Key Takeaways

• In 2025, Medicare continues to expand its mental health coverage, including new provider types and broader service access, but gaps in availability and awareness still limit real impact for many enrollees.

• You must meet specific requirements and use Medicare-approved providers to fully benefit from the new mental health services now covered under Part B and Part D.

Medicare’s Mental Health Expansion: What’s Different in 2025?

Medicare made significant changes in 2024 to expand access to mental health care. In 2025, those changes remain in place, and additional steps are being taken to improve coverage and provider availability. But despite policy improvements, many beneficiaries like you may still struggle to find the care you need.

The most notable shift is that Medicare now includes licensed marriage and family therapists (LMFTs) and mental health counselors (MHCs) as approved providers under Part B. This update, effective since January 1, 2024, was designed to improve access, especially in rural and underserved areas. However, one year later, you may still find it challenging to locate providers who accept Medicare, despite the policy being in place.

Types of Mental Health Services Medicare Covers in 2025

Your Medicare benefits can cover a wide range of mental health services if specific conditions are met. Here is what is currently available:

Inpatient Mental Health Services (Part A)

If you are hospitalized for a mental health condition, Part A covers your inpatient care. This includes:

• Semi-private rooms

• Meals

• Nursing and therapy services

• Medications administered during your stay

However, inpatient psychiatric hospital coverage is limited to 190 lifetime days. This limit has not changed in 2025.

Outpatient Mental Health Services (Part B)

Part B covers many outpatient services, including:

• Psychiatric evaluations

• Medication management

• Individual and group therapy

• Services from psychologists, psychiatrists, LMFTs, and MHCs

• Intensive outpatient programs (IOPs)

• Partial hospitalization programs (PHPs)

• Preventive screenings for depression and substance use disorders

You must pay the Part B deductible (currently $257 in 2025) and 20% coinsurance after that. Services must be provided by Medicare-approved professionals.

Prescription Drug Coverage (Part D)

Part D continues to cover mental health medications, including antidepressants, antipsychotics, and mood stabilizers. The out-of-pocket cap of $2,000 introduced in 2025 significantly reduces your financial burden for medications.

If your prescriptions exceed this amount, your plan covers 100% of drug costs for the rest of the year.

New Provider Access: LMFTs and MHCs

The inclusion of LMFTs and MHCs in 2024 was a major step. It means you no longer need to rely solely on psychologists or psychiatrists for therapy. These newly added professionals can provide therapy services under Part B just like other recognized mental health specialists.

However, you must still:

• Ensure the provider is Medicare-approved

• Confirm they accept assignment (to avoid higher charges)

• Get a referral or diagnosis, if required by your plan

Despite the policy change, the supply of LMFTs and MHCs enrolled in Medicare remains lower than expected in 2025. This ongoing gap means you might still experience delays or long wait times.

Telehealth Mental Health Services in 2025

Medicare permanently extended coverage for mental health telehealth services during and after the pandemic. As of 2025, you can continue to access mental health care from home via video or audio visits.

Telehealth covers:

• Therapy sessions

• Psychiatric evaluations

• Medication reviews

However, starting October 1, 2025, an in-person visit is required every 12 months to maintain eligibility for telehealth services. Exceptions exist for those who cannot travel due to hardship or location-based limitations.

To remain eligible for telehealth:

• Complete at least one in-person visit every year

• Document medical necessity if an exemption is requested

This requirement may disrupt care if you rely exclusively on telehealth, especially if your provider does not offer in-person appointments.

Mental Health Preventive Services: Are You Using Them?

Preventive screenings are fully covered by Medicare. These include:

• Annual depression screening

• Alcohol misuse screening and counseling

• Smoking cessation support

You pay nothing for these preventive services as long as your provider accepts Medicare assignment.

However, utilization remains low. Many beneficiaries don’t realize they qualify for these screenings or are unsure how to request them. You should proactively ask your primary care provider about these benefits during your annual wellness visit.

Intensive Outpatient and Partial Hospitalization Options

If your mental health needs go beyond traditional therapy but don’t require full hospitalization, Medicare covers two intermediate options:

• Partial Hospitalization Programs (PHPs)

• Intensive Outpatient Programs (IOPs)

These programs include multiple hours of care per day, several days per week, often involving group therapy, medication management, and structured activities.

Covered under Part B, these services:

• Require a formal diagnosis and treatment plan

• Must be provided by Medicare-approved facilities

• Involve coinsurance costs after your deductible

In 2025, these programs are still underutilized. They could provide a vital bridge for individuals with moderate to severe mental health needs, but access and awareness remain challenges.

Challenges You Might Still Face in 2025

Despite the 2024 improvements, many barriers remain in 2025:

• Provider Shortages: Especially in rural areas, where fewer mental health professionals accept Medicare.

• Appointment Wait Times: Even where providers exist, demand often exceeds capacity.

• Limited Understanding of Benefits: Many enrollees are unaware of new mental health coverage options or preventive services.

• Plan Confusion: Medicare Advantage enrollees may face stricter networks and prior authorization requirements.

Unless you actively review your plan details and verify provider participation, you may encounter unexpected costs or denied claims.

Medicare Advantage: Mental Health Coverage Varies

If you’re enrolled in a Medicare Advantage plan, you receive at least the same mental health coverage as Original Medicare. However, each plan may vary in the following:

• Network restrictions (you may be limited to certain providers)

• Prior authorization requirements

• Cost-sharing structures

• Extra services such as transportation or wellness apps

You should carefully review your Annual Notice of Change (ANOC) each fall to understand what mental health benefits and provider options are changing for the following year.

Keep in mind that the $2,000 cap on out-of-pocket drug costs applies regardless of whether you’re in Original Medicare or Medicare Advantage with a Part D component.

How to Make Sure You Get the Mental Health Care You Deserve

With the expansion of coverage and provider types, you now have more opportunities to seek support. Still, it’s up to you to ensure your care is covered and accessible. Here’s how:

• Verify Provider Participation: Ask your therapist, counselor, or psychiatrist if they are enrolled in Medicare.

• Ask About Assignment: Choosing a provider who accepts assignment helps you avoid extra charges.

• Stay Current on Telehealth Rules: Track your in-person visit status to continue qualifying for remote therapy.

• Use Your Preventive Services: Request screenings and wellness visits every year.

• Understand Your Plan’s Limits: Review coverage details, including pre-authorization rules and network restrictions.

• Seek Help If You’re Unsure: Contact a licensed agent listed on this website to walk through your options.

Medicare may offer the framework for mental health care, but your access depends on how that coverage is implemented in your area and how you use it.

Mental Health Coverage Has Grown, but So Have the Gaps

The improvements made in 2024 were long overdue. Adding LMFTs and MHCs, removing cost barriers for preventive screenings, and capping drug costs were all major wins. But in 2025, the reality remains: coverage is not the same as access.

You may find that the help you need is now technically covered, but the practical steps to getting that care are still filled with hurdles. Don’t wait until your mental health reaches a crisis. Use the tools now available to check your plan, explore your preventive options, and schedule an appointment with a Medicare-approved provider.

For help understanding your plan or comparing options, get in touch with a licensed agent listed on this website.