Key Takeaways

• In 2025, not all licensed therapists accept Medicare, which could significantly impact your ability to access timely and consistent mental health care.

• Knowing how to verify provider participation and understanding your plan’s requirements can help you avoid delays and unexpected costs.

Why Therapist Participation Matters More Than Ever

If you’re counting on Medicare for mental health support in 2025, there’s one critical truth you need to know: not every therapist accepts Medicare. This isn’t a minor detail. It can affect how quickly you get help, how much you pay, and how consistent your treatment is.

You may already be aware that Medicare now covers a wider range of mental health professionals, including marriage and family therapists (MFTs) and mental health counselors (MHCs) as of January 1, 2024. That was a long-awaited change. But even with this improvement, therapist participation in Medicare remains voluntary. This means that many qualified professionals may not be accessible through your Medicare plan.

Let’s break down what that means for you, your treatment options, and your care in 2025.

Medicare Mental Health Coverage: A Brief Overview

Before diving into the access issue, it’s important to understand what Medicare covers for mental health services in 2025.

Medicare Part A: Inpatient Mental Health Care

• Covers psychiatric hospital stays

• Limited to 190 days over your lifetime in a psychiatric hospital

• Deductible applies: $1,676 per benefit period

• Coinsurance begins after 60 days of hospitalization

Medicare Part B: Outpatient Mental Health Services

• Psychiatric evaluations

• Individual and group therapy

• Medication management

• Partial hospitalization programs (PHP)

• Intensive outpatient programs (IOP)

• Preventive screenings for depression and substance use disorders

You typically pay 20% coinsurance after meeting the $257 annual Part B deductible.

Medicare Part D: Mental Health Medications

• Covers prescriptions, including antidepressants, anti-anxiety medications, and antipsychotics

• 2025 out-of-pocket maximum is $2,000 under Part D reform

Medicare Advantage (Part C)

• Covers the same services as Original Medicare

• May include extra benefits like wellness programs

• Must still follow Medicare rules for mental health coverage

The Therapist Acceptance Gap: What’s Happening in 2025

While Medicare expanded the types of providers it reimburses, the program does not require mental health professionals to enroll. As a result, many therapists decline to participate.

Here’s why that matters:

• If a therapist isn’t enrolled in Medicare, you can’t use your Medicare coverage to pay them

• Even if you’re willing to pay upfront, you usually can’t get reimbursed by Medicare for care from a non-participating provider

• Some providers are “opt-out,” meaning they have formally opted out of Medicare and can only bill you directly

This dynamic limits your choices, especially if you live in a rural area, need specialized care, or want culturally competent therapy.

Common Reasons Therapists Don’t Accept Medicare

Therapists may have various reasons for not enrolling in Medicare:

• Low reimbursement rates: Medicare often pays less than private insurance

• Administrative burden: Claims processing and Medicare compliance can be time-consuming

• Patient population focus: Some providers tailor their practice to younger or privately insured clients

Even those newly eligible to bill Medicare, like MFTs and MHCs, may be hesitant to enroll. While the Mental Health Access Improvement Act expanded eligibility, it didn’t change provider incentives.

How to Know if a Therapist Accepts Medicare

You can take steps to avoid confusion and wasted time by verifying provider status upfront:

• Use Medicare’s online Physician Compare tool to search for participating mental health providers

• Call the provider’s office and ask directly: “Do you accept Medicare? Are you a participating provider?”

• Confirm with your Medicare Advantage plan if you’re enrolled in one; network restrictions may apply

If a provider says they “accept Medicare patients,” clarify whether they are truly participating, non-participating, or opted out. Only participating providers can directly bill Medicare.

Options When You Can’t Find a Participating Therapist

If you’re having trouble locating a therapist who accepts Medicare, you’re not alone. The shortage of Medicare-participating mental health providers is a well-documented challenge. Here are your potential paths:

1. Use Telehealth Services

Telehealth remains a covered option for mental health care in 2025, including:

• Therapy from your home via video

• Audio-only sessions (if clinically appropriate)

• Services from Medicare-participating providers anywhere in the U.S.

