Key Takeaways

• Starting in 2024, Medicare expanded coverage to include licensed mental health counselors (MHCs) and marriage and family therapists (MFTs) under Part B services.

• To benefit fully, you must ensure your provider meets all Medicare requirements, including licensure, Medicare enrollment, and billing compliance.

Expanded Access, But With Conditions

If you’ve been waiting for Medicare to catch up with the mental health needs of older adults, 2024 marked a significant milestone. For the first time, Medicare Part B now pays for outpatient mental health services provided by licensed mental health counselors and marriage and family therapists. This long-overdue change opens new doors, but it also comes with some important caveats.

You can now schedule therapy sessions with a broader range of professionals, potentially reducing wait times and improving access in underserved areas. However, just because someone is licensed in your state doesn’t automatically mean Medicare will pay for their services. Understanding the eligibility requirements and limitations is essential before you book an appointment.

What Medicare Covers in 2025

Medicare Part B covers medically necessary outpatient mental health services, including:

• Diagnostic evaluations

• Individual and group therapy

• Family counseling (if it helps with your treatment)

• Medication management

• Partial hospitalization programs (PHP)

• Intensive outpatient programs (IOP)

• Telehealth visits

As of 2025, these services are reimbursable when provided by any of the following enrolled providers:

• Psychiatrists and other physicians

• Clinical psychologists

• Clinical social workers

• Nurse practitioners and physician assistants

• Marriage and family therapists (MFTs)

• Mental health counselors (MHCs)

This means if you are receiving care from an MFT or MHC, and they meet all the Medicare conditions, you should only be responsible for your Part B deductible and 20% coinsurance.

Who Exactly Are MFTs and MHCs?

Marriage and Family Therapists (MFTs) specialize in treating mental health and emotional issues in the context of relationships. They are trained to work with couples, families, and individuals dealing with interpersonal challenges, trauma, and behavioral disorders.

Mental Health Counselors (MHCs) focus on diagnosing and treating a wide range of mental and emotional disorders, including anxiety, depression, PTSD, and more. Their training involves therapy models, ethics, and supervised clinical practice.

Both MFTs and MHCs must hold a master’s or doctoral degree, complete extensive supervised clinical experience, and be licensed by the state.

Eligibility Criteria for Medicare Reimbursement

Not every licensed MFT or MHC is automatically approved to bill Medicare. To qualify under Medicare Part B, your therapist must:

• Hold a master’s or doctoral degree in mental health counseling, marriage and family therapy, or a related field.

• Be licensed by the state to independently diagnose and treat mental illness.

• Enroll in Medicare as an approved provider.

• Use proper billing codes when submitting claims.

If your counselor hasn’t gone through the Medicare enrollment process, you will likely be responsible for the full cost of services. Always confirm their Medicare status before scheduling care.

Why This Change Matters in 2025

For years, the mental health provider network under Medicare has been too narrow to meet rising demand, especially in rural and underserved areas. By adding MFTs and MHCs to the list of covered professionals, Medicare significantly increases the supply of potential providers.

This change matters for a few reasons:

• More provider options: You may now access care from a counselor who previously wasn’t covered.

• Shorter wait times: Broader networks mean less waiting, especially for ongoing therapy.

• Cultural competence: You may have more luck finding a provider who understands your background or treatment preferences.

• Local access: Many MFTs and MHCs operate in community clinics or private practices closer to home.

Telehealth Services Still Covered

Medicare continues to support telehealth as part of its mental health strategy. In 2025, you can still receive therapy sessions from an MFT or MHC via live video conferencing from your home.

However, beginning October 1, 2025, you are required to have an in-person visit every 12 months with your provider if you’re receiving telehealth for mental health services. Exceptions apply if you’re unable to travel or if the provider documents why a virtual-only approach is more appropriate.

This rule is designed to ensure continuity of care while still preserving access for people who may not be able to attend sessions in person regularly.

Limitations You Should Be Aware Of

Despite this expanded access, there are still limitations:

• No coverage for unlicensed therapists or life coaches, even if they offer similar services.

• No reimbursement for services without a mental health diagnosis.

• Marriage counseling for relationship enrichment (not linked to mental health treatment) is still not covered.

• Prior authorization may be required for some services like intensive outpatient programs or partial hospitalization.

Medicare does not cover support groups, holistic wellness coaching, or alternative therapies such as acupuncture for mental health unless part of an approved clinical service.

What You’ll Pay in 2025

Under Medicare Part B, mental health services are subject to the standard cost-sharing structure:

• Annual Part B deductible: $257 in 2025

• Coinsurance: 20% of the Medicare-approved amount after you meet your deductible

If you have a Medigap policy or Medicare Advantage plan, your out-of-pocket costs may vary. Many enrollees use supplemental insurance to help reduce these expenses, but the specifics depend on the plan you have.

Steps You Can Take to Use These Benefits

To get the full benefit of these expanded services, here’s what you should do:

• Check your provider’s credentials. Ask if they’re enrolled with Medicare.

• Verify licensure. They must hold a current license in your state.

• Confirm the service type. Make sure the therapy is medically necessary and billed properly.

• Review your Medicare Summary Notice (MSN). This helps you understand what was billed and what Medicare paid.

• Call Medicare or a licensed agent if you have billing questions or need help finding an enrolled therapist.

Mental Health Screenings Are Also Covered

Medicare covers one free depression screening per year, typically as part of your Annual Wellness Visit. This screening must be performed in a primary care setting with access to follow-up treatment if needed.

This is a valuable first step in identifying whether you could benefit from further mental health services. It does not replace therapy but helps direct you to it.

Partial Hospitalization and IOP: What’s Included?

Medicare also covers more intensive services such as:

• Partial Hospitalization Programs (PHP): Structured programs often lasting 4 to 6 hours per day, several days a week. Offered in hospitals or community mental health centers.

• Intensive Outpatient Programs (IOP): Less intensive than PHP, usually lasting 2 to 3 hours per day, multiple days a week.

Both options require a physician’s certification and must be provided by Medicare-approved facilities. They may be helpful for those transitioning from inpatient psychiatric care or managing conditions like major depression, bipolar disorder, or severe anxiety.

Still a Long Way to Go

While this policy change is a step forward, there are still barriers to equitable mental health care within Medicare:

• Provider shortages: Even with expanded eligibility, many areas lack enough MFTs or MHCs who accept Medicare.

• Reimbursement challenges: Some therapists are reluctant to enroll due to lower Medicare reimbursement rates.

• Administrative hurdles: Providers must navigate a complex system to get credentialed and bill correctly.

You may still face difficulty finding an available therapist in your area, and even more difficulty if you’re looking for someone with specific language skills, cultural competence, or specialty training.

Accessing the Support You Deserve

If you’re feeling overwhelmed, anxious, depressed, or struggling with grief, relationship stress, or trauma, you deserve support—and now, you have more ways to get it under Medicare.

But navigating eligibility, costs, and provider networks takes effort. A licensed agent listed on this website can help you understand your Medicare coverage, review your plan, and find therapists who accept Medicare and meet the new qualifications.

Don’t hesitate to ask for help. This expansion gives you the legal right to more options—make sure you take full advantage.