to Find a Medicare-Enrolled Therapist

Use the Medicare Provider Search tool on Medicare.gov to find therapists in your area who accept Medicare. Search by your zip code and select "Mental Health Counselor," "Psychologist," "Clinical Social Worker," or "Marriage and Family Therapist." The search will show you providers who are enrolled in Medicare, but it does not tell you whether they are currently taking new patients or accepting new Medicare patients.

Call the therapist's office directly and ask: "Do you accept Medicare?" "Are you accepting new Medicare patients?" "What is your fee?" and "Do you accept Medicare assignment?" If they do not accept Medicare, ask whether they offer a reduced rate for uninsured or out-of-pocket patients. Some therapists who do not accept Medicare will still work with you if you pay upfront and submit a claim yourself, though this is less common.

Your primary care doctor can also refer you to a therapist. Many primary care offices have a list of in-network or Medicare-enrolled mental health providers. Your state's mental health department or a local community mental health center can also provide referrals.

Medicare Advantage Plans and Therapy Coverage

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage for therapy may be different. Most Medicare Advantage plans cover therapy, but they may require you to use in-network providers, get a referral from your primary care doctor, or limit the number of sessions per year. Some plans charge a copay per session instead of coinsurance.

Check your plan's coverage documents or call the plan directly to find out what therapy is covered, what you pay, and whether you need a referral. If your plan does not cover the type of therapy you need, you may be able to switch to Original Medicare during the annual open enrollment period (October 15 to December 7).

Frequently Asked Questions

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

No. Medicare Part B covers therapy directly from a licensed therapist without a referral. However, some Medicare Advantage plans do require a referral, so check your plan's rules. Your doctor does not need to order therapy for it to be covered, but the therapist will ask whether you have a diagnosed mental health condition.

Does Medicare cover therapy for anxiety or depression?

Yes. Anxiety and depression are both conditions that Medicare covers therapy for, as long as the therapist is Medicare-enrolled and the therapy is documented as treatment for the condition. You pay 20% coinsurance after your deductible.

What if I cannot afford the 20% coinsurance?

Some community mental health centers offer sliding-scale fees based on income. You can also ask your therapist whether they offer a reduced rate or payment plan. If you have limited income, you may be may be able to access for Medicaid in your state, which could cover therapy with little or no cost-sharing.

Can I use telehealth therapy with Medicare?

Yes, Medicare covers telehealth therapy if the provider is Medicare-enrolled and you meet certain conditions. During the COVID-19 public health emergency, Medicare expanded telehealth coverage. Check with your therapist about whether they offer telehealth and whether it is covered under your specific situation.

What happens if my therapist charges more than Medicare allows?

If your therapist accepts Medicare assignment, they can only charge the Medicare-approved amount, and you pay 20% of that. If they do not accept assignment, they can charge up to 15% more, and you owe that difference on top of your 20% coinsurance. Always confirm assignment status before starting therapy.