Key Takeaways

• Despite Medicare expanding its mental health coverage, many older adults still face difficulty accessing care due to a lack of participating therapists.

• Understanding which types of mental health providers are eligible under Medicare and how reimbursement policies work is crucial to finding covered care.

Why This Is Still a Problem in 2025

In 2025, Medicare covers more mental health services than ever before. You’re now eligible to receive therapy from a wider range of providers, including marriage and family therapists (MFTs) and mental health counselors (MHCs), thanks to recent policy changes. Telehealth is also permanently covered for mental health visits, and Medicare Part D now includes a $2,000 annual cap on prescription drug costs, helping with psychiatric medications.

So why is it still so hard to find a therapist who takes Medicare?

The issue is layered, and while policy progress is clear, the on-the-ground reality remains challenging. You’re not imagining things if you’ve searched for weeks only to find no local therapists accepting new Medicare patients. Here’s a deeper look into why access remains limited.

Low Reimbursement Rates Are a Major Barrier

Medicare’s reimbursement rates for mental health services are significantly lower than what many therapists can receive from private insurance or cash-paying clients. In practice, this means:

• Some therapists lose money accepting Medicare patients.

• Others face heavy paperwork burdens that aren’t compensated.

• Therapists in high-demand areas prioritize better-paying clients.

Even with the inclusion of new provider types in 2024, many MFTs and MHCs still choose not to enroll as Medicare providers due to these financial and administrative hurdles.

Provider Enrollment Takes Time and Effort

Another barrier is that enrolling as a Medicare provider involves a complex application and credentialing process. This can discourage therapists who are already managing full caseloads.

In 2025, you may encounter therapists who are eligible to bill Medicare but haven’t completed enrollment. They legally cannot accept Medicare unless fully credentialed, which delays your access even further.

Regional Disparities Make Access Worse

Depending on where you live, finding a Medicare-participating therapist might range from difficult to nearly impossible. Rural and underserved urban areas are particularly affected. These regions often lack sufficient behavioral health professionals to begin with, let alone those willing to take Medicare.

If you’re in a medically underserved area, you may have:

• No in-network therapists within a 50-mile radius.

• Only a handful of behavioral health clinics with months-long waitlists.

• A reliance on telehealth as the only realistic access point.

New Providers Were Added, But Not All Joined

Medicare began covering services from licensed marriage and family therapists and mental health counselors starting January 1, 2024. This was a significant change meant to increase your access to care.

However, in 2025, many of these newly eligible professionals still aren’t billing Medicare. Reasons include:

• Lack of awareness about the policy change.

• Inexperience with Medicare’s billing system.

• Concerns about low reimbursement.

The result is a missed opportunity. You might search for a counselor listed as eligible under Medicare rules, only to find they haven’t signed up to participate.

Medicare Advantage Plans Add Another Layer

If you’re enrolled in a Medicare Advantage plan, the situation may be even more confusing. These plans must cover the same mental health services as Original Medicare, but they use provider networks. That means:

• Your plan might cover therapy, but only from in-network professionals.

• Your preferred therapist might not be in-network, even if they take Medicare.

• Prior authorization or referrals might be required before starting therapy.

This leads to added administrative friction, making it harder for you to get timely care.

Telehealth Isn’t a Perfect Solution

Medicare’s permanent telehealth coverage for mental health services helps close some gaps, especially in remote or underserved areas. You can now have video or audio sessions from your home.

But there are limitations:

• Starting October 1, 2025, an in-person visit is required once every 12 months to keep telehealth eligibility (some exceptions apply).

• Not all therapists offer telehealth.

• Some mental health conditions are better managed with in-person care.

• Older adults may face technology access and usability challenges.

So while telehealth expands the reach of services, it doesn’t fully solve the issue of limited access.

Medicare’s Mental Health Benefits in 2025: What You Should Know

If you’re trying to understand what services are actually covered and what types of providers can bill Medicare in 2025, here’s a breakdown:

Part A (Hospital Insurance)

• Covers inpatient psychiatric hospital stays.

• Limited to 190 lifetime days in a psychiatric facility.

• Requires meeting the $1,676 deductible per benefit period.

Part B (Medical Insurance)

• Covers outpatient therapy, psychiatric evaluations, and medication management.

• Includes services from:

  • Psychiatrists

  • Clinical psychologists

  • Clinical social workers

  • Nurse practitioners

  • Mental health counselors (new in 2024)

  • Marriage and family therapists (new in 2024)

• Subject to the $257 annual deductible and 20% coinsurance.

Part D (Prescription Drug Coverage)

• Covers medications for depression, anxiety, bipolar disorder, schizophrenia, and other conditions.

• New in 2025: Out-of-pocket drug costs are capped at $2,000 annually.

Medicare Advantage (Part C)

• Must include at least the same mental health benefits as Original Medicare.

• May include extras like care coordination or wellness programs.

• Requires using plan networks and may involve authorizations.

Tips to Improve Your Access to Care

If you’re struggling to find a therapist who accepts Medicare, consider these practical steps:

• Ask if the provider is a Medicare-assigned provider. That means they accept Medicare-approved amounts as full payment.

• Check both Original Medicare and your Advantage plan network (if applicable). Networks vary widely.

• Consider telehealth as an entry point. It can shorten wait times and provide broader geographic access.

• Search through Medicare’s official Care Compare tool. While not always up to date, it’s a good starting place.

• Call your plan’s member services. They can give you a list of in-network therapists and help with referrals.

Why Mental Health Coverage Isn’t Enough Without Access

Coverage alone doesn’t mean care is available. Even if Medicare pays for therapy, the reality in 2025 is that you still might not be able to find someone to provide it. That’s a serious gap, especially considering that older adults face unique mental health challenges, such as:

• Grief and loss

• Chronic illness and disability

• Cognitive decline and isolation

• Caregiver stress

If you’re dealing with any of these issues, access to timely, professional support matters. But without enough therapists accepting Medicare, you may find yourself stuck in a system where help is promised but not actually reachable.

How Policy May Shift in the Future

There is growing attention on mental health access in Congress and at CMS. You may see more efforts in the next few years aimed at:

• Raising Medicare reimbursement rates for therapists.

• Simplifying the provider enrollment process.

• Encouraging more MFTs and MHCs to join Medicare.

• Expanding telehealth flexibilities further.

However, none of these proposals are guaranteed or immediate. In the meantime, you’re left to navigate a difficult system with limited provider participation.

Make Sure You’re Set Up for the Coverage You Need

If you’re not sure whether you have the right setup to access mental health care through Medicare in 2025, take these steps:

• Confirm that your providers are Medicare-approved.

• Verify whether your plan requires referrals or prior authorizations.

• Understand your out-of-pocket costs for therapy visits and medications.

• Look into whether your plan covers extra benefits like care coordination.

• Review your Part D coverage to ensure your prescriptions are included.

A licensed agent listed on this website can walk you through these details and help you find a plan or provider setup that better supports your mental health needs.

Gaps in Access Undermine the Benefits You Deserve

In 2025, Medicare offers better mental health coverage than it ever has. But the system still falls short when you can’t find a therapist to treat you. Structural issues like low reimbursement, administrative complexity, and regional disparities continue to make access a challenge.

If you’ve been frustrated by the lack of options, you’re not alone. The problem is not with you but with a healthcare system that’s struggling to deliver what it promises. To get the care you deserve, don’t hesitate to seek help. Get in touch with a licensed agent listed on this website to review your options and make a plan that fits your situation.