Insurance

Does medicare cover mental health services?

Find the keys to unlocking your mental health benefits with Medicare! This guide breaks down the different Medicare plans, mental health care available to policy holders, out-of-pocket costs, and more.

derek lee grow therapy By Derek Lee, VP of Insurance Operations
An elderly couple are shown from behind as they look out over a green landscape along the base of a tree-covered hill.

Updated on Oct 07, 2024

Did you know that 30% of people enrolled in Medicare have a mental health condition? However, less than half of adults living with mental health conditions  in the United States have received mental health services within the past year. Mental health services are widely available and may be covered by insurance, including Medicare.

Key takeaways:

  • Medicare is a four-part federal government health insurance program that covers adults 65+, certain people with disabilities, and people with kidney failure.

  • Depending on the plan, Medicare offers some mental health care coverage, including outpatient treatment and medication management.

  • Under Medicare Part B, people typically pay 20% of the cost of service out-of-pocket.

  • You can check your coverage online using your Medicare.gov account.

What is Medicare?

Medicare is a federal government health insurance program in the U.S. that provides coverage to several eligible groups, including individuals 65 or older, certain individuals with disabilities, and those with kidney failure. Medicare may cover more than physical health services, such as physical therapy. It may help cover mental health services as well. Medicare has three parts:

Medicare Part A

This hospital insurance covers inpatient care in hospitals, hospices, skilled nursing facilities, and nursing homes. It also covers some at-home health care. This means it covers inpatient care at general hospitals as well as mental health care in a psychiatric hospital. There is a 190-day lifetime limit for coverage in a psychiatric hospital under Medicare Part A. Additionally, your doctor will have to provide certification of necessity, meaning they have to certify that the inpatient treatment is medically necessary.

Medicare Part B

Part A and Part B have their differences. The primary one is that Part B covers some practitioner services outside hospitals, medical supplies, and preventive services. This could be therapy or medication management, including the Welcome to Medicare visit.

Medicare Part C

Part C, also called Medicare Advantage, includes plans offered by private insurers.As an alternative to original Medicare, Plan C has the same hospital and medical insurance as Parts A and B, and many plans also include prescription drug coverage, which are typically offered primarily by Part D.

Medicare Part D

Medicare Part D helps cover the cost of prescription drugs. Medicare Part D is optional, and available to everyone who qualifies for Medicare. It is provided through private insurance companies approved by the federal government.

Does Medicare cover mental health care?

If you have a mental health condition and are hospitalized for inpatient services or require prescription drugs, you may be covered under Medicare Parts A and D, respectively. The information below shows what Medicare covers for outpatient mental health services under Part B.

Types of therapy and mental health care Medicare covers

Medicare covers depression screenings, including a one-time Welcome to Medicare visit to assess your risk factors for depression within the first year of having Medicare Part B. Additionally, Medicare fully covers one depression screening per year if done with a primary care doctor or clinic that can provide follow-up treatment or refer you to someone who can. On top of this, Medicare covers one wellness visit per year to speak with your care provider about your mental health concerns.

One-on-one or group psychotherapy or mental health counseling visits are also covered by Medicare, including cognitive behavioral therapy (CBT) and family counseling. The doctor, psychiatrist, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, or physician assistant must be a licensed professional who accepts Medicare (see below).

Psychiatric evaluation is covered and includes assessment for mental health conditions such as depression, anxiety, bipolar, attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), schizophrenia and other psychotic disorders, and substance use disorders. Some coverage is offered for substance use disorder assessments, treatments, and counseling, such as alcohol, tobacco, and opioid use disorders.

Medicare also covers medication management, diagnostic tests, partial hospitalization services, and structured psychiatric services more intense than what you’d get at a doctor or therapist’s office. With this coverage, you don’t stay in the hospital overnight and must meet specific requirements.

What mental health care Medicare doesn’t cover

Medicare does not cover meals, transportation, or support groups (not including group psychotherapy, which Medicare does cover).

Therapy covered by Medicare

Book now

How to check your Medicare coverage

There are a few ways to check your Medicare coverage online using the Medicare.gov website, which we’ll outline below.

Use your Medicare.gov account to check mental health care coverage

  1. If you have a Medicare number, you can create a secure online Medicare.gov account.
  2. Log in to your account and click the button in the top right corner that displays your first name.
  3. Click the My Preventive Services link.
    • You may see a list of preventive visits that you are currently eligible for.
    • You should be able to see Yearly depression screening and Yearly wellness visit from the list, for example.

You can also explore other mental health services you may be eligible for through your account.

What if I don’t have a Medicare.gov account?

The Get Started with Medicare page on Medicare.gov has information about coverage options, how to sign up, general costs, and more. You can check your mental health benefits with Medicare using the What Medicare covers link. You can also search for specific coverage using the Is my test, item, or service covered? link.

On the Medicare.gov website, you can converse with a representative to inquire specifically about the mental health benefits available to you.

How much does therapy cost with medicare?

There are several terms that you need to know to understand your coverage. If you’re ever in doubt, reach out to a Medicare representative who will be able to guide you on your plan.

In-network vs. out-of-network: Does your mental health care provider accept Medicare?

