Key Takeaways

• Medicare Part B covers most outpatient therapy services, including individual and group psychotherapy, psychiatric evaluations, and counseling from licensed professionals.

• You must first meet your annual deductible, and then pay 20% of the Medicare-approved amount for each therapy session.

How Therapy Coverage Works Under Part B

If you’re enrolled in Medicare and seeking mental health treatment, knowing what Part B covers is essential. Medicare Part B covers outpatient mental health services, which include therapy sessions with a variety of licensed professionals. This coverage plays a crucial role in ensuring that you can access care when you need it, but there are conditions and costs you should understand in 2025.

What Medicare Part B Covers

You are eligible for coverage under Part B for the following mental health services:

• Individual and group psychotherapy by licensed professionals such as psychiatrists, psychologists, clinical social workers, and mental health counselors.

• Psychiatric diagnostic evaluation, including assessments needed for treatment planning.

• Family counseling, if it directly helps with your treatment plan.

• Medication management, if prescribed by a qualified provider.

• Partial hospitalization services in structured outpatient psychiatric programs.

• Telehealth visits, which are permanently included for mental health when provided through video or, in some cases, audio.

As of 2025, Medicare also includes coverage for services provided by licensed marriage and family therapists (LMFTs) and mental health counselors (MHCs). This expansion helps fill long-standing provider gaps, especially in underserved areas.

Your Out-of-Pocket Costs for Therapy

While Medicare covers a substantial portion of the cost, it is not free. Here’s what you can expect to pay in 2025:

• Annual Part B deductible: You must first pay the yearly deductible, which is $257 in 2025.

• Coinsurance: After meeting your deductible, you are responsible for 20% of the Medicare-approved cost of each therapy visit. Medicare pays the remaining 80%.

It’s important to understand that therapists and mental health professionals must accept Medicare assignment. If they do not, you may be charged more or may not be reimbursed for the visit.

Limits on Therapy Sessions

Medicare does not set a strict cap on the number of therapy visits you can have each year. However, your provider must document that the services are medically necessary and meet Medicare’s coverage criteria. If you continue therapy beyond a certain threshold, Medicare may conduct a review to ensure the care remains appropriate.

In general, therapy visits must:

• Be part of a care plan reviewed periodically.

• Be provided by a Medicare-enrolled professional.

• Be targeted at improving, maintaining, or preventing deterioration of mental health conditions.

Providers You Can See for Therapy

Medicare Part B will only pay for therapy if the provider is licensed and enrolled in Medicare. In 2025, your provider can be:

• A psychiatrist (MD or DO)

• A clinical psychologist (PhD or PsyD)

• A clinical social worker (LCSW)

• A nurse practitioner or physician assistant specializing in mental health

• A licensed marriage and family therapist (LMFT)

• A licensed mental health counselor (MHC)

You can search for a participating provider through the Medicare website or ask your primary care physician for referrals.

Therapy Through Telehealth

Telehealth services are now a permanent part of Medicare’s mental health benefits. This means you can receive therapy from home through a secure video platform or phone call if video is not possible.

In 2025, the rules for telehealth include:

• No geographic restrictions: You can be at home or in a healthcare setting.

• Eligible providers: The same professionals qualified for in-person therapy can provide telehealth therapy.

• In-person requirement: Starting October 1, 2025, Medicare requires at least one in-person visit every 12 months, unless you qualify for an exception due to hardship or geographic barriers.

Telehealth services are billed the same way as in-person visits. You will still pay 20% after your deductible is met.

How Partial Hospitalization Fits In

If your condition requires more intensive treatment but not full inpatient hospitalization, Medicare may cover Partial Hospitalization Programs (PHPs). These programs are structured outpatient treatment plans that provide multiple services during the day but allow you to return home in the evening.

Coverage includes:

• Therapy (individual, group, and family)

• Medication education and management

• Activity therapies associated with mental health treatment

To qualify for PHP coverage:

• Your doctor must certify that you would otherwise need inpatient psychiatric care.

• The program must be Medicare-certified.

• You must meet coverage and eligibility requirements.

You’ll still pay 20% of the Medicare-approved cost for each service within the program, and your deductible applies.

What Isn’t Covered

Even though Medicare Part B covers a wide range of therapy services, some mental health services are not included:

• Life coaching, stress management, or non-medical counseling

• Therapy from providers who are not Medicare-enrolled

• Services that are not considered medically necessary

• Missed appointments or late cancellation fees

Always confirm your provider’s participation and ensure services are coded and billed according to Medicare rules.

Prescription Medications for Mental Health

Therapy may be just one part of your treatment. If your provider prescribes medication for depression, anxiety, bipolar disorder, or another mental health condition, these drugs are not covered under Part B.

Instead, they are typically covered under Medicare Part D, which is your prescription drug plan. In 2025, Medicare Part D includes a $2,000 annual out-of-pocket cap, which offers some financial protection for those who need ongoing psychiatric medications.

Be sure your medication is on your plan’s formulary and that your pharmacy is in-network to avoid higher costs.

How to Get Started With Therapy

If you think you may benefit from therapy, here’s how to begin under Medicare Part B:

1. Speak to your primary care provider (PCP). They can assess your needs and refer you to a mental health specialist.

2. Check provider enrollment. Make sure your therapist or counselor is enrolled in Medicare and accepts assignment.

3. Review your Part B costs. You’ll need to meet your deductible and then pay 20% for each covered service.

4. Understand your rights. You are entitled to receive a written care plan and ask questions about the necessity and frequency of services.

5. Track your claims. Use your Medicare account to track services and confirm billing accuracy.

What Happens if You Can’t Afford the 20%

If the 20% coinsurance is unaffordable for you, you may be eligible for one of the following options:

• Medicare Supplement Insurance (Medigap): Some Medigap policies can help cover the 20% coinsurance. These require separate enrollment and monthly premiums.

• Medicare Savings Programs (MSPs): If you meet income and resource limits, you may qualify for assistance through a state-run program.

• Medicaid: Dual eligibility (Medicare and Medicaid) may result in full coverage for therapy without out-of-pocket costs.

Even if you don’t qualify for these programs, you can ask your provider if they offer sliding-scale fees or payment plans.

Special Considerations in 2025

There are a few important updates and reminders to be aware of for therapy coverage this year:

• Expanded provider network: LMFTs and MHCs are now officially covered under Part B.

• Out-of-pocket cap for medications: The $2,000 Part D limit can offer relief if therapy is combined with drug treatment.

• In-person telehealth rule: The October 1, 2025 requirement may affect your access to virtual care.

• No session limits: There are no arbitrary caps, but your provider must show medical necessity.

Stay informed of policy updates each year during the Medicare Open Enrollment period from October 15 to December 7.

Understanding Therapy Coverage Helps You Take Action

Medicare Part B provides a strong foundation for outpatient mental health care, but it’s not without its costs and caveats. The 20% coinsurance and in-person telehealth requirement are important to consider when planning for your therapy needs in 2025.

Review your current plan, speak to a licensed agent listed on this website if you have questions, and make sure you are matched with providers who accept Medicare. Mental health is a vital part of your well-being, and knowing your benefits gives you the confidence to seek the help you need.