Key Takeaways

• In 2025, Medicare now covers a broader range of behavioral health services, including more types of mental health professionals and community-based treatment options.

• While coverage has expanded, you still need to meet eligibility rules, and out-of-pocket costs can apply depending on the provider, setting, and your overall plan.

Expanded Behavioral Health Services in 2025

Medicare has taken a significant step in 2025 by expanding its behavioral health coverage. For the first time, services that were once limited to specific settings or provider types are now available more widely.

New Providers Are Now Covered

You can now get behavioral health care from more professionals than ever under Medicare. As of January 1, 2025, the program includes coverage for services from:

• Marriage and family therapists (MFTs)

• Mental health counselors (MHCs)

• Addiction counselors, if they meet Medicare criteria

• Clinical social workers and psychologists (previously covered, but with broader access now)

These additions mean you may no longer have to travel far or wait long to find a covered mental health provider.

Wider Access to Community-Based Treatment

Medicare now recognizes more community-based settings as valid locations for behavioral health treatment. In 2025, you can receive services at:

• Opioid Treatment Programs (OTPs)

• Intensive outpatient programs (IOPs)

• Partial hospitalization programs (PHPs)

• Mobile crisis units

This shift reflects an effort to treat mental health on par with physical health, using community-based approaches to reduce hospitalization and emergency room visits.

What Medicare Part Covers What?

Understanding which part of Medicare covers your behavioral health care is essential. Here’s how the coverage is divided:

Medicare Part A

• Covers inpatient hospital care if you’re admitted for mental health treatment

• Covers stays in psychiatric hospitals (limited to 190 lifetime days)

• Covers semi-private rooms, meals, nursing, and medications during inpatient stays

Medicare Part B

• Covers outpatient therapy, including individual and group sessions

• Covers visits with psychologists, psychiatrists, MFTs, and other approved providers

• Covers partial hospitalization if prescribed

• Pays 80% of the Medicare-approved amount after the Part B deductible, leaving you with 20% coinsurance

Medicare Advantage (Part C)

• Must cover at least what Original Medicare does

• May offer additional behavioral health benefits (but costs, networks, and rules vary by plan)

• Includes required mental health screenings annually

Medicare Part D

• Covers prescription medications for mental health conditions

• Includes antidepressants, antipsychotics, and mood stabilizers (coverage depends on the formulary of your plan)

What’s New in Behavioral Health Screenings?

In 2025, all Medicare beneficiaries are entitled to one annual mental health screening at no cost when performed by a Medicare-participating provider. This screening includes:

• Evaluation for depression and anxiety

• Risk assessment for substance use disorders

• Cognitive health screening

While the screening itself is covered fully, follow-up care might still include out-of-pocket costs.

Know the Limits and Cost Details

Despite the expanded access, there are still some limitations and cost-sharing you should understand.

Cost-Sharing Under Original Medicare

• Deductibles: In 2025, the Part B deductible is $257.

• Coinsurance: You generally pay 20% of the Medicare-approved amount for outpatient services.

• Inpatient care: Part A deductible is $1,676 per benefit period; daily coinsurance applies beyond 60 days.

You may also be responsible for:

• Copayments if receiving care in hospital outpatient settings

• Transportation if using mobile crisis units (unless local policies cover it)

Service Limits Still Apply

• Medicare only covers medically necessary services. Routine counseling for lifestyle issues, stress, or self-help may not qualify.

• Coverage may require documentation from a physician or mental health provider explaining medical necessity.

• Prior authorization may be required in some Medicare Advantage plans for higher-level services like PHPs.

Telebehavioral Health in 2025

Telehealth remains a key part of behavioral health care, and in 2025, it continues to be covered under Medicare.

What’s Included

• Individual and group therapy via video

• Psychiatric evaluations

• Medication management

Telebehavioral services are covered under the same cost-sharing rules as in-person visits if your provider accepts Medicare assignment.

Key Conditions

• Must use a secure platform compliant with CMS telehealth rules

• Most services can be provided from your home without prior in-person visits

• Some specialties may require at least one in-person appointment every 12 months, depending on your plan

Who Can Provide What Services?

Knowing which provider can deliver the care you need helps avoid claim denials or surprise bills.

• Psychiatrists: Can diagnose, prescribe, and treat mental health conditions.

• Psychologists: Provide therapy and psychological testing but cannot prescribe.

• MFTs and MHCs: Provide therapy for individuals, couples, and families. As of 2025, their services are newly reimbursable by Medicare.

• Clinical Social Workers: Provide therapy, care planning, and connect you to community resources.

• Primary Care Providers: May screen and refer you to specialists.

Substance Use Treatment Has Expanded Too

Medicare now supports more intensive substance use disorder treatments:

• Coverage for Medication-Assisted Treatment (MAT), such as methadone or buprenorphine, in certified facilities

• Counseling and therapy in group or individual settings

• Outpatient detox when medically appropriate

Your plan may require that you use facilities certified by Medicare or state-approved OTPs.

Mental Health Services in Rural Areas

CMS has introduced special allowances to improve access to behavioral health in underserved areas. These include:

• Coverage for community health workers and peer support specialists in rural zones

• Mobile crisis response teams that can bill Medicare

• Expanded telehealth reach without geographic restrictions

These improvements aim to reduce the urban-rural gap in behavioral care.

When You Might Need a Referral or Prior Authorization

Original Medicare typically does not require referrals for outpatient mental health services, but Medicare Advantage plans may.

In 2025, most Medicare Advantage plans require:

• A referral from your primary care doctor for specialists

• Prior authorization for intensive treatment like partial hospitalization

Always check your Evidence of Coverage document or talk with a licensed agent listed on this website to understand your plan’s rules.

How to Start Using Your Behavioral Health Benefits

You can begin accessing care by:

• Asking your primary care provider for a behavioral health screening

• Searching the Medicare.gov physician compare tool for in-network therapists

• Contacting your plan’s customer service if you’re on Medicare Advantage

• Verifying that your provider accepts Medicare assignment to avoid excess charges

Getting the right help starts with understanding what Medicare does—and doesn’t—cover.

Behavioral Health in 2025 Is a Step Forward—With Conditions

While 2025 brings long-overdue improvements to behavioral health access, those gains come with boundaries you need to understand. Coverage varies by provider type, care setting, and plan structure. Some services still require cost-sharing or approvals.

To make the most of your benefits, review your plan details, ask your providers about Medicare acceptance, and explore your options early. For guidance that’s specific to your situation, speak with a licensed agent listed on this website who can help you understand your Medicare behavioral health benefits.