Is mental health therapy covered by medicare?

Medicare covers inpatient and outpatient mental health services, but you may be responsible for your deductible, copay and coinsurance costs. Medicare Part A covers mental health services in a hospital and Part B covers outpatient visits to a doctor and other mental health providers. Original Medicare and Medicare Advantage cover both inpatient and outpatient mental health services. Both help pay for screening tests, therapy appointments, and limited hospital stays.

Yes, Medicare covers mental health care, which includes counseling or therapy. Depending on your needs, mental health care can be provided in a variety of settings. The goal is to get the right kind of support when you need it. Medicare also covers outpatient treatment programs, where beneficiaries can receive more rigorous or structured mental health services without being admitted for inpatient care.

Certain drugs that treat mental health conditions are in the protected classes of Medicare Part D, including antipsychotic drugs, antidepressants, and anti-seizure drugs. You're only covered for mental health services from a psychiatrist, clinical psychologist, or other licensed health professional who accepts Medicare allowance. In addition to the services offered at PHPs, community mental health centers offer an alternative to hospitalization. Medicare Part B pays 80 percent of the Medicare-approved amount for outpatient mental health services as long as the doctor or other health care provider participates in Medicare.

Medicare helps pay for inpatient and outpatient mental health care through Original Medicare or Medicare Advantage plans. Once you meet your Part B deductible for the year, you will be responsible for paying 20 percent of the Medicare-approved amount for doctor's office visits to diagnose and treat your mental health condition. Psychiatrists are trained doctors who can prescribe medications to treat complex and serious mental illnesses, and are one of the health care providers covered by Medicare Part B. Medicare Part B covers many preventive services, including assessments to access your risk for certain mental health conditions.

Nutrition therapy may include an initial lifestyle assessment, helping to manage factors affecting your nutritional health, and tracking individual or group therapy sessions. You may also be required to pay an additional copayment or coinsurance if you receive mental health therapy services at a hospital outpatient clinic. Medicare covers this service in hospital outpatient centers and community mental health centers (CMHC). As part of Medicare mental health care benefits, therapy or counseling is usually covered under Part B as an outpatient service with Original Medicare.

In severe cases of mental illness, a psychiatrist can determine that a patient needs to be admitted to a psychiatric hospital or a general hospital for treatment, and Medicare Part A (hospital insurance) can help pay for inpatient mental health services during a stay in a hospital or mental health center. You only have coverage for mental health services you receive through a psychiatrist, clinical psychologist, or other licensed health professional who accepts Medicare allowance.

Diana Anzaldua
Diana Anzaldua

Diana Anzaldua, LCSW - S, TYCT, is a Licensed Clinical Social Worker and Trauma-Informed Yoga Teacher in Central Texas. As the founder and owner of Austin Trauma Therapy Center, she teaches clients new skills for coping and adapting to the daily stresses of life so they can live the life they imagined by connecting them to their true authentic selves. Diana has been featured in industry magazines & websites such as Bustle, Hello Giggles, Yahoo, PBS, Allure, and more. Diana started this website to help answer FAQs for people interested in learning more about therapy around the world!