Key Takeaways

• In 2025, Medicare continues to cover services from licensed marriage and family therapists (LMFTs) and mental health counselors (MHCs), expanding access to family counseling and substance use treatment.

• Coverage still depends on provider eligibility, plan type, and setting of care, so you need to verify key details before using these services.

Expanded Mental Health Support: What Changed in 2024

As of January 1, 2024, Medicare began including services provided by licensed marriage and family therapists (LMFTs) and mental health counselors (MHCs). This significant change opened up new avenues for family counseling and substance use disorder (SUD) treatment. These providers are now reimbursable under Part B, making outpatient therapy more accessible.

This expansion is part of broader efforts to close gaps in mental health access, especially in underserved areas. For years, Medicare’s restrictions excluded these professionals, even though they form a major part of the behavioral health workforce in many communities.

Family Counseling is Now Covered, But With Conditions

You can now receive family counseling under Medicare, but not all types of sessions are eligible. Medicare covers family counseling only if it directly supports the treatment of a Medicare beneficiary’s diagnosed mental health condition. This means the counseling must be part of a treatment plan created by an eligible provider.

What qualifies:

• Counseling sessions where your family members participate to support your treatment for depression, anxiety, bipolar disorder, or substance use.

• Therapy sessions ordered or supervised by a physician, psychologist, LMFT, or MHC.

• Services billed under Medicare-approved billing codes.

What doesn’t qualify:

• Marriage counseling solely for relationship issues without a diagnosed mental health condition.

• Family sessions that are not tied to a Medicare-enrolled beneficiary’s treatment plan.

Substance Use Treatment: Wider Access, New Providers

In addition to family therapy, Medicare now offers expanded support for substance use disorder (SUD) treatment. Since 2024, Medicare has recognized outpatient therapy from LMFTs and MHCs, which includes services like:

• Individual or group therapy for alcohol or drug use disorders

• Family counseling as part of SUD treatment

• Intensive outpatient programs (IOPs)

• Partial hospitalization programs (PHPs)

These services fall under Part B, and in some cases, Part A if they’re delivered in a hospital or PHP setting.

Important Cost Considerations:

• You pay 20% of the Medicare-approved amount after the Part B deductible, which is $257 in 2025.

• Coinsurance for services may vary based on setting and type of provider.

• If you receive care through a Medicare Advantage plan, you may need to stay in-network and get prior authorization.

Check Provider Eligibility Before Scheduling Services

Not every mental health provider who advertises therapy is enrolled in Medicare. To ensure coverage, your provider must:

• Be a Medicare-enrolled LMFT, MHC, clinical social worker (LCSW), psychologist, psychiatrist, or physician

• Bill Medicare directly (or through a Medicare-enrolled organization)

• Follow Medicare documentation and billing standards

If your provider is not enrolled in Medicare, you will be responsible for the full cost of the session.

How to verify:

• Ask the provider if they accept Medicare assignment

• Check Medicare.gov’s Care Compare tool

• Call 1-800-MEDICARE or your plan’s member services line

Where Services Can Be Provided

Medicare now pays for mental health services in a variety of settings:

• Outpatient clinics and private offices

• Community mental health centers

• Federally qualified health centers (FQHCs)

• Hospitals and hospital outpatient departments

• Telehealth, including audio-only visits (must meet Medicare criteria)

Family counseling and substance use services may be delivered in any of these settings, as long as the provider is enrolled and the treatment meets Medicare’s coverage rules.

Telehealth Still Plays a Role, But With One Key Rule

Medicare continues to cover mental health services via telehealth in 2025. This includes sessions conducted by video or by audio-only communication (for patients unable to use video). This is especially valuable for patients in rural or underserved areas.

However, there is a requirement you must follow:

• You must have an in-person visit with your provider at least once every 12 months, unless you qualify for an exception.

This rule applies even if you primarily receive care virtually. Failing to complete the required in-person session could make future telehealth visits ineligible for coverage.

What About Medicare Advantage?

If you are enrolled in a Medicare Advantage plan (Part C), your plan must offer at least the same benefits as Original Medicare, including the 2024 expansion to LMFT and MHC services. However, each plan may:

• Require prior authorization for family counseling or substance use treatment

• Limit services to network providers only

• Set different copayment amounts or coinsurance levels

Always review your plan’s Evidence of Coverage or contact member services to confirm:

• Whether your provider is in-network

• If referrals or authorizations are needed

• What your costs will be

Preventive Screenings and Follow-Up Support

Medicare covers annual depression screenings and alcohol misuse screenings as part of its preventive services. These are free if provided by a Medicare-approved provider during a visit that meets screening criteria.

If your screening shows signs of a mental health condition or substance use issue, your provider can create a treatment plan that may include therapy, medication, or family counseling. Follow-up services are then covered under Part B, subject to cost-sharing.

What You Should Do Before Getting Care

To avoid unexpected bills or coverage denials, follow these steps:

1. Confirm your diagnosis: Family therapy and SUD treatment are only covered when tied to a documented condition.

2. Get a referral or prescription if needed: Some services require a physician’s order.

3. Check the provider’s Medicare status: Ensure they are enrolled and accept Medicare.

4. Understand your costs: Review deductibles, copayments, and coinsurance.

5. Ask about prior authorization: Especially for Medicare Advantage.

These checks can prevent delays and ensure your sessions are covered.

Don’t Assume Everything Is Covered Automatically

Medicare’s expanded mental health benefits offer more options, but the program still applies strict rules. For instance:

• Group sessions or IOPs may require pre-approval.

• Family therapy for a relative’s issues is not covered unless it supports your treatment.

• Reimbursement depends on correct use of billing codes.

This means that you or your provider must document the clinical need for services and follow all Medicare rules for documentation and coding.

What Stays the Same in 2025

Even with these changes, certain Medicare rules are still in place:

• The 190-day limit for inpatient psychiatric hospital care under Part A remains.

• Part B still covers outpatient visits at 80% of the approved amount, after your deductible.

• Mental health medication coverage is available through Part D plans, with a $2,000 out-of-pocket cap in 2025.

So while your access to therapists has expanded, some structural limits still apply.

Why These Changes Matter

The inclusion of LMFTs and MHCs fills a major workforce gap in the mental health system. Many people live in areas where psychologists or psychiatrists are scarce. Allowing Medicare to pay these additional providers helps reduce wait times, expands treatment availability, and lowers costs for beneficiaries.

It also brings Medicare closer to parity with other insurance programs that have long recognized these providers. But the full benefit depends on you knowing how to use the system properly.

Get the Right Support for Your Mental Health

Now that Medicare covers a broader range of providers and services, including family counseling and substance use disorder treatment, you have more choices. But those choices come with responsibility.

Make sure your provider is eligible, your sessions are tied to a covered diagnosis, and your plan doesn’t require pre-approval. If anything is unclear, speak to a licensed agent listed on this website for guidance tailored to your situation.