Key Takeaways

• In 2025, Medicare covers a wide range of mental health services including therapy, psychiatric evaluations, and prescription medications, but only when certain criteria are met.

• While recent expansions include more provider types and telehealth options, gaps remain in access, provider availability, and out-of-pocket costs.

Understanding Medicare’s Mental Health Benefits in 2025

If you’re considering starting therapy in 2025 and you have Medicare, it’s important to know what is actually covered. Medicare has improved its mental health benefits in recent years, especially with legislative changes allowing more types of therapists to bill Medicare. But there are still some limitations you need to plan around.

Let’s break down what Medicare will pay for, what it won’t, and what you should prepare for before your first session.

What Medicare Covers for Mental Health in 2025

Medicare Part A: Inpatient Mental Health Care

Medicare Part A helps cover hospital stays, including psychiatric inpatient care. You’re covered if you’re admitted to a general hospital or a psychiatric hospital. However, there are limits:

• You’re allowed up to 190 days of inpatient psychiatric care in a lifetime if treated in a freestanding psychiatric hospital.

• If you’re treated in a general hospital, those days do not count toward the 190-day limit.

You will pay:

• The Part A deductible, which is $1,676 per benefit period in 2025.

• Coinsurance for stays beyond 60 days.

Medicare Part B: Outpatient Mental Health Services

Medicare Part B provides coverage for outpatient services including:

• Individual and group psychotherapy

• Psychiatric evaluations

• Medication management

• Depression screenings

• Partial hospitalization programs (PHPs)

• Intensive outpatient programs (IOPs)

• Family counseling (if part of your treatment plan)

Covered Providers in 2025

As of January 1, 2024, Medicare expanded coverage to include services from:

• Licensed Marriage and Family Therapists (LMFTs)

• Licensed Mental Health Counselors (LMHCs or MHCs)

In addition to:

• Psychiatrists

• Clinical psychologists

• Clinical social workers

• Nurse practitioners

• Physician assistants

This expansion continues into 2025, improving access in rural and underserved areas.

What You Pay Under Part B

• 20% of the Medicare-approved amount after meeting the $257 Part B deductible in 2025.

• If you receive care in a hospital outpatient setting, you may also owe a facility copayment.

Medicare Part D: Mental Health Medications

Medicare Part D covers prescription drugs, including those used for mental health such as antidepressants, antipsychotics, and anti-anxiety medications.

• The deductible in 2025 is up to $590.

• Once you reach $2,000 in out-of-pocket spending, your plan covers 100% of covered drug costs for the rest of the year.

Telehealth Therapy and Medicare in 2025

Medicare continues to support telehealth for mental health services, including video and audio-only sessions. This means you can receive therapy from home if:

• Your provider accepts Medicare and offers telehealth.

• The service is within the scope of covered mental health benefits.

New Rule: In-Person Visit Requirement

Starting October 1, 2025, if you are receiving mental health services via telehealth from home, you must:

• Have an in-person visit with your provider every 12 months.

• This visit may be waived if both you and your provider agree it’s not clinically necessary and document the reason.

What Medicare Doesn’t Cover

Despite expanded benefits, Medicare won’t cover everything. Here are services Medicare does not pay for:

• Life coaching or motivational therapy not considered medically necessary

• Services from providers not enrolled in Medicare

• Missed appointment fees

• Marriage counseling not tied to a mental health diagnosis

• 24/7 residential treatment centers

• Long-term custodial care, even if you have a mental illness

How to Get Therapy Covered Under Medicare

To ensure your therapy is covered, follow these key steps:

1. Confirm the Provider Accepts Medicare

• Not all therapists are Medicare-approved.

• Use Medicare.gov’s provider search tool or call your provider’s office to verify.

2. Make Sure the Service Is Medically Necessary

• Your therapy must be part of a treatment plan for a diagnosed mental health condition such as depression, anxiety, bipolar disorder, PTSD, or others.

• Your provider must document this in your record.

3. Check Coverage Under Your Plan

• If you have Original Medicare, confirm whether your services fall under Part B.

• If you’re in a Medicare Advantage plan, check if your therapist is in-network and what prior authorizations may be required.

4. Monitor Out-of-Pocket Costs

Even with Medicare, you’re responsible for:

• 20% coinsurance for most outpatient services

• Annual deductibles

• Any charges from providers who don’t accept Medicare assignment

Medicare Supplement (Medigap) policies may help cover these costs if you have one.

Comparing Original Medicare and Medicare Advantage for Mental Health

Medicare Advantage (Part C) plans must cover at least the same mental health services as Original Medicare, but there can be differences in how you access care.

With Original Medicare:

• You can see any provider who accepts Medicare.

• You may need Medigap for cost-sharing.

With Medicare Advantage:

• You typically must use network providers.

• Plans may offer extra benefits like care coordination or telehealth platforms.

• Prior authorization or referrals might be needed.

However, not all Medicare Advantage plans include the same level of mental health benefits, and some may restrict access with narrow networks or limited specialists.

Access Remains a Challenge in 2025

Even with broader coverage, getting therapy through Medicare is not always easy. You may still face:

• Shortages of Medicare-accepting therapists

• Long wait times for psychiatric care

• Limited access in rural or underserved areas

These challenges may be partially eased by telehealth, but only if the provider participates in Medicare and offers virtual visits.

Medicare and Preventive Mental Health Services

Medicare also pays for some preventive services related to mental health:

• Annual depression screening in a primary care setting

• Cognitive assessment for early signs of dementia

• Substance use screenings and brief interventions

These services are fully covered (no cost to you) if your provider accepts Medicare assignment.

What About Group Therapy?

Group psychotherapy is covered under Part B when it’s led by a Medicare-approved provider and meets the definition of medically necessary care. This includes:

• Cognitive behavioral therapy groups

• Supportive therapy groups for chronic mental health conditions

You’ll still owe 20% coinsurance after the deductible.

If You’re New to Medicare: Timing Matters

If you just turned 65 or recently became eligible for Medicare due to disability, you can enroll in:

• Original Medicare (Parts A and B) during your Initial Enrollment Period (7 months surrounding your eligibility month)

• Part D for drug coverage

• Medicare Advantage plans if you prefer bundled coverage

You can also switch plans during the Annual Enrollment Period (October 15 to December 7) each year.

If you’re dealing with a new mental health diagnosis or just considering therapy, check whether your current Medicare plan supports the services and providers you need.

Taking the First Step Toward Therapy in 2025

Whether you’ve been in therapy before or are just exploring it for the first time, Medicare in 2025 gives you options. But taking advantage of those options means being aware of what’s covered, what isn’t, and how to plan your care.

Action Steps:

• Find a Medicare-approved therapist

• Confirm coverage through your Medicare plan

• Budget for copays and deductibles

• Use telehealth if appropriate, but plan for the 12-month in-person rule

• Keep up with annual screenings and preventive services

If you’re unsure where to begin, support is available.

Your Path to Covered Therapy Starts with the Right Guidance

Mental health matters, and Medicare’s expanded support in 2025 helps you access the care you need. But understanding the fine print is essential to avoid unexpected bills or delays in treatment.

For help reviewing your Medicare plan or comparing mental health coverage options, get in touch with a licensed agent listed on this website. They can walk you through what’s available, what’s covered, and what fits your personal care goals.