Key Takeaways

• Medicare covers a broad range of mental health services in 2025, including annual depression screenings and therapy visits, but many benefits are only available if you know how to request them.

• Your Annual Wellness Visit is a critical opportunity to raise mental health concerns and begin accessing covered services, but you must meet specific conditions for ongoing treatment coverage.

Why Your Annual Wellness Visit Matters More Than Ever

The Annual Wellness Visit (AWV) offers more than a basic check-up. In 2025, it includes a review of your physical and mental health, with special attention given to cognitive and emotional well-being. If you’re experiencing mood changes, memory lapses, or feelings of isolation, this visit is your chance to flag them. Medicare covers this service once every 12 months, and it lays the groundwork for further care.

During the AWV, your provider will assess risk factors for depression, anxiety, and cognitive disorders. This assessment is your gateway to accessing further services under Medicare’s mental health coverage. However, Medicare does not cover routine psychiatric evaluations unless they are medically necessary, so this visit can help you establish that need.

What’s Included in Medicare’s Mental Health Coverage

Medicare covers both inpatient and outpatient mental health services. Each part of Medicare plays a role:

Part A: Inpatient Mental Health Care

• Covers psychiatric hospital stays (up to 190 lifetime days in a psychiatric hospital)

• Coverage includes semi-private rooms, meals, nursing, therapy, and medications

• You pay the Part A deductible ($1,676 in 2025) and coinsurance after 60 days of hospitalization

Part B: Outpatient Mental Health Care

• Covers services like:

  • Individual and group therapy

  • Diagnostic testing

  • Psychiatric evaluations and medication management

  • Partial hospitalization programs (PHPs)

  • Intensive outpatient programs (IOPs)

  • Family counseling (if related to your treatment)

• You pay the Part B deductible ($257 in 2025), then 20% coinsurance for most services

• As of 2025, services from mental health counselors and marriage and family therapists are also covered

Part D: Prescription Drug Coverage

• Covers medications used to treat mental health conditions

• Subject to a $2,000 annual out-of-pocket maximum in 2025

• Includes coverage through standard Part D plans or employer-based EGWP plans

Medicare Advantage (Part C)

• Includes all services under Original Medicare, often with extra benefits

• May include coverage for teletherapy, over-the-counter items, or wellness programs

• Plans have varying networks, referral requirements, and copays

Screening Tools and Mental Health Checks

Every Medicare beneficiary is eligible for at least one depression screening per year under Part B. This screening must be conducted in a primary care setting with follow-up options in place. You pay nothing if your provider accepts assignment.

During your AWV, your provider will also conduct a cognitive assessment. If issues are detected, a more thorough cognitive evaluation may be scheduled, which is separately billable.

In addition, Medicare covers alcohol misuse screenings and counseling, anxiety screenings, and suicide risk assessments when medically necessary. These are especially important for beneficiaries managing chronic illness, bereavement, or life transitions.

Telehealth and Mental Health Access in 2025

Teletherapy remains covered under Medicare in 2025. You can receive mental health services via video or audio-only telehealth visits from your home. This coverage was initially expanded during the COVID-19 public health emergency and has since become a permanent benefit.

However, starting October 1, 2025, a new rule requires you to meet your mental health provider in person at least once every 12 months to continue receiving telehealth care. Some exceptions apply if travel poses a significant burden or if you live in a rural or underserved area.

Providers You Can See Under Medicare

Medicare now covers a broader range of mental health professionals than ever before. In 2025, you can receive covered services from:

• Psychiatrists

• Clinical psychologists

• Clinical social workers

• Psychiatric nurse practitioners

• Mental health counselors (MHCs)

• Marriage and family therapists (MFTs)

To ensure coverage, the provider must accept Medicare. Some specialists limit the number of Medicare patients they see or require a referral. If you’re in a Medicare Advantage plan, you may need to stay within your plan’s network.

Partial Hospitalization and Intensive Outpatient Programs

When standard outpatient therapy isn’t enough, Medicare Part B covers more structured programs:

Partial Hospitalization Program (PHP)

• Structured program provided during the day, with no overnight stay

• Often used for severe depression, anxiety, or substance use recovery

• Includes therapy, medication management, and group support

• Requires a physician’s certification and ongoing treatment plan

Intensive Outpatient Program (IOP)

• Similar to PHP but fewer hours per week

• Typically includes 9–19 hours of structured treatment per week

• Must be provided by a Medicare-certified facility

• Covered by Medicare Part B with standard cost-sharing

Prescription Drug Management

Mental health medications are often long-term, so it’s important to review your Part D coverage during the Annual Enrollment Period (October 15 to December 7 each year).

As of 2025:

• The $2,000 annual out-of-pocket limit helps reduce financial stress for those on multiple medications

• The Medicare Prescription Payment Plan allows you to spread drug costs over the year rather than paying them all at once

• Some drugs may require prior authorization or step therapy under certain plans

Ask your prescriber to confirm your medications are on your plan’s formulary to avoid denials or delays.

Common Barriers to Accessing Care

Despite expanded coverage, several barriers can limit access to mental health care under Medicare:

• Provider shortages: Many areas lack Medicare-participating mental health professionals

• Referrals and network restrictions: Especially in Medicare Advantage plans

• Stigma: Emotional hesitancy or cultural resistance can delay seeking care

• Administrative delays: Denials, prior authorization, and incorrect billing can complicate access

Being proactive during your Annual Wellness Visit can help address these challenges before they escalate.

Your Next Steps at the Wellness Visit

If you’re approaching your Annual Wellness Visit, prepare in advance to make the most of your time:

• Write down any mental health symptoms you’ve experienced: changes in mood, sleep, appetite, memory, or motivation

• Be honest about stressors: loneliness, family issues, grief, or caregiving burdens

• Ask about follow-up services if the screening indicates a concern

• Discuss your current medications, especially if you take mood stabilizers or sleep aids

• Review your Part D drug list with your provider to check for lower-cost or better-covered alternatives

Your provider can refer you to covered mental health services and help you set up a care plan. If additional assessments are needed, they can be scheduled right away.

Support Services and Resources

Medicare also connects you with broader support systems:

• Care coordination: Often available in Medicare Advantage plans or through Accountable Care Organizations (ACOs)

• Chronic care management: May include mental health if it coexists with conditions like diabetes or heart disease

• Social work services: Available under certain circumstances to help manage social and emotional factors

• Suicide prevention support: National crisis lines and local providers offer resources for urgent care

In 2025, more tools are available than ever, but accessing them requires knowledge and planning. Your Annual Wellness Visit is your entry point.

Protecting Your Mental Health Benefits

To avoid losing access or facing unexpected costs:

• Make sure your provider accepts Medicare or is in-network if you have a Medicare Advantage plan

• Track how many therapy visits or inpatient days you’ve used

• Know the frequency limits: one depression screening per year, one Annual Wellness Visit per year, and one telehealth in-person follow-up every 12 months

• Stay up to date during Open Enrollment to ensure your plan still meets your mental health needs

Medicare may cover more in 2025, but you’re still responsible for understanding the system to use it effectively.

How to Take Advantage of What Medicare Offers Now

Mental health care is essential to your well-being, and Medicare provides a framework that supports it. But getting the care you need depends on asking the right questions at the right time, especially during your Annual Wellness Visit.

If you’re unsure what your Medicare plan includes or how to get started, connect with a licensed agent listed on this website. They can help you find mental health providers, review coverage details, and guide you in making informed choices for your care.