Medicare

Medicare provides significant coverage for mental health services, recognizing that emotional and psychological wellness is an essential part of overall health. If you or a loved one with Medicare coverage is seeking mental health care, understanding how these benefits work is crucial to accessing appropriate treatment while managing costs.

Medicare coverage encompasses a range of services across different parts of the program. Whether you need outpatient therapy, psychiatric medication management, or inpatient care during a crisis, Medicare offers coverage options to support your mental health journey.

What Mental Health Services Does Medicare Cover?

Medicare covers a variety of mental health services across its different parts:

• Medicare Part A (Hospital Insurance) covers inpatient mental health care in a general hospital or psychiatric facility, including room, meals, nursing care, therapy, and medications during your stay.

• Medicare Part B (Medical Insurance) covers outpatient mental health services, including visits with psychiatrists, clinical psychologists, clinical social workers, nurse practitioners, and physician assistants. Starting in 2024, licensed marriage and family therapists and mental health counselors (including addiction counselors) can also receive Medicare reimbursement.

• Medicare Part D (Prescription Drug Coverage) helps cover medications prescribed for mental health conditions, such as antidepressants, anti-anxiety medications, antipsychotics, and mood stabilizers.

Specific mental health services covered by Medicare include individual therapy and group therapy, psychiatric evaluations, medication management, diagnostic tests, one annual depression screening, family counseling (when the main purpose is to help with your treatment), and partial hospitalization programs when more intensive care is needed but full hospitalization isn't required.

How Medicare Mental Health Coverage Works

Coverage Under Different Medicare Parts

Part A (Hospital Insurance) covers inpatient mental health care in general hospitals with no limit on the number of benefit periods. However, if you receive care in a psychiatric hospital, Medicare imposes a 190-day lifetime limit. After reaching this limit, you would need to receive inpatient psychiatric care in a general hospital for Medicare to cover it.

Each benefit period for inpatient care begins when you're admitted and ends after you've been out of the hospital or skilled nursing facility for 60 consecutive days.

For each benefit period in 2025, you'll pay:

• $1,632 deductible

• $0 coinsurance for days 1-60

• $408 daily coinsurance for days 61-90

• $816 daily coinsurance for each "lifetime reserve day" after day 90 (up to a maximum of 60 days over your lifetime)

Part B (Medical Insurance) covers outpatient mental health services after you meet the annual deductible ($240 in 2025). You typically pay 20% of the Medicare-approved amount for covered services if your provider accepts assignment. Some preventive services, like an annual depression screening in a primary care setting, require no coinsurance or deductible.

Medicare Advantage Plans (Part C) must cover all services that Original Medicare covers, including mental health care, but may have different costs and restrictions. These plans often include prescription drug coverage and may offer additional mental health benefits not covered by Original Medicare.

Important Telehealth Updates for 2025

Medicare has expanded telehealth coverage for mental health services, with some important updates for 2025:

• Through September 30, 2025, Medicare beneficiaries can access mental health services via telehealth from any location, including their home. After that date, most Medicare telehealth services will revert to requiring patients to be in an approved healthcare facility in a rural area.

• However, mental health telehealth services have a permanent exception: Even after September 30, 2025, Medicare will continue to cover telehealth services for "diagnosis, evaluation, or treatment of a mental and/or behavioral health disorder (including substance use disorders)" in your home, regardless of your location. This means you can continue receiving therapy and psychiatric care virtually from home even if you don't live in a rural area.

• Additionally, the requirement for an in-person visit before initiating mental health telehealth services (and annually thereafter) has been suspended through September 30, 2025.

Costs and Coverage Details

Understanding Your Financial Responsibility

The cost of mental health services under Medicare depends on several factors, including the specific service, your provider, and which parts of Medicare you have:

• Outpatient Services: After meeting your Part B deductible ($240 in 2025), you pay 20% of the Medicare-approved amount for most mental health services if your provider accepts assignment. Some preventive services like depression screenings are fully covered when provided in primary care settings.

• Inpatient Services: You pay the Part A deductible ($1,632 in 2025) for each benefit period, with additional daily coinsurance for longer stays as described above.

• Prescription Medications: Costs vary based on your Part D plan and the specific medication. Many mental health medications are included in plan formularies, though coverage and tiers differ by plan.

