Key Takeaways

• Medicare only pays for mental health care if the provider accepts Medicare and meets certain eligibility requirements.

• Even with coverage, your out-of-pocket costs may depend on whether the provider accepts Medicare assignment and what type of service you receive.

Mental Health Help Through Medicare Is Possible—But Provider Choice Matters

Medicare offers a range of mental health services in 2025, but getting those services paid for starts with one simple detail: your provider must accept Medicare. If you skip this step, you could end up with bills that Medicare won’t cover.

In this article, you’ll find exactly what Medicare covers, who qualifies to provide those services, how to confirm a provider’s participation, and why this decision directly impacts your costs.

What Medicare Covers for Mental Health Services

Medicare covers both inpatient and outpatient mental health services when they meet eligibility criteria. These services fall under different parts of Medicare:

Medicare Part A: Inpatient Psychiatric Care

Part A covers inpatient hospital care, including stays in a psychiatric hospital. However, there is a 190-day lifetime limit for inpatient care in a standalone psychiatric facility. This limit does not apply to mental health care received in a general hospital.

Covered services include:

• Room and meals

• Nursing care

• Medications

• Therapy and counseling as part of inpatient treatment

You must first meet the Part A deductible ($1,676 in 2025), and coinsurance applies if your stay exceeds 60 days.

Medicare Part B: Outpatient Mental Health Services

Part B covers outpatient services such as:

• Individual and group therapy

• Psychiatric evaluation and diagnosis

• Medication management

• Services from psychiatrists, psychologists, social workers, and now in 2025, licensed marriage and family therapists (LMFTs) and mental health counselors (MHCs)

• Intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs)

After the annual Part B deductible ($257 in 2025), you typically pay 20% coinsurance of the Medicare-approved amount.

Medicare Part D: Prescription Drug Coverage

Part D covers prescription drugs used to treat mental health conditions. Your out-of-pocket costs are capped at $2,000 annually in 2025. Plans vary in terms of drug formulary and pharmacy networks, so it’s important to check which medications are covered.

Types of Mental Health Providers Eligible Under Medicare

Not all therapists or counselors are eligible to be paid by Medicare. The following provider types are approved for coverage under Medicare in 2025:

• Psychiatrists (MD or DO)

• Clinical psychologists (PhD or PsyD)

• Clinical social workers (LCSW)

• Nurse practitioners and physician assistants

• Licensed professional counselors (LPCs)

• Licensed marriage and family therapists (LMFTs)

• Mental health counselors (MHCs)

New in 2025, Medicare officially covers services from LMFTs and MHCs. However, these professionals must be enrolled in Medicare as participating providers.

If your provider is not in this list or is not Medicare-certified, Medicare will not cover your treatment.

Why It Matters Whether a Provider Accepts Medicare

Even if a provider is licensed and offers services covered by Medicare, it does not guarantee that they accept Medicare payments.

There Are Three Types of Provider Relationships With Medicare:

1. Participating Providers: Accept Medicare and always accept Medicare-approved amounts as full payment. You only pay coinsurance and deductibles.

2. Non-Participating Providers: Accept Medicare but may charge up to 15% more than the Medicare-approved rate. You must pay this excess charge out of pocket.

3. Opt-Out Providers: Do not accept Medicare at all. They can bill you directly, and Medicare will not reimburse you.

If your therapist or psychiatrist is an opt-out provider, Medicare pays nothing, even if the service itself is covered.

How to Confirm a Mental Health Provider Accepts Medicare

Before you book an appointment, take the following steps to confirm the provider’s Medicare status:

• Ask Directly: When calling the provider’s office, ask, “Do you accept Medicare assignment?”

• Check Medicare.gov: Use the official Medicare provider search tool to find participating providers near you.

• Contact 1-800-MEDICARE: Speak to a representative who can verify your provider’s enrollment.

If you’re seeing a provider under a Medicare Advantage plan, contact your plan directly to confirm they are in-network.

Telehealth and Mental Health Services in 2025

Medicare continues to cover telehealth for mental health, including video and some audio-only visits. These services must be:

• Delivered by a Medicare-approved provider

• Done through HIPAA-compliant technology

• Available only after an in-person visit every 12 months, starting October 1, 2025, unless you’re exempt due to hardship or geographical barriers

Telehealth visits are billed the same as in-person visits, including coinsurance and deductibles.

Out-of-Pocket Costs You Should Expect

Even with Medicare coverage, you still share in the cost of care. Your expected costs include:

• Part A Deductible: $1,676 per benefit period

• Part B Deductible: $257 annually

• Part B Coinsurance: 20% of Medicare-approved costs

• Part D Drug Costs: Up to $2,000 annually, depending on your prescriptions

• Non-Participating Provider Surcharge: Up to 15% over approved rates

Choosing a provider who accepts Medicare assignment helps you avoid unnecessary extra charges.

What Happens if You Pick the Wrong Provider?

Choosing a provider who does not accept Medicare can mean:

• You are billed the full amount with no Medicare reimbursement

• Services don’t count toward your deductible or out-of-pocket cap

• Medications may not be covered if the provider isn’t coordinating with a Part D network

In short, using a non-Medicare provider can lead to higher costs and missed benefits.

Coordinating Medicare With Other Coverage

If you have other coverage (such as retiree benefits, Medicaid, or a Medigap plan), Medicare may not be the only payer. However, your provider still must accept Medicare to coordinate benefits.

Medigap policies can help pay the 20% coinsurance for outpatient services. Medicaid may also cover copayments for dual-eligible individuals. But again, none of this applies if the provider is not enrolled in Medicare.

Why Many Providers Don’t Accept Medicare

You might wonder why some mental health professionals decline to take Medicare. Reasons include:

• Low reimbursement rates compared to private insurance

• Administrative burden of billing Medicare

• Restrictions on telehealth or treatment methods

This makes finding a provider more difficult, especially in rural areas or high-demand specialties. That’s why confirming provider participation before care is essential.

How to Find a Medicare-Accepting Mental Health Provider

You can start your search with the following options:

• Medicare.gov Care Compare Tool: Search for providers by location, specialty, and whether they accept Medicare

• State Health Insurance Assistance Program (SHIP): Offers free local counseling

• Your Medicare plan directory: If enrolled in Medicare Advantage

Make a short list and call ahead to verify they’re currently accepting new Medicare patients.

Ensuring You Maximize Your Coverage and Avoid Gaps

To avoid coverage gaps:

• Always check if the provider is enrolled in Medicare

• Understand what part of Medicare the service falls under (A, B, or D)

• Make sure prescriptions are filled at a pharmacy in your plan’s network

• Track how close you are to hitting deductibles or out-of-pocket caps

Your Mental Health Benefits Depend on the Right Provider

In 2025, Medicare makes it possible to access mental health services, including therapy, evaluations, and medication. But your benefits are only as good as the provider you choose. If they don’t participate in Medicare, you’re at risk of paying entirely out of pocket.

Before your next appointment, confirm your provider’s Medicare status and stay informed about your rights and responsibilities as a Medicare enrollee.

For personalized help, get in touch with a licensed agent listed on this website who can walk you through your coverage options and assist you in finding a provider who accepts Medicare.