Key Takeaways

• Medicare does cover mental health care, but the benefits vary by part (A, B, C, and D) and can come with unexpected costs, conditions, and limitations.

• Finding a provider who accepts Medicare, understanding billing rules, and knowing what’s actually covered are crucial to making the most of your mental health benefits.

Understanding the Scope of Medicare’s Mental Health Coverage

If you’re enrolled in Medicare and need help with anxiety, depression, or other mental health conditions, it’s important to know that coverage is available. However, it doesn’t always work the way you might expect. Medicare’s mental health benefits are distributed across its various parts, and each part plays a specific role.

Medicare Part A: Inpatient Mental Health Services

Part A covers inpatient mental health care in general hospitals, psychiatric hospitals, and skilled nursing facilities. If you’re admitted to a psychiatric hospital, Medicare will pay for up to 190 days over your lifetime.

What is included:

• Semi-private room

• Meals and medications

• Nursing care

• Therapy and related services during hospitalization

Costs:

• $1,676 deductible per benefit period in 2025

• Coinsurance applies after 60 days of hospitalization

After you’ve used the 190-day lifetime limit in a psychiatric facility, Medicare Part A will no longer pay for those services in that type of setting.

Medicare Part B: Outpatient Mental Health Services

Part B offers the most comprehensive coverage for outpatient mental health services. These include:

• Diagnostic evaluations

• Individual and group therapy

• Family counseling (when part of the patient’s care plan)

• Medication management

• Psychiatric nurse practitioner services

• Telehealth visits for mental health

New in 2025: Medicare now covers services from licensed marriage and family therapists (LMFTs) and licensed mental health counselors (MHCs), expanding access to more professionals.

Costs:

• $185 monthly premium (standard)

• $257 annual deductible

• 20% coinsurance for most outpatient mental health services after deductible

Note: If the provider does not accept Medicare assignment, you may pay more out-of-pocket.

Medicare Part D: Prescription Drug Coverage for Mental Health

If you’re prescribed antidepressants, anti-anxiety medications, or antipsychotics, you’ll need Part D to help cover these drugs.

What to expect:

• A maximum $590 deductible in 2025

• Once you spend $2,000 out-of-pocket, you’re protected from additional costs for the rest of the year

Keep in mind:

• Not all medications may be on your plan’s formulary

• Prior authorizations and step therapy may apply

Medicare Advantage (Part C): Coverage Varies

Medicare Advantage plans must cover at least what Original Medicare does, including mental health care. Some plans go beyond that, offering extra benefits like wellness programs, behavioral health coaching, and more.

However, limitations may include:

• Smaller provider networks

• Prior authorization requirements

• Referral mandates for specialists

Because each plan is different, you’ll need to review the Evidence of Coverage (EOC) and Summary of Benefits documents.

Key Limitations You Should Be Aware Of

Even though mental health care is covered, you could face limitations that affect access, cost, or continuity of care. Here’s what to watch out for:

1. The 190-Day Lifetime Limit in Psychiatric Hospitals

If you need repeated inpatient psychiatric care, your Medicare coverage for psychiatric hospital stays ends after 190 days in your lifetime. This limit doesn’t apply to general hospitals.

2. Network Participation and Acceptance

Many mental health professionals do not accept Medicare. This includes therapists, psychiatrists, and counselors. Even if someone is technically eligible to bill Medicare, they might opt out or not take assignment, which affects your costs.

In 2025, provider availability remains one of the biggest hurdles to accessing timely mental health care.

3. In-Person Requirement for Telehealth Services

Medicare permanently covers mental health telehealth services, including at-home video and phone visits. However, starting October 1, 2025, an in-person visit is required at least once every 12 months to continue using telehealth for mental health, unless you’re exempt due to hardship or geographical location.

4. Prior Authorizations and Step Therapy

Some medications or services may require prior authorization. This can delay care or limit your access. In Part D and Medicare Advantage plans, step therapy rules may require trying lower-cost medications first, even if they’re not the most effective for your condition.

