Therapy coverage with Medicare

Over 68 million Americans are enrolled in Medicare, and 30% of people enrolled in Medicare have a mental health condition. Medicare, which covers Americans who meet certain age, health, or ability requirements, covers a wide variety of mental health treatments including therapy.

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, and people with certain disabilities or health conditions. Medicare has four 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 and mental health care in psychiatric hospitals. 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.

Who is eligible for Medicare?

Generally, Medicare is for people 65 or older. You may be able to get Medicare earlier if you have a disability, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig’s disease).

In general, Medicare covers people who:

• Are 65 or older
• Have a disability
• Have end-stage renal disease (permanent kidney failure)
• Have ALS (also known as Lou Gehrig’s disease)

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.

Does Medicare cover therapy?

One-on-one or group psychotherapy or mental health counseling visits are 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.

Medicare also 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.

Psychiatric evaluation is also covered and includes assessment for mental health conditions such as depression, anxiety, bipolar disorder, 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.

Does Medicare cover group therapy?

Yes, group therapy is covered by Medicare.

Does Medicare cover family therapy?

Family therapy is also covered by Medicare under Part B’s outpatient mental healthcare benefit.

Does Medicare cover couples therapy?

Similarly to family therapy, couples therapy or marriage counseling is covered by Medicare’s Part B outpatient mental healthcare benefit.

Does Medicare cover online therapy?

Both Medicare and the Medicare Advantage plan (Part C) may cover online therapy for in-network providers. When looking for an online therapist, make sure to check if they’re in your network.

What does Medicare not cover?

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

How many therapy sessions does Medicare pay for?

Medicare doesn’t limit the number of therapy sessions. However, there is a maximum most plans are willing to pay, and this is determined by ongoing review of medical necessity. If it is medically deemed necessary by your primary care provider, more sessions could be authorized. That means Medicare beneficiaries can go to therapy once every two weeks, typically.

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. For starters, you will 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.”

There are a few factors to consider when deciding how much you’ll have to pay. You’ll have to check how much your deductible is, which is the amount you must pay out-of-pocket each year before your insurance will start to pay. For example, 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)

What’s the difference between Medicaid and Medicare?

These two sound similar, so let’s make the distinction. Medicare is federal health insurance for anyone age 65 and older, and some people under 65 with certain disabilities or conditions. On the other hand, Medicaid is a joint federal and state program that serves people with limited resources and income with health care services and coverage.

How do I find a therapist who accepts 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.