Medicare enrollees face an increased risk of having mental health concerns. Fortunately, Medicare covers counseling, which can help make support more accessible for you.
Mental health programs and services are designed to help diagnose and treat mental health needs. As a beneficiary, you can take advantage of depression screenings, counseling sessions, medications, and partial hospitalization through your Medicare plan.
How much you end up paying depends on where you get service, your healthcare provider’s fees, and other insurance you may have. You can expect to pay for any deductibles and coinsurance.
This article discusses what mental health services your Medicare plan might cover and which types of plans are best for the mental health benefits you’re looking for. It also explains when and where to seek help for mental illness or Medicare concerns.
Medicare Plans for Mental Health Services
Medicare plans include Parts A and B of Original Medicare, which the federal government manages. Medicare Advantage, or Part C plans, and prescription drug plans called Part D plans, are privately run.
The government requires these plans to provide mental care coverage for enrollees.
Original Medicare vs. Medicare Advantage
Original Medicare and Medicare Advantage cover inpatient and outpatient mental health services. Both help pay for screenings, therapy appointments, and limited hospital stays.
Medicare Part A
Original Medicare includes Part A and Part B. Part A covers inpatient care in a facility and limited home health services. Such care is important for people whose mental condition makes it unsafe to remain at home.
Part A covers:
- Semi-private room costs
- Standard nursing care
- Lab tests
- Certain medications
- Inpatient therapy
Medicare Part B
Part B covers outpatient treatment for mental health services. This can help people who need ongoing support.
Part B helps pay for:
Medicare Part C
Medicare Advantage, also called Medicare Part C, typically matches the coverage offered by Parts A and B. Part C plans may cover extra telehealth benefits, grief counseling, and conflict resolution.
Some Part C plans include Part D benefits as well.
Medicare Part D and Medigap
Medicare Part D covers prescription drug benefits. Part D plans help pay for antidepressants, mood stabilizers, and most other protected mental health treatment medications.
If you do not have a Medicare Advantage plan, Medigap may also pay for some of your deductibles, copayments, and coinsurance related to inpatient or outpatient care.
What Is Covered?
Original Medicare covers visits to licensed mental health professionals who participate in Medicare. Your healthcare provider must be registered with Medicare and agree to its payment structure. The visits may be through telehealth or in a doctor’s office, clinic, or hospital.
Qualifying professionals include:
Assignment is an agreement on a provider’s part to be paid directly by Medicare and accept the payment amount Medicare authorizes for services. Your healthcare provider must accept assignment to keep your out-of-pocket costs down.
If your doctor or supplier accepts assignment, they will only charge you the Medicare deductible and coinsurance amounts. They’ll submit your claim to Medicare and won’t charge you for doing so.
What Isn’t Covered?
While Medicare offers extensive coverage for mental health, it has limits you should be aware of. Many plans come with some exclusions, lifetime maximums, and substantial out-of-pocket costs.
Original Medicare does not cover costs for the following mental health expenses:
- Adult day health
- Private duty nurse charges
- Hospital room phone or television costs (if any)
- Toiletries such as toothpaste, socks, or razors
- Additional costs for a private room if not medically necessary
- Report preparation or data interpretation
- Pastoral counseling
- Outpatient meals
- Recreational activities
- Hemodialysis for treating schizophrenia
Coverage for Other Types of Counseling
Depression and anxiety aren’t the only issues that Medicare can help you address. Plans also cover treatments for substance use disorder and co-occurring mental illnesses.
However, Medicare will only cover types of counseling that directly address your specific mental health condition.
Substance Use Disorder
Substance use disorder (SUD) is a chronic mental illness. Medicare plans treat SUD as they would diabetes or heart disease.
Medicare Part B covers certain inpatient and outpatient services for SUD, including:
- Monthly care management
- Drug testing
- Counseling to prevent or stop tobacco use
- Opioid use disorder treatment
- Alcohol use disorder screenings
- Individual and group therapy
- Treatment for co-occurring mental health disorders
- Drug withdrawal treatment
Original Medicare covers the total cost of opioid use disorder treatment if you receive it from a program that’s enrolled in Medicare.
Services from a hospital outpatient setting may require an extra copayment or coinsurance on your part.
Alcohol Use Disorder
Medicare provides alcohol use disorder screening and therapy for people who use alcohol but aren’t dependent. If alcohol misuse is detected, Medicare may cover up to four counseling sessions per year.
Medicare also covers:
- Advance care planning
- Behavioral health integration into primary care to better plan and monitor care
You pay nothing for alcohol misuse screening and counseling if your healthcare provider accepts assignment.
Marriage and Family
Medicare Part B plans help cover family counseling. The main purpose must be a medically necessary part of your mental health treatment, though.
Medicare does not typically provide marriage counseling or couples counseling.
Specific Mental Health Services
You can access mental health care through Medicaid in a variety of formats and locations. Ask a healthcare provider which option is best for you or your loved one.