Making Sense of Your Mental Health Benefits

Understanding your Medicare coverage means knowing how to use it without unexpected roadblocks. Here’s how to make it work for you.

Find the Right Providers

When looking for care:

• Confirm the provider accepts Medicare

• Ask if they take assignment to avoid excess charges

• If using Medicare Advantage, check if they are in-network

You can use Medicare’s online Physician Compare tool or contact your plan for help finding providers.

Understand Billing Structures

Billing confusion is one of the top reasons beneficiaries don’t seek mental health care. Knowing who can bill Medicare and how services are charged helps avoid surprises.

• Clinical psychologists and psychiatrists can bill directly under Part B

• LMFTs and MHCs are now recognized as eligible providers in 2025

• Social workers, psychiatric nurse specialists, and primary care providers may also offer mental health services under Part B

If you’re billed more than the Medicare-approved amount, request an “Advance Beneficiary Notice of Noncoverage” (ABN) to know your financial responsibility.

Know the Costs You’ll Likely Face

Here’s a basic estimate of out-of-pocket costs:

• Part A: Deductibles and daily coinsurance if hospitalized long term

• Part B: 20% of service cost after deductible

• Part D: Copayments and deductibles based on your plan and medication tier

• Medicare Advantage: Copayments, coinsurance, and possible out-of-network fees

You may also qualify for:

• Extra Help with prescription costs

• Medicare Savings Programs

• Medicaid (if dual eligible)

Telehealth as a Bridge to Care

Telehealth has expanded mental health access, especially in rural or underserved areas. Services include:

• Psychotherapy

• Psychiatric evaluations

• Medication check-ins

But don’t forget the 2025 in-person requirement for continued use unless you qualify for an exception.

Explore Additional Support Services

Some beneficiaries benefit from:

• Partial hospitalization programs (PHPs)

• Intensive outpatient programs (IOPs)

• Peer support services (covered in some states and plans)

• Wellness and prevention programs under Advantage plans

Always check whether these are covered and how to access them under your plan.

Navigating the Medicare Appeals Process

If your claim for mental health treatment is denied, you have the right to appeal. This can include denials for:

• Services you’ve already received

• Services you haven’t received yet

• Prescription drugs under Part D

Steps include:

1. Review the denial notice or Explanation of Benefits (EOB)

2. File a redetermination request within 120 days

3. If denied again, proceed to reconsideration and higher levels of appeal

It’s often helpful to get support from:

• Your doctor, who can provide medical justification

• A caseworker or advocate

• A licensed agent who understands Medicare billing and appeals

Timeline of Medicare’s Mental Health Changes

Recent years have seen meaningful, though gradual, changes in mental health coverage.

• 2022: Telehealth for mental health becomes permanent

• 2023: CMS finalizes rule to include audio-only services

• 2024: Medicare begins preparing provider inclusion for LMFTs and MHCs

• 2025: LMFTs and MHCs become fully covered under Part B

• October 2025: Annual in-person visit required for ongoing telehealth coverage (with exceptions)

These updates reflect growing awareness of mental health needs and Medicare’s response to expand access.

Common Pitfalls to Avoid

Watch out for these issues when using your mental health benefits:

• Assuming all providers accept Medicare

• Forgetting to check if your medication is on your Part D formulary

• Missing your in-person telehealth compliance visit

• Not verifying referral or authorization requirements

Staying informed helps you avoid care interruptions and unnecessary costs.

What You Can Do Right Now

• Review your Medicare Summary Notice (MSN) regularly

• Call your plan before scheduling mental health appointments

• Ask your provider if they accept Medicare and take assignment

• Keep records of all communication regarding services and billing

If you’re unsure how your coverage works, don’t guess. Get clear, accurate information from someone who can guide you.

Make Medicare Work for Your Mental Health Needs

While Medicare’s mental health coverage has expanded significantly in 2025, it’s still full of details that can affect your access and costs. Knowing your rights, choosing the right providers, and asking the right questions can make a real difference in your care.

If you need help understanding your benefits or finding covered services, reach out to a licensed agent listed on this website who can walk you through your options.