Medicare Mental Health Benefits Have Expanded, But How Do You Actually Use Them?

Key Takeaways

• In 2025, Medicare covers a wider range of mental health services and providers, including therapists and counselors, but using these benefits effectively still requires understanding eligibility, costs, and provider access.

• While teletherapy remains covered, Medicare is reintroducing in-person requirements for some services later in 2025, which may affect how and where you get care.

Why Medicare Mental Health Coverage Matters More Than Ever

Mental health needs don’t disappear as you age. In fact, depression, anxiety, substance use disorders, and loneliness can intensify during retirement. Medicare now recognizes this reality more clearly than ever, with expanded benefits aimed at helping you manage your mental well-being. But access doesn’t always translate to simplicity.

In 2025, Medicare covers more mental health services and providers than in any previous year. That said, figuring out how to use those benefits can feel like solving a puzzle. The good news? If you understand your coverage, know your rights, and follow the correct steps, you can receive care that supports your mental and emotional health.

What Medicare Covers for Mental Health in 2025

Medicare’s mental health coverage spans inpatient, outpatient, medication, and telehealth services. Here’s how it breaks down:

Inpatient Psychiatric Care (Part A)

You are covered for mental health-related hospital stays under Medicare Part A. This includes:

• Semi-private room, meals, nursing, and medications

• Psychiatric evaluation and treatment

• Inpatient hospitalization in either a general hospital or a psychiatric hospital

Limits to be aware of:

• Up to 190 lifetime days in a standalone psychiatric hospital

• Standard Part A deductible of $1,676 per benefit period in 2025

• Coinsurance kicks in after 60 days of inpatient care

Outpatient Mental Health Services (Part B)

This is where most therapy and counseling services are covered. Part B pays for:

• Psychiatric evaluations

• Individual and group therapy

• Medication management

• Services from psychiatrists, psychologists, clinical social workers, and now licensed marriage and family therapists (LMFTs) and mental health counselors (MHCs)

• Partial hospitalization programs (PHPs)

• Intensive outpatient programs (IOPs)

You pay:

• The annual Part B deductible ($257 in 2025)

• 20% of the Medicare-approved amount for services after meeting the deductible

Prescription Drug Coverage (Part D)

Part D covers medications used to treat mental health conditions, including antidepressants, antipsychotics, mood stabilizers, and anxiety medications.

Key changes in 2025:

• Your annual out-of-pocket cap for prescription drugs is now $2,000, thanks to new legislation

• The donut hole has been eliminated, streamlining your costs through the year

Telehealth Services

Medicare continues to cover telehealth visits for mental health services in 2025, including care delivered from your home. Covered services include:

• Video-based psychotherapy

• Psychiatric assessments

• Medication follow-ups

However, starting October 1, 2025, Medicare will require at least one in-person visit every 12 months for ongoing telehealth eligibility. Exceptions exist for hardship or geographic barriers, but you must document them.

Understanding Your Provider Options

You can now receive care from a broader set of professionals under Medicare. Covered providers include:

• Psychiatrists

• Psychologists

• Clinical social workers

• Nurse practitioners

• Physician assistants

• Mental health counselors (MHCs)

• Marriage and family therapists (LMFTs)

What you should do:

• Ensure the provider accepts Medicare assignment

• Confirm that they are enrolled in Medicare (not just licensed in your state)

• Use Medicare.gov or call 1-800-MEDICARE to locate qualified providers in your area

When and How to Start Getting Mental Health Care

Step 1: Talk to Your Primary Care Provider

If you’re unsure where to start, your primary care doctor can initiate a mental health screening or refer you to a specialist. Annual depression screenings are already included in your Medicare preventive benefits at no cost.

Step 2: Use Your Annual Wellness Visit

Every year, Medicare Part B covers a wellness visit that can include a cognitive and mental health assessment. This is a good opportunity to discuss changes in mood, sleep, energy, or concentration.

Step 3: Get a Referral (If Required)

Most mental health services under Medicare do not require a referral, but some managed care plans (like Medicare Advantage) might. Always double-check the plan’s requirements before making an appointment.

