Key Takeaways

• Medicare now covers licensed mental health counselors (MHCs) and marriage and family therapists (MFTs), but your ability to access these services still depends on your specific plan and provider network.

• Not all Medicare Advantage plans include every newly eligible provider, so you need to confirm whether your chosen plan gives you access to MHCs and MFTs before scheduling care.

A Major Expansion in Medicare Mental Health Coverage

Since January 1, 2024, Medicare Part B has covered services provided by licensed mental health counselors and licensed marriage and family therapists. This marks a pivotal step forward in expanding access to mental health care for millions of Medicare beneficiaries.

Before this change, Medicare only reimbursed mental health services delivered by psychiatrists, clinical psychologists, clinical social workers, and psychiatric nurse specialists. By recognizing MHCs and MFTs as eligible providers, Medicare has opened up a broader pool of mental health professionals you can now work with—especially important in areas where psychiatrist and psychologist shortages are common.

But just because Medicare now covers these providers doesn’t mean every Medicare plan includes them or has made them readily accessible. There are still a few layers you need to navigate.

What Does Original Medicare Cover in 2025?

If you are enrolled in Original Medicare (Part A and Part B), mental health services from qualified MHCs and MFTs are now covered under Part B. Here’s what that includes:

• Psychiatric diagnostic evaluations

• Individual and group therapy sessions

• Family counseling if it supports your treatment plan

• Crisis intervention and care coordination

• Telehealth mental health visits

You pay the standard Part B deductible, which is $257 in 2025, and then 20% coinsurance of the Medicare-approved amount. If you have a Medigap policy, it may help cover these costs.

Access is based on whether the provider is enrolled in Medicare and accepts assignment. This means you need to confirm in advance that your counselor participates in Medicare and agrees to the payment terms.

What About Medicare Advantage?

Medicare Advantage (Part C) plans are required to cover at least the same mental health services as Original Medicare. However, they operate through managed care networks, which means:

• Not every MHC or MFT in your area may be in-network.

• Your plan may require referrals or prior authorizations.

• There may be restrictions on how and where you receive services (e.g., telehealth limits, designated providers).

Just because the law changed in 2024 doesn’t mean every Medicare Advantage plan instantly added new providers. Each insurer updates their network on their own timeline, and some may still be contracting with MHCs and MFTs. That’s why it’s essential to check your plan’s directory or call the plan directly before assuming your counselor is covered.

How to Verify Mental Health Counselor Access

To make sure you can work with the mental health counselor of your choice, take these steps:

1. Confirm that the provider is Medicare-enrolled. Ask the counselor directly or use Medicare’s online provider search tool.

2. If you have Medicare Advantage, call your plan. Ask whether the counselor is in-network and whether you need a referral.

3. Ask about telehealth rules. Some plans allow virtual mental health visits, others have restrictions.

4. Understand your costs. Find out if your plan has different copays for in-network mental health specialists versus out-of-network ones.

These details matter. Not every Medicare Advantage plan has immediately updated their mental health provider directories. Even if a counselor is technically eligible under Medicare rules, they may not be covered under your current plan.

Marriage and Family Therapists Are Included Too

MFTs are now eligible to provide services under Medicare Part B as of 2024. Like MHCs, they must be licensed in your state and enrolled as Medicare providers.

They can provide:

• Couples counseling (as part of a treatment plan for a diagnosed mental health condition)

• Family therapy for caregiving support or conflict resolution

• Behavioral health treatment for depression, anxiety, PTSD, and more

MFT services are also covered at 80% of the Medicare-approved rate after the deductible. But again, your access depends on whether the provider accepts Medicare or is included in your Advantage plan’s network.

Don’t Forget About Part D Coverage for Mental Health Medications

If your mental health treatment includes medications, you’ll need a Medicare Part D plan or a Medicare Advantage plan that includes drug coverage.

The good news for 2025 is that the annual out-of-pocket limit for prescription drugs is now capped at $2,000. This change can significantly lower the cost burden if you require ongoing prescriptions such as antidepressants, antipsychotics, or mood stabilizers.

You may also be eligible for the Medicare Prescription Payment Plan, which lets you spread out drug costs over monthly installments instead of paying all at once.

Check that your chosen plan covers the medications prescribed by your mental health provider and whether there are any prior authorization requirements or formulary restrictions.

Telehealth Is Still Covered

Medicare continues to allow telehealth for mental health treatment in 2025. You can receive services from licensed providers via:

• Live video calls

• Audio-only calls (if you lack access to video)

• Remote sessions conducted from your home or another qualifying location

However, a new rule now requires that you meet with your mental health provider in person once every 12 months. Some exceptions apply if you live in a rural or medically underserved area, or if transportation presents a barrier.

If telehealth is how you plan to access counseling, ask your provider and your plan how they’re meeting the 12-month in-person rule and whether any exceptions apply to you.

Gaps You Might Still Face

Even with this expanded access, some gaps remain in the Medicare mental health system:

• Provider shortages: Many areas, especially rural regions, still lack enough Medicare-participating mental health professionals.

• Network delays: Not all Medicare Advantage plans have fully updated their provider networks to include newly eligible MHCs and MFTs.

• Inconsistent reimbursement: Some counselors may not yet accept Medicare due to administrative or payment concerns.

• Plan confusion: Beneficiaries often struggle to understand whether their plan allows access to specific mental health providers.

These issues can make it difficult to secure consistent care, even with the law now on your side. That’s why verifying your coverage before you begin therapy is so important.

What This Means for You in 2025

If you’ve been waiting to get help from a licensed mental health counselor or family therapist, you now have more options under Medicare than ever before. But while the legal barrier has been lifted, administrative and logistical hurdles still exist.

Here’s how to move forward with confidence:

• Use Medicare’s official tools to verify provider participation.

• Contact your Medicare Advantage plan directly to check for in-network MHCs and MFTs.

• Don’t assume your plan has updated its network just because Medicare changed the law.

• Ask your provider if they’re actively billing Medicare and whether they require any additional documentation.

• Review your drug coverage annually to ensure your mental health medications are included and affordable.

Accessing mental health services under Medicare is becoming easier, but it still takes preparation. Knowing the right questions to ask and where to look can make the difference between delayed care and timely support.

Get Help Finding the Right Coverage for Mental Health Care

With more providers now included in Medicare and new limits on prescription drug costs, it’s a great time to revisit your coverage options. Whether you’re enrolled in Original Medicare or a Medicare Advantage plan, understanding how your mental health benefits work is essential.

If you need help making sense of it all, speak with a licensed agent listed on this website. They can walk you through plan details, provider networks, and cost-sharing rules so you can confidently access the mental health support you deserve.