It's important to verify that your mental health provider accepts Medicare assignment, as this ensures they accept the Medicare-approved amount as full payment. Providers who don't accept assignment can charge up to 15% more than the Medicare-approved amount, which you would be responsible for paying.

Coverage Limitations and Exclusions

While Medicare provides comprehensive mental health coverage, there are some important limitations to be aware of:

• The 190-day lifetime limit for inpatient care in a psychiatric hospital (though inpatient care in general hospitals has no such limit)

• No coverage for certain types of counseling, such as marriage counseling when the primary purpose isn't treating a diagnosed condition

• Limited coverage for some specialized treatments or alternative therapies without strong clinical evidence

• No coverage for services provided by certain types of mental health professionals who aren't Medicare-eligible providers

Medicare also does not cover some services that may benefit people with serious mental illness, such as psychiatric rehabilitation, assertive community treatment, or peer support services, though Medicaid may cover these for dual-eligible beneficiaries.

Finding Mental Health Providers Who Accept Medicare

Provider Participation in Medicare

Finding mental health providers who accept Medicare can sometimes be challenging. According to research, the percentage of psychiatrists accepting Medicare has declined over time, with less than 55% accepting Medicare patients in recent years. This is significantly lower than the acceptance rate among other physician specialties (over 85%).

This provider shortage is particularly pronounced in rural areas, making the telehealth exceptions for mental health services especially valuable for beneficiaries in these regions.

To find Medicare-participating mental health providers, you can:

• Use the Medicare Physician Compare tool on Medicare.gov to search for psychiatrists, psychologists, and other mental health professionals who accept Medicare assignment

• Contact your State Health Insurance Assistance Program (SHIP) for help finding local providers who accept Medicare

• Call Medicare directly at 1-800-MEDICARE (1-800-633-4227) for assistance

• Ask your primary care physician for referrals to mental health providers who accept Medicare

What to Look for in a Mental Health Provider

Beyond Medicare acceptance, several factors are important when choosing a mental health provider:

• Specialization - Find providers with experience treating your specific condition, whether it's depression, anxiety, PTSD, or another mental health concern.

• Approach to treatment - Different providers use different therapeutic methods. Research approaches like cognitive-behavioral therapy (CBT), psychodynamic therapy, or interpersonal therapy to understand what might work best for you.

• Telehealth availability - If in-person visits are difficult, look for providers offering telehealth services, which Medicare now covers extensively for mental health care.

• Accessibility - Consider practical factors like location, office hours, and how quickly you can get an appointment, especially if you need prompt care.

How Our Directory Can Help You Find the Right Care

Navigating Medicare's mental health benefits and finding providers who accept Medicare can be challenging. Our comprehensive provider directory simplifies this process by connecting you with mental health facilities and professionals who accept Medicare insurance across all levels of care.

Our directory is regularly updated with current information about Medicare acceptance, helping you identify providers who participate in the program and accept assignment. We verify Medicare participation to ensure you receive accurate information about coverage options.

Beyond just listing Medicare providers, our directory helps you identify facilities specializing in your specific concerns, whether you're dealing with depression, anxiety, substance use disorders, or other mental health challenges. We provide detailed information about treatment approaches, specialized programs, and available services to help you make informed decisions about your care.

Find Mental Health Providers That Accept Medicare Today

Taking the first step toward mental health treatment shows courage, and we're here to make that step easier. Our comprehensive directory of mental health facilities that accept Medicare can connect you with quality care that works with your coverage.

Find Providers Near You

Our directory allows you to:

• Quickly identify facilities that accept Medicare

• Filter by treatment specialties to match your unique needs

• Find providers in your local area for convenient access to care

• Get detailed information about treatment approaches and services

Don't let insurance questions delay your path to wellness. With our directory, you can find Medicare-covered mental health providers today and begin your healing journey with confidence.

References

1. Medicare.gov. "Outpatient Mental Health Coverage." https://www.medicare.gov/coverage/mental-health-care-outpatient

2. AARP. "Will Medicare Cover Services I Need for Mental Health?" https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-mental-health.html

3. The Commonwealth Fund. "Medicare Mental Health Coverage: What Changed and What Gaps Remain." https://www.commonwealthfund.org/publications/explainer/2023/mar/medicare-mental-health-coverage-included-changed-gaps-remain

4. Medicare.gov. "Telehealth Insurance Coverage." https://www.medicare.gov/coverage/telehealth

5. Telehealth.HHS.gov. "Telehealth policy updates." https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates