Therapy can be life-changing. It can also be budget-changingespecially when you’re staring at a bill that looks like it was priced by a motivational speaker: “Believe in yourself… and also pay $220.”
The good news: Medicare does cover a wide range of mental health services, including therapy and counseling. The “it depends” news: what’s covered, who can provide it, and what you’ll pay varies based on whether you have Original Medicare (Part A and Part B) or a Medicare Advantage plan (Part C), plus whether you have Part D drug coverage.
This guide walks you through what Medicare covers for mental health, what it typically doesn’t, and how to use your benefits without needing a therapy session because of the paperwork.
The quick answer
Yes. Medicare covers many mental health services, including outpatient therapy (like individual and group psychotherapy), psychiatric evaluations, medication management, and certain higher-intensity outpatient programs. It also covers inpatient mental health care when you’re admitted to a hospital. Your costs depend on the setting, the provider, and your specific Medicare coverage.
Medicare basics: which “Part” pays for what?
- Part A (Hospital Insurance): Inpatient hospital care, including inpatient mental health services.
- Part B (Medical Insurance): Outpatient mental health services (therapy, counseling, evaluation), plus preventive screenings and some program-based services.
- Part C (Medicare Advantage): Private plans that must cover everything Original Medicare covers, but with plan rules (networks, copays, prior authorization).
- Part D (Prescription Drug Coverage): Coverage for many mental health medications (varies by plan formulary).
Outpatient therapy and counseling: what Part B covers
Most therapy and outpatient mental health care is covered under Medicare Part B. This includes services you get in a provider’s office, a clinic, a hospital outpatient department, or a community mental health center.
Who can provide therapy under Medicare?
Medicare Part B generally covers outpatient mental health services when they’re provided by qualified professionals who are enrolled in Medicare. Covered provider types include:
- Psychiatrists and other physicians
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists, nurse practitioners, and physician assistants
- Marriage and family therapists and mental health counselors (now included as eligible Medicare providers)
Practical tip: When you’re booking, ask two questions: “Are you enrolled in Medicare?” and “Do you accept assignment?” Those two answers can dramatically change your out-of-pocket costs.
What outpatient services are typically covered?
Medicare Part B covers a wide range of outpatient mental health services, such as:
- Diagnostic evaluation and assessment
- Individual psychotherapy (one-on-one therapy)
- Group psychotherapy
- Family counseling when it’s part of your treatment plan
- Medication management and psychiatric visits
- Partial hospitalization (structured, intensive outpatient psychiatric care)
- Intensive Outpatient Program (IOP) services in approved settings
- Preventive services like certain screenings (for example, depression screening in eligible settings when assignment is accepted)
What will you pay for outpatient therapy?
In general, under Original Medicare:
- You pay the Part B deductible before Medicare starts paying for most Part B services.
- After you meet the deductible, you typically pay 20% of the Medicare-approved amount for covered outpatient mental health visits, if the provider accepts assignment.
- If you receive services in a hospital outpatient department, you may also owe an additional hospital copayment or coinsurance amount.
2025 snapshot (Original Medicare): The standard Part B deductible is $257 in 2025, and the standard Part B premium is $185/month (most people pay the standard premium, but higher-income beneficiaries may pay more).
What does “accepting assignment” mean (and why should you care)?
“Accepting assignment” means the provider agrees to accept Medicare’s approved amount as payment in full (aside from your deductible and coinsurance). If a provider doesn’t accept assignment, you could pay more.
A simple cost example (because math should not be the villain)
Let’s say you’ve met your Part B deductible for the year. You see a clinical psychologist for a therapy session and the Medicare-approved amount is $150.
- Medicare generally pays 80%: $120
- You generally pay 20% coinsurance: $30
If the same session happens in a hospital outpatient setting, your share could be higher due to facility charges. That doesn’t mean hospital-based care is “bad”just that it often comes with extra billing layers.
Inpatient mental health care: what Part A covers (and the important 190-day rule)
If you’re admitted to a hospital as an inpatient for mental health care, Medicare Part A covers inpatient hospital services. This can include care in a general hospital or in a psychiatric hospital.
The 190-day lifetime limit (freestanding psychiatric hospitals)
Here’s a rule many people don’t learn until they need it: Medicare Part A pays for up to 190 days of inpatient mental health care in a freestanding psychiatric hospital over your lifetime. This limit generally does not apply the same way to psychiatric care received in a Medicare-certified psychiatric unit within a general hospital.
What will you pay for inpatient mental health care?
Inpatient costs under Part A are measured by a benefit period (not the calendar year). In 2025, the typical cost-sharing for inpatient hospital care per benefit period includes:
- Days 1–60: $1,676 deductible
- Days 61–90: $419 per day
- Days 91+ (lifetime reserve days): $838 per day (while you have reserve days available)
Also, while you’re inpatient, Part B generally applies to professional services from doctors and other providers, and you typically pay coinsurance for those services (often 20% of the Medicare-approved amount after the Part B deductible).
Medicare Advantage (Part C): same basic benefits, different rules
Medicare Advantage plans are offered by private insurers and must cover all medically necessary services that Original Medicare covers. That includes therapy, outpatient mental health care, and inpatient mental health care.
So what’s different?
Medicare Advantage plans can come with:
- Provider networks (you may pay moreor all costsout of network, depending on plan type)
- Copays instead of coinsurance for some visits
- Prior authorization for certain services (especially higher-intensity care like partial hospitalization, inpatient psychiatric stays, or certain specialty services)
- Referral requirements in some plans
Reality check: Many Medicare Advantage enrollees are in plans that use prior authorization for some mental health and substance use services. That doesn’t mean you can’t get careit means you should plan for an extra administrative step (and ask your provider’s office for help navigating it).
Prescription drugs for mental health: Part D coverage
Many mental health treatment plans include medicationsantidepressants, antipsychotics, mood stabilizers, anti-anxiety medications, or medications used in substance use disorder treatment.
Medicare Part D (or Medicare Advantage plans with drug coverage) typically covers outpatient prescription drugs. Coverage depends on your plan’s formulary (drug list), the medication tier, and utilization rules like prior authorization or step therapy.
Protected classes matter
Medicare Part D plans must include most drugs in certain “protected classes” on their formularies. These protected classes include antidepressants, antipsychotics, and anticonvulsants (often used as mood stabilizers), among others. This policy helps protect access for people who need stable medication regimens.
Still, expect plan rules
Even when a drug is covered, your plan might apply:
- Tiered copays/coinsurance (generic vs. brand vs. specialty)
- Prior authorization
- Step therapy
- Quantity limits
If your medication isn’t covered or is too expensive, ask your prescriber about alternatives, and consider requesting a formulary exception if medically appropriate.
Substance use disorder treatment and opioid treatment programs
Medicare covers a range of services related to substance use disorder treatment, including counseling and medication-assisted treatment when delivered through appropriate settings.
Opioid Treatment Programs (OTPs)
Medicare Part B covers certain medications used to treat opioid use disordersuch as methadone, buprenorphine, and naltrexonewhen provided through an Opioid Treatment Program. Medicare may also cover related services like counseling and therapy as part of treatment, depending on how and where services are delivered.
Tip: If you or a family member is using an OTP, confirm whether the program is enrolled in Medicare and how cost-sharing applies (because the details can vary by service type and benefit category).
Telehealth therapy under Medicare: what’s allowed now
Telehealth can be a big deal for mental health careespecially if transportation is hard, providers are far away, or you simply want to have your appointment from the comfort of your own couch (which, unlike some waiting-room chairs, has never judged anyone).
Behavioral/mental health telehealth is broadly available
Medicare allows beneficiaries to receive behavioral/mental health care via telehealth in their home, and Medicare policy supports telebehavioral health access without geographic restrictions. Medicare also allows certain behavioral/mental health telehealth services to be delivered via audio-only when appropriate.
The in-person visit requirement (and the current waiver)
There has been an in-person visit requirement connected to certain Medicare behavioral/mental health telehealth services. However, policy updates have waived this in-person requirement through January 30, 2026. Rules can evolve, so it’s smart to confirm requirements with your provider and Medicare resources when you schedule telehealth therapy.
What Medicare usually doesn’t cover (so you’re not surprised later)
Medicare is generous in many ways, but it does draw lines. Common examples of what isn’t covered (or isn’t covered in the way people expect) include:
- Transportation to and from most routine mental health appointments
- Meals tied to outpatient programs
- Support groups that are mainly for socializing (this is different from covered group psychotherapy)
- Job skills testing or training that isn’t part of a covered mental health treatment plan
- Private duty nursing (in inpatient settings)
- Coaching services that aren’t medically necessary treatment by eligible Medicare-enrolled providers
- Couples counseling may not be covered unless it’s clearly part of the patient’s treatment plan (for example, family counseling intended to support the patient’s therapy)
How to use your Medicare mental health benefits: a no-drama checklist
- Identify your coverage: Original Medicare? Medicare Advantage? Do you also have Part D? Medigap?
- Confirm the provider’s Medicare status: Are they enrolled in Medicare? Do they accept assignment?
- Ask about the setting: Office visit vs. hospital outpatient department can change your costs.
- For Medicare Advantage: Confirm network status and whether prior authorization is needed for your service.
- For medications: Check your plan formulary and ask about lower-cost alternatives if needed.
- Keep documentation: If you ever need to appeal a denial, documentation of medical necessity matters.
FAQ
Does Medicare cover therapy sessions with a counselor?
Yes, Medicare covers outpatient therapy when provided by eligible Medicare-enrolled professionals under Part B (or through a Medicare Advantage plan). Medicare now includes additional provider types such as marriage and family therapists and mental health counselors, expanding access.
Does Medicare cover online therapy?
Medicare covers telehealth for behavioral/mental health services, including therapy, in many situationsoften allowing you to receive care from home. Coverage still depends on provider eligibility, service type, and Medicare rules at the time you receive care.
Is there a limit on the number of therapy sessions?
Medicare doesn’t set a simple “X visits per year” cap for outpatient psychotherapy the way some plans do, but services must be medically necessary. Medicare Advantage plans may have additional management tools like prior authorization or network limits, so check your plan.
What if I need a higher level of outpatient care than weekly therapy?
Medicare covers structured options like partial hospitalization and intensive outpatient program services in approved settings when medically necessary. These programs can be a step up in support without a full inpatient admission.
Conclusion: Medicare can cover therapyif you know how to ask for it
Medicare mental health coverage is real, meaningful, and more robust than many people assume. Under Original Medicare, Part B generally covers outpatient therapy and counseling (often with 20% coinsurance after the deductible), while Part A covers inpatient mental health carethough freestanding psychiatric hospitals come with a notable 190-day lifetime limit. If you have Medicare Advantage, you get the same baseline coverage, but plan rules like networks and prior authorization can affect how quickly and where you receive care. And if medications are part of treatment, Part D can help cover many mental health drugs, including those in protected classes like antidepressants and antipsychotics.
The biggest “secret” isn’t a secret at all: success often comes down to verifying three things up frontprovider eligibility, assignment/network status, and setting. Do that, and Medicare becomes far less mysterious and far more helpful.
Experiences: what Medicare mental health coverage looks like in real life (composite examples)
Example 1: Weekly therapy with Original Medicare (the smooth path). “Pat,” a retiree with Original Medicare and Part B, starts weekly therapy for anxiety after a stressful year of health issues. Pat finds a clinical social worker who is enrolled in Medicare and accepts assignment. After meeting the Part B deductible, each session costs Pat about 20% of the Medicare-approved amount. Pat’s biggest lesson: asking “Do you accept assignment?” on the first phone call prevented surprise bills later. Pat also learned that the location mattersan office visit stayed predictable, while a hospital outpatient clinic would have added extra facility charges.
Example 2: Medicare Advantage and the prior authorization speed bump. “Diane” enrolls in a Medicare Advantage plan with a low monthly premium. Diane wants therapy and is surprised that the plan’s network is narrower than expected. She finds an in-network psychologist, but when her clinician recommends a more intensive program (partial hospitalization after symptoms worsen), the plan requires prior authorization. The good news: it can be approved. The frustrating part: it takes time, forms, and follow-up. Diane’s takeaway is not “Medicare Advantage is bad”it’s “I should treat plan rules like weather: check them before I leave the house.” Once approved, Diane pays set copays that are different from Original Medicare’s 20% coinsurance model.
Example 3: Inpatient care and understanding the 190-day rule. “Robert” needs inpatient stabilization and is admitted to a general hospital with a psychiatric unit. Medicare Part A covers the inpatient stay under benefit-period rules (deductible, then coinsurance after day 60 if the stay is that long). Later, Robert’s family learns about the 190-day lifetime limit that applies to freestanding psychiatric hospitals. They realize the type of facility can matter for long-term planning, especially for people with recurring inpatient needs. The experience reinforces a practical point: it’s okay to ask care teams about facility type and coverage implicationsthis is common, and it can shape both care continuity and costs.
Example 4: Telehealth therapy reduces friction. “Gloria” lives far from a metro area and struggles with transportation. Telehealth becomes the difference between consistent therapy and missed appointments. With Medicare behavioral/mental health telehealth options, Gloria attends sessions from home. When video is unreliable, audio-only appointments help keep care going. Gloria’s “aha” moment is that telehealth isn’t a second-rate backupit can be a legitimate way to stay engaged in treatment, especially when the alternative is no care at all.
Example 5: Medications under Part D (coverage, but not always the same price). “Sam” is prescribed an antidepressant that is covered, but the copay is higher than expected because it’s on a higher tier. Sam’s prescriber suggests a therapeutically similar alternative on a lower tier, lowering monthly costs. Later, when a medication requires prior authorization, Sam’s provider submits documentation and it’s approved. Sam’s main lesson: Part D often works best when you treat the formulary like a menustill plenty of choices, but prices vary, and asking your prescriber about alternatives is normal.
Across these experiences, a pattern emerges: Medicare coverage is often there, but the path is easiest when beneficiaries (and families) confirm provider status, understand the setting, and don’t hesitate to ask “what will this cost under my plan?” before care begins.