Step 4: Schedule Your Appointment

Once you’ve chosen a provider, contact their office and confirm they:

• Accept Medicare

• Are accepting new patients

• Offer the specific type of therapy or treatment you need

Medicare Advantage and Mental Health Coverage

Medicare Advantage (Part C) plans are required to offer at least the same mental health benefits as Original Medicare. Many offer additional coverage such as:

• Expanded provider networks

• Extra telehealth options

• Behavioral health case managers

• Transportation to mental health appointments

However, these extras come with trade-offs. You may face:

• Prior authorization requirements

• Network restrictions

• Copayment variations

Always review your plan’s Evidence of Coverage (EOC) to understand what is included and how to access it. Also, expect plan changes annually during the Medicare Open Enrollment period from October 15 to December 7.

Common Misunderstandings That Delay Care

Even though Medicare offers extensive mental health support in 2025, many people still don’t get the care they need. These common mistakes can be obstacles:

• Assuming therapy isn’t covered: It is, including from MHCs and LMFTs.

• Not checking provider eligibility: Not every therapist accepts Medicare.

• Confusing Original Medicare with Advantage plans: Coverage rules may vary significantly.

• Ignoring annual plan changes: Each year may bring new costs, provider rules, or required paperwork.

Mental Health Screenings and Preventive Services

You don’t have to wait for symptoms to become severe. Medicare covers several preventive screenings:

• Annual depression screening: Covered with no cost if performed in a primary care setting

• Alcohol misuse screening and counseling: Covered once per year for those at risk

• Cognitive assessments: Part of your Annual Wellness Visit

• Substance use disorder services: Covered under Part B or Part D, depending on the treatment type

These are good entry points into care and should be used even if you’re unsure whether you need formal treatment.

How Costs Work and What You Can Expect

Medicare does not make mental health care free, but it does reduce financial barriers. Here’s a summary of 2025 costs:

• Part A hospital deductible: $1,676 per benefit period

• Part B deductible: $257 per year

• Part B coinsurance: 20% of the Medicare-approved amount for outpatient care

• Part D out-of-pocket cap: $2,000 annually

You may also owe:

• Copayments under Medicare Advantage plans

• Monthly Part B and Part D premiums

If cost is a concern, you may qualify for programs like:

• Medicare Savings Programs (MSPs)

• Extra Help for Part D prescription costs

• State Medicaid assistance if you meet income requirements

How Telehealth Rules Are Changing in Late 2025

One of the most significant changes coming in 2025 affects how you continue receiving mental health services via telehealth.

Beginning October 1, 2025:

• You must have one in-person visit every 12 months to continue receiving telehealth services

• Your provider must document that the visit occurred

• Exceptions apply for hardship or location barriers, but they must be verified

What you can do:

• Plan ahead for your in-person visit early in the benefit year

• Keep transportation or mobility concerns in mind when choosing a provider

This rule applies to mental health services delivered from your home under Original Medicare.

What to Do If You’re Denied Coverage

Medicare denials can happen, but they are not final. If your claim for mental health services is denied:

• Request a written notice explaining why

• File an appeal within 120 days of the denial

• Submit supporting medical records or letters from your doctor

• Ask for help from a licensed agent or SHIP counselor to guide you through the appeals process

Why You Should Be Proactive With Mental Health Benefits

Even with expanded coverage, the burden of getting care often falls on you. The best way to avoid delays, denials, or confusion is to:

• Review your Medicare Summary Notice (MSN) or EOBs regularly

• Know what your plan covers and what requires prior authorization

• Stay on top of Medicare changes each year

• Talk openly to your providers about mental health needs

• Don’t wait for a crisis before seeking care

Take the Next Step Toward Better Mental Health Support

Medicare is doing more than ever in 2025 to support your mental health, but you have to take action to benefit from it. Whether you want therapy, medication support, or just a mental health check-in, the tools are available.

Get in touch with a licensed agent listed on this website to help you understand your options, compare plans if necessary, and avoid unnecessary out-of-pocket costs. Taking that first step today could make all the difference in how you feel tomorrow.