Keep in mind that as of October 1, 2025, you’ll need to have one in-person visit every 12 months to keep using telehealth for mental health.

2. Visit Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs)

These clinics typically accept Medicare and often provide mental health services on a sliding fee scale. They are more likely to have therapists who are Medicare-enrolled.

3. Explore Group Practices and Hospital Clinics

Larger behavioral health organizations are more likely to participate in Medicare than solo private practices. Consider contacting hospital outpatient departments or community mental health centers.

4. Speak to Your Primary Care Provider

Many primary care clinics now include behavioral health services. These integrated settings often employ Medicare-eligible therapists or offer collaborative care for mental health treatment.

5. Use Medicare Advantage Networks

If you have a Medicare Advantage plan, it may contract with more local therapists than Original Medicare. Just make sure to check:

• Is the provider in-network?

• Do you need a referral?

• Are there prior authorization rules?

Cost Considerations When a Therapist Doesn’t Accept Medicare

Therapists who don’t participate in Medicare set their own fees, and Medicare won’t reimburse you. This creates potential for:

• Unexpected out-of-pocket costs

• Disruption in care if you later switch to a provider who does accept Medicare

• Confusion about what’s covered when you receive services from multiple sources

To avoid surprises, always confirm the provider’s billing status and request an estimate of your costs before your first visit.

Timeline: What’s Changing and What You Need to Track

2025 is a year of change and continued access challenges. Here’s what you should track:

• January 1, 2025: MFTs and MHCs are fully integrated into the Medicare system (a continuation from the 2024 rollout)

• Ongoing in 2025: Provider directories are being updated, but delays persist

• October 1, 2025: In-person visit requirement begins for ongoing telehealth mental health care

• Throughout 2025: Expect evolving participation by newly eligible providers, but not full uptake

What You Can Do Now to Protect Your Access

You don’t have to wait for a crisis to prepare. Here are some practical steps you can take in 2025:

• Make a list of local Medicare-participating therapists or clinics in your area

• Talk to your primary care provider about referrals

• Plan ahead for the October telehealth changes

• Keep copies of any communications with your provider about their Medicare status

And if you’re newly eligible for Medicare or considering switching plans during the Annual Enrollment Period (October 15 to December 7), make sure mental health provider access is part of your plan comparison process.

Why Access Still Isn’t Equal for All Beneficiaries

Unfortunately, the lack of participating therapists doesn’t affect all groups equally. Disparities remain across:

• Geographic areas: Rural and underserved communities face the greatest access shortages

• Racial and ethnic groups: Cultural and linguistic barriers remain high, with few diverse Medicare-participating therapists

• Income level: Higher out-of-pocket costs make non-participating providers inaccessible for many

These gaps reinforce the importance of Medicare’s ongoing efforts to increase provider participation and reduce access inequities. But progress is slow.

Getting Mental Health Care Through Medicare Isn’t Automatic

Medicare’s mental health coverage in 2025 is broader than ever. But you still have to do your homework. The system expects you to:

• Confirm your provider’s Medicare status

• Understand coverage rules

• Track in-person visit requirements for telehealth

• Advocate for yourself when provider access is limited

Mental health care is essential, not optional. Yet the onus remains on you to work within a fragmented system. Knowing what to look for and taking proactive steps can improve your access and reduce frustration.

Better Access Starts With Being Informed

If you’re navigating mental health care under Medicare in 2025, understanding who accepts your insurance is just as important as knowing what’s covered. Access delays, unexpected costs, and inconsistent care are avoidable if you take the time to ask the right questions and plan ahead.

For personalized help evaluating your Medicare options or understanding which therapists are covered, reach out to a licensed agent listed on this website. They can walk you through your coverage, available provider directories, and changes for 2025 that may impact your access.