It’s Easier Than Ever to Use Medicare for Mental Health, But There’s Still Red Tape

Key Takeaways

• Medicare now includes more mental health professionals and services than ever before, but practical barriers still limit access.

• You may need to navigate provider networks, documentation requirements, and prior authorizations, depending on your Medicare coverage.

More Providers Are Covered in 2025

In 2025, Medicare covers a broader range of mental health professionals. Alongside psychiatrists, psychologists, clinical social workers, and psychiatric nurse specialists, Medicare now pays for services provided by licensed marriage and family therapists (LMFTs) and mental health counselors (MHCs). This expansion began in 2024 and remains in place today.

This change is significant because it expands your options if you’re seeking therapy or counseling. Before 2024, you could only see a narrow group of providers under Medicare. Now, with the addition of LMFTs and MHCs, you have more flexibility when finding a provider who fits your needs.

However, while the list of eligible providers has grown, getting seen by one is not always straightforward. The number of providers accepting Medicare has not necessarily kept up with demand, especially in rural or underserved areas.

Covered Mental Health Services Under Medicare

Medicare provides mental health coverage under Parts A, B, C, and D. But each part works differently and can involve different rules. Here is how these parts work for mental health:

Part A: Inpatient Psychiatric Care

Medicare Part A covers mental health services when you are admitted to a hospital or psychiatric facility.

• Coverage includes semi-private room, meals, nursing, therapy, and medication during your stay.

• You are limited to 190 days in a psychiatric hospital over your lifetime.

• You will pay the Part A deductible, which is $1,676 per benefit period in 2025.

• Coinsurance applies after 60 days of hospitalization.

Part B: Outpatient Mental Health Services

Medicare Part B handles outpatient services. This includes many of the mental health care services you may seek regularly.

• Psychotherapy or counseling sessions (individual and group)

• Psychiatric evaluations and medication management

• Partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs)

• Telehealth mental health services (available from your home)

You pay the annual Part B deductible ($257 in 2025), and then generally 20% of the Medicare-approved amount for most services.

Part D: Prescription Drug Coverage

If you’re prescribed medication for anxiety, depression, or another mental health condition, your Medicare Part D plan covers it.

• Most antidepressants, antipsychotics, and mood stabilizers are included.

• In 2025, out-of-pocket costs for prescriptions are capped at $2,000 annually.

Medicare Advantage (Part C)

If you’re enrolled in a Medicare Advantage plan, it must include all benefits of Original Medicare, including mental health coverage.

• These plans often include additional benefits, such as case management or wellness programs.

• You may face prior authorization or need to use in-network providers.

• Mental health telehealth services are generally included.

Telehealth Coverage Has Become Permanent

Medicare expanded telehealth access during the COVID-19 public health emergency. These changes are now permanent for mental health services.

• You can receive therapy via video or audio-only visits from home.

• Providers must offer an in-person visit within 12 months of your first telehealth session, with some exceptions.

• Telehealth is covered under Part B and subject to the same coinsurance and deductible rules.

This means you can get care without needing to travel, which is particularly helpful if you live in a rural area or have mobility challenges. But again, the issue is not whether Medicare pays for the service—it’s whether a provider has availability.

Access Gaps Still Limit Use

Even though more providers and services are covered, significant access issues remain in 2025:

• Shortage of Medicare-participating therapists: Many LMFTs and MHCs still do not accept Medicare. This reduces your options even after the expansion.

• Network restrictions under Medicare Advantage: If you’re enrolled in a Medicare Advantage plan, you may have a limited pool of in-network mental health providers.

• Long wait times: It’s not unusual to wait weeks or even months to get a mental health appointment, especially in high-demand areas.

• Geographic disparities: Rural and underserved communities often have very few, if any, Medicare-accepting mental health professionals.

Documentation and Prior Authorization Hurdles

Medicare coverage is not automatic just because you see a mental health provider. There are administrative requirements that can cause delays or denials:

• Treatment plans may be required and must be updated regularly.

• Progress notes must show medical necessity and justify continued services.

• Prior authorizations may be needed under Medicare Advantage for therapy, medication, or inpatient stays.

These policies are in place to prevent overuse, but they can become frustrating barriers when you’re just trying to get care.

Preventive Mental Health Screenings Are Included

Medicare covers certain preventive services that can help catch mental health conditions early:

• Annual depression screening with your primary care provider

• Alcohol misuse screening and counseling

• Cognitive assessment for memory or mood-related issues

These screenings are covered once per year at no cost to you under Part B, as long as your provider accepts Medicare assignment.

What to Know About Cost Sharing in 2025

Understanding your out-of-pocket costs can help you plan for mental health care under Medicare:

• Part A: $1,676 deductible per benefit period; coinsurance begins after day 60.

• Part B: $257 deductible, then 20% coinsurance for outpatient therapy.

• Part D: $590 maximum deductible, $2,000 cap on out-of-pocket drug costs.

• Medicare Advantage: Cost-sharing varies but must remain within annual out-of-pocket limits, which are $9,350 for in-network and $14,000 for combined services.

Help Is Available, But You May Need to Ask for It

If you’re struggling to find a Medicare provider, you can:

• Use the Medicare.gov “Find & Compare” tool to locate participating mental health professionals.

• Call your plan provider (if in Medicare Advantage) to request assistance with scheduling.

• Reach out to local health departments or nonprofit organizations offering senior mental health programs.

You May Be Eligible for More Support

Some Medicare enrollees qualify for additional services under specialized programs:

• Special Needs Plans (SNPs) may offer more focused mental health support.

• Medicare-Medicaid dual eligibles often receive coordinated mental and behavioral health care.

• PACE (Programs of All-Inclusive Care for the Elderly) may include counseling, social work, and group therapy.

Ask about these options if you have complex health needs or low income.

Getting the Mental Health Care You Deserve Takes Persistence

The progress made in Medicare mental health coverage is real. You now have more provider types to choose from, prescription drug protections, and permanent access to telehealth. But it doesn’t mean the process is smooth.

You may still encounter waitlists, limited provider networks, administrative delays, or care coordination gaps. The key is to stay informed and proactive. If you’re unsure about your plan’s mental health benefits, or you need help finding the right support, speak with a licensed agent listed on this website for one-on-one guidance.