Key Takeaways

• As of January 1, 2024, Medicare expanded mental health coverage by including licensed marriage and family therapists (LMFTs) and mental health counselors (MHCs) as eligible providers under Part B.

• Despite this progress, significant disparities in provider availability, especially in rural and underserved regions, still limit access to care for many Medicare beneficiaries in 2025.

A Broader Network of Providers in 2025

Medicare Part B now includes a wider range of mental health professionals, offering new avenues of care. Since the start of 2024, beneficiaries have had access to services provided by licensed marriage and family therapists (LMFTs) and mental health counselors (MHCs). These additions represent a crucial step toward addressing the mental health needs of older adults and people with disabilities.

With the inclusion of LMFTs and MHCs, Medicare recognizes the importance of specialized, community-based therapy. These professionals often provide care in settings that feel more approachable or familiar, which can be essential for individuals hesitant to seek traditional psychiatric treatment.

This expanded access supports early intervention, improves continuity of care, and fills gaps in behavioral health services where other provider types may be unavailable or overbooked.

What Medicare Covers for Mental Health in 2025

Medicare now covers a wide spectrum of mental health services, but it’s important to understand what types of treatment fall under each part:

Medicare Part A

Part A covers inpatient mental health treatment in:

• General hospitals

• Psychiatric hospitals (up to 190 lifetime days)

• Skilled nursing facilities for follow-up behavioral care

Deductibles and coinsurance apply based on length of stay and facility type.

Medicare Part B

Outpatient mental health services covered include:

• Individual and group therapy

• Psychiatric evaluations and medication management

• Services from psychiatrists, psychologists, clinical social workers, LMFTs, and MHCs

• Partial hospitalization programs (PHPs)

• Intensive outpatient programs (IOPs)

• Preventive screenings for depression and substance use

You’re generally responsible for 20% of the Medicare-approved amount after meeting the Part B deductible, which is $257 in 2025.

Medicare Part D

Mental health medications are covered under Medicare Part D prescription drug plans. In 2025, there is a $2,000 annual out-of-pocket cap for covered drugs, helping you manage long-term medication costs.

Where Access Still Falls Short

Even with more providers now eligible under Medicare, actual access remains uneven across the country.

Regional Shortages

In many rural areas, there are not enough mental health professionals accepting Medicare. This includes both newer provider types like LMFTs and MHCs and long-standing Medicare-eligible providers such as psychiatrists and clinical psychologists. These regions often have:

• Fewer mental health clinics

• Longer waitlists

• Greater travel distances to the nearest provider

As a result, simply having coverage on paper does not guarantee care.

Low Provider Participation

Many behavioral health providers do not accept Medicare due to low reimbursement rates, administrative complexity, or lack of familiarity with billing requirements. This means that even in urban or suburban areas with more providers, you may struggle to find one who:

• Is accepting new patients

• Accepts Medicare assignment

• Offers appointments within a reasonable timeframe

Telehealth Still Has Limits

Telehealth remains covered for mental health services in 2025, including sessions conducted from your home. However, a key change applies starting October 1, 2025: an in-person visit is required at least once every 12 months to maintain telehealth access for mental health.

Exceptions apply for:

• Certain rural areas with travel hardship

• People with mobility limitations

• Those under active crisis care or ongoing intensive treatment

This new rule adds a logistical hurdle for some individuals, especially those who are homebound or lack transportation.

How to Use the Expanded Provider Network

To make the most of your Medicare mental health coverage in 2025, there are several practical steps you can take:

1. Check Provider Status

Always confirm that your mental health provider:

• Is enrolled in Medicare

• Accepts Medicare assignment

• Is licensed in your state and authorized to provide covered services

Use the official Medicare provider finder tool or contact the provider’s office directly.

2. Understand Covered Services

Each type of mental health professional has a specific scope of practice. For example:

• Psychiatrists can prescribe medications and provide evaluations

• Psychologists focus on psychotherapy and assessments

• LMFTs and MHCs provide talk therapy, often focusing on family, relationship, or community dynamics

Choosing the right type of provider depends on your treatment goals.

3. Coordinate With Primary Care

Your primary care doctor can play a vital role in your mental health care. They can:

• Refer you to a mental health provider

• Monitor how mental health conditions affect other medical issues

• Help manage medications

Medicare does not require a referral for most mental health services, but coordinating care helps improve outcomes.

4. Plan for Cost Sharing

Even though Medicare covers many mental health services, you are still responsible for:

• Deductibles (e.g., $257 for Part B in 2025)

• 20% coinsurance after deductible is met

• Prescription drug costs up to the $2,000 out-of-pocket cap

Consider if you have Medigap or other supplemental insurance to reduce your out-of-pocket costs.

5. Explore Community Health Centers

Federally Qualified Health Centers (FQHCs) and rural health clinics often provide mental health services and are more likely to accept Medicare. These centers may have:

• Sliding scale fees

• Integrated primary and behavioral care

• Greater availability in underserved areas

What Makes the 2025 Changes Important

The addition of LMFTs and MHCs has expanded the potential mental health provider pool by tens of thousands nationwide. Prior to 2024, these professionals were excluded from Medicare, even though they make up over 40% of the licensed behavioral health workforce in the United States.

This change not only increases capacity, but also broadens the types of therapy available to you as a Medicare beneficiary. LMFTs and MHCs often work in:

• Community mental health centers

• Private practices

• Addiction recovery programs

• Family-focused care models

Their services are particularly valuable for issues like grief, trauma, depression, relationship stress, and anxiety—conditions commonly experienced by older adults.

Why Access Gaps Persist

Despite policy improvements, several structural challenges remain:

• Geographic disparities: Rural counties often have no local Medicare-accepting behavioral health providers.

• Reimbursement complexity: Newer providers face billing challenges, limiting participation.

• Lack of awareness: Many beneficiaries and even providers are unaware of the recent changes.

• Systemic shortages: Demand for mental health services is increasing, and the supply of professionals is not keeping pace.

Solving these issues requires long-term investment, streamlined Medicare billing systems, and efforts to incentivize providers to serve Medicare populations.

Policy and Program Updates to Watch

Several ongoing initiatives aim to improve mental health access within Medicare:

• Workforce development grants: Federal and state programs are funding training and placement for behavioral health professionals in underserved areas.

• Expanded telehealth access: Medicare continues to evaluate data on telehealth utilization to determine if additional flexibility should be made permanent.

• Incentives for provider enrollment: Policy efforts are underway to reduce administrative burdens and improve reimbursement for mental health professionals.

• Outreach campaigns: CMS and advocacy organizations are increasing educational efforts to inform beneficiaries about their expanded rights and benefits.

Make Sure You Get the Mental Health Care You Deserve

Having Medicare coverage is only the first step. To receive effective mental health treatment, you must also know how to access care, understand the rules, and be persistent when barriers arise.

If you feel overwhelmed by the complexity of provider networks, billing questions, or care planning, help is available. A licensed agent listed on this website can walk you through your Medicare mental health options, help you find a provider, and make sure your plan meets your needs.