Medicare will cover inpatient services if the person needs intense care only available in an inpatient setting. Plans will help pay for treatments at inpatient psychiatric facilities, critical access hospitals, and psychiatric units in hospitals.
Medicare Part A pays for up to 190 days of inpatient care in a psychiatric hospital. Part B helps cover a portion of doctor or specialist fees related to inpatient care for mental illnesses.
If your doctor accepts assignment, your yearly depression screening will be free. You’ll need to pay the Part B deductible and 20% of the Medicare approved amount for doctor’s visits to diagnose and treat mental illness.
Medicare covers outpatient psychiatric hospital expenses for the following services and supplies if they are:
- Medically necessary for diagnostic study
- The patient is expected to improve
- Provided under a plan of care (a written plan where your healthcare provider lists the type of services you need, the span in which services are needed, and the predicted outcomes of treatment)
- Supervised and monitored by a doctor who prescribes and monitors the services
Partial Hospitalization Program (PHP)
PHPs are structured programs providing intensive outpatient mental health care. Medicare covers this service in hospital outpatient centers and community mental health centers (CMHCs).
PHPs provide mental health care less than 24 hours a day to people who are:
- Discharged from inpatient hospital treatment and need continued inpatient support
- At risk of needing to enter a hospital
If the healthcare provider accepts assignment, you may still pay part of the Medicare-approved amount for each service. You may also have to pay coinsurance for each day of PHP services.
Community Mental Health Centers (CMHCs)
In addition to services offered at PHPs, community mental health centers offer an alternative to hospitalization. These facilities provide:
- 24-hour emergency care with follow-up
- Day treatment, partial hospitalization, or rehab in line with the patient’s needs
- Screening for admission to a state mental health facility
Medicare Part B helps cover telehealth office visits, consultations, and psychotherapy. You’ll pay the Part B deductible and 20% of the amount Medicare approves for your healthcare provider’s services.
In most cases, telehealth costs are about the same as costs for in-person visits.
Medicare may cover some medications to treat mental illness in inpatient or outpatient care. You must enroll in a Medicare-approved Part D drug plan to get drug coverage.
Most Part D plans list the drugs they pay for. They must cover most antidepressants, antipsychotics, anticonvulsants, and opioid use disorder treatment drugs.
Using the Medicare Helpline
Medicare gives you special rights and resources for protecting them. These include:
- The Medicare Beneficiary Ombudsman (MBO)
- Your State Health Insurance Assistance Program (SHIP)
- The Competitive Acquisition Ombudsman (CAO)
- The Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO)
These resources provide information and advice to make informed healthcare decisions that best meet your needs and situation. They can also help you address and work through grievances with Medicare providers.
Call 1-800-MEDICARE (1-800-633-4227) to ask questions or get help with a complaint. You can also contact your state’s elder helpline for assistance.
Medicare helps millions of older Americans access quality health care. Mental health counseling and programs come with every plan. Free annual wellness visits give you and your healthcare provider a chance to discuss how you’re doing emotionally and help prevent or ease mental issues. Your plan should also pay for a free depression screening each year.
Medicare plans provide a wide range of outpatient services, including individual and group therapy, prescription medications, and diagnostic testing for depression, drug and alcohol misuse, and other psychiatric conditions. In-person and virtual appointments are covered as well.
If you should face an emotional crisis requiring care in a medical facility, help is here. Medicare can bear much of the cost of inpatient care, too.
Make Sure Your Provider Accepts Medicare
Bear in mind that your healthcare provider must be registered with Medicare and agree to its payment structure. Before agreeing to any service, confirm with your plan that the service will be covered.
A Word From Verywell
Medicare helps make mental health therapy and treatment more affordable for seniors. Your plan can help you obtain confidential advice and medical care for managing your emotional health in the healthiest way possible.
Your mental health is as important as your physical health, and it affects your overall well-being, too. Emotional problems and substance use disorders need and deserve urgent medical attention just like physical ailments do.
If you or a loved one is having mental health issues, call a Medicare plan provider, a medical professional, or helpline right away. You can also call your local United Way, community center, or Area Agency on Aging for free or low-cost counseling options.
Frequently Asked Questions
Does Medicare reimburse you for therapy?
Medicare does not reimburse you for therapy or counseling. Yearly wellness checks and depression screenings are available at no cost with your plan. For other services, you’ll pay your Part B deductible and 20% of the Medicare-approved amount above the deductible.
How do you find therapists that accept Medicare?
It can be challenging to find a therapist that accepts Medicare because of complicated paperwork and low reimbursement rates. If possible, start seeing a mental health professional who takes Medicare before enrolling in the program.
Check your Medicare plan for telehealth therapists or collaborative care practices. These specialists often accept Medicare and other kinds of insurance.
Do you need to visit your general practitioner before seeking therapy?
With Medicare, you do not need to visit a general practitioner before seeking mental health therapy or counseling. Annual mental health checkups are free. Be certain that your provider accepts Medicare assignment before your appointment.