First, you need to know if your provider accepts Medicare, as this will affect how much you pay. Healthcare providers who accept Medicare are considered “in-network,” while those who don’t accept Medicare are “out-of-network.”

Next, there are a few factors to consider when deciding how much you’ll have to pay. Learn more about these terms here: Does insurance cover therapy?

Deductibles

The deductible is the amount you must pay out-of-pocket each year before your insurance will start to pay.

Coinsurance

Coinsurance is the percentage of the total cost of a treatment or service that Medicare doesn’t pay for. You must pay this amount out-of-pocket. For mental health care under Medicare Part B, this number is generally 20% of the Medicare-approved amount during your benefit period.

Example of Medicare’s cost

Let’s say you find a therapist who accepts Medicare. You have already met your deductible for the year (in 2023, this amount is $226) by paying for other treatments and services covered under Part B. The cost of the visit is $100 for a single counseling session. With a coinsurance of 20%, this means that you’ll pay $20 out-of-pocket, while Medicare will pay the remaining 80% ($80).

Other factors to consider regarding using Medicare for mental health services

These costs are on top of your monthly premium, the amount you pay for your Medicare insurance each month.

This article focuses on original Medicare plans. The coverage for other Medicare health plans, such as Medicare Advantage, may vary. If you have additional insurance coverage, it may help reduce your out-of-pocket costs.

Additionally, if you have limited income and resources, some programs may help cover costs, such as Extra Help, State Medical Assistance (Medicaid), or a State Health Insurance Assistance Program (SHIP).

How to maximize mental health care benefits with Medicare

Maximizing your mental health care benefits with Medicare involves understanding your coverage and knowing how to access the right services for you. Start by taking advantage of Medicare’s covered services like yearly wellness visits, depression screenings, and therapy sessions, which are often fully or partially covered under Part B.

If you’re on Medicare Advantage (Part C), explore the additional mental health benefits specific to your plan. Check for programs like Extra Help or Medicaid if you have limited income, as they can assist with covering costs. Finding a provider who accepts Medicare and discussing a care plan tailored to your needs can also help you make the most of your benefits.

How to find a healthcare provider who takes Medicare

At Grow Therapy, we help connect you with a wide range of mental health professionals who accept Medicare insurance.

Use our Find a Therapist tool and select Medicare as the insurance type. You can then find a therapist near you who specializes in your needs.

You can also check your healthcare provider’s website or mental health centers, or contact them directly to ask if they accept Medicare.

Final thoughts

Investing in your mental health is an investment in your well-being, growth, and healing. Insurance coverage like Medicare can help make mental health care affordable. In particular, Medicare Part B can cover depression screenings, wellness visits, psychotherapy, and psychiatric evaluations.

It’s easy to check your Medicare coverage online using the above mentioned steps. To figure out how much you’ll need to pay out of pocket for mental health services, make sure you’re familiar with whether your provider is in-network and what your Medicare plan’s deductibles and coinsurance amounts are.

Here at Grow Therapy, we make it easy to find a mental health provider who’s right for you. Check out our search tool to explore our network of providers who accept Medicare. Get started today with taking care of your mental well-being.

FAQs

  • Yes, if enrolled in Medicare Part B, you will have coverage for outpatient therapy, including individual and group sessions, if provided by licensed professionals who accept Medicare. Many Medicare Part C plans also cover mental health services.

  • You typically pay 20% coinsurance for outpatient services after meeting your annual Part B deductible.

  • Yes, Medicare Part B covers one free depression screening per year if conducted in a primary care setting that provides follow-up treatment.

  • Yes, but you will likely pay more out-of-pocket since Medicare will not cover services from out-of-network providers.

  • Yes, Medicare Part D plans cover prescription drugs for mental health, including substance use disorders. Drugs that must be covered include antidepressant, antipsychotic, and anticonvulsant medications. However, the specific drugs in these categories that are covered may vary.

  • Yes, there is a 190-day lifetime limit for inpatient care in a psychiatric hospital under Medicare Part A.

  • Yes, Medicare covers telehealth services for mental health, including therapy and counseling sessions.

About the author
derek lee grow therapy Derek Lee, VP of Insurance Operations

Derek Lee is Grow Therapy's Vice President of Insurance Operations, overseeing payor relations and success, credentialing and enrollment, new payor launch, revenue cycle management and billing, and insurance operations data analytics.

This article is not meant to be a replacement for medical advice. We recommend speaking with a therapist for personalized information about your mental health. If you don’t currently have a therapist, we can connect you with one who can offer support and address any questions or concerns. If you or your child is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should dial 9-1-1 and/or go to the nearest emergency room.

Frequently Asked Questions

  • Grow Therapy connects clients, therapists, and insurance companies to make mental healthcare simple to access.

  • We make it easy to find a therapist who looks like you and can support your needs. The right therapist is one who ensures you feel safe and comfortable. If you need help choosing, read these tips or contact our scheduling team by phone at 786-244-7711. More contact options are available here.

  • We conduct an intensive interview process to ensure our therapists have the skills, training, and experience to help you grow.

  • People who use their insurance save an average of 77% on the cost of therapy. Sessions cost an average of $21 with insurance, but will vary depending on your plan. Get a cost estimate, learn more about how to check your coverage, or contact your insurance company for more details.