Getting Long-Term Therapy with Medicare Isn’t Impossible—But You’ll Need to Understand These Limits

Key Takeaways

• Medicare covers a broad range of mental health services in 2025, including long-term therapy, but there are strict rules around eligibility, provider types, and visit frequency.

• Getting consistent long-term therapy requires understanding the rules for both Part B outpatient therapy and any restrictions placed by Medicare Advantage plans.

What Long-Term Therapy Actually Means Under Medicare

Long-term therapy generally refers to ongoing, regular sessions with a mental health professional that span several months or even years. This could include talk therapy for chronic depression, cognitive behavioral therapy (CBT) for anxiety disorders, or ongoing counseling for PTSD.

Under Medicare in 2025, these services are available, but only if they meet medical necessity criteria. You must have a documented diagnosis, and your provider must regularly update your treatment plan to justify continued care.

What Medicare Part B Covers for Therapy

Medicare Part B is the main part of Medicare that covers outpatient mental health care, including long-term therapy. Here’s what is covered:

• Individual therapy (psychotherapy) sessions with a licensed professional.

• Group therapy, when appropriate for your condition.

• Family counseling that helps with your treatment.

• Diagnostic tests such as psychiatric evaluations.

• Medication management by a psychiatrist or primary care doctor.

• Partial hospitalization programs (PHPs) for more intensive outpatient needs.

Medicare pays 80% of the approved amount after you meet the annual Part B deductible ($257 in 2025). You are responsible for the remaining 20% coinsurance unless you have other coverage, like a Medigap plan, that picks it up.

Which Providers Are Eligible Under Medicare

As of 2025, Medicare covers services from the following types of licensed professionals:

• Psychiatrists

• Clinical psychologists

• Clinical social workers

• Nurse practitioners and physician assistants (for mental health care)

• Licensed mental health counselors (LMHCs)

• Licensed marriage and family therapists (LMFTs)

You must make sure your provider accepts Medicare assignment. If not, you may pay more or the visit may not be covered at all.

Frequency and Duration Limits

Medicare does not place a formal cap on the number of therapy sessions per year. However, each session must be considered medically necessary. This means that your provider must:

• Establish a diagnosis

• Document your need for ongoing care

• Periodically update your treatment plan

• Show evidence of progress or continued need

If reviews indicate that treatment is not helping or not medically necessary, Medicare may stop paying.

Also note:

• Initial visits are usually limited to one diagnostic evaluation.

• Follow-up therapy sessions typically occur once a week or every two weeks.

• Extended frequency, like multiple sessions per week, may require pre-approval or special documentation.

The Role of Medicare Advantage Plans

Medicare Advantage (Part C) plans are required to cover at least what Original Medicare does. However, they often impose:

• Prior authorization requirements for long-term therapy

• Network limitations, meaning you must use in-network therapists

• Caps on visits, either annually or per condition

Before starting therapy, check your plan’s Evidence of Coverage document to understand any additional rules. In 2025, many Advantage plans still require authorizations after a specific number of visits, commonly around 20 or 30 sessions.

When You Might Need a New Authorization

Medicare can require new authorizations or treatment plans if:

• Your condition changes significantly

• You switch therapists

• You are transitioning from inpatient to outpatient care

This requirement exists in both Original Medicare and Medicare Advantage, especially if you’ve been receiving therapy for 6 months or more.

Annual Wellness Visits and Mental Health Screenings

Your Medicare Annual Wellness Visit includes a depression screening. This doesn’t count as therapy, but it can help you:

• Identify new or worsening symptoms

• Get referred to a therapist

• Start a treatment plan

Medicare also covers alcohol misuse screenings, anxiety screenings, and suicide risk assessments as preventive services. These are typically free and can trigger referrals for longer-term mental health care.

Telehealth Options in 2025

Medicare permanently covers telehealth for mental health services. You can receive therapy by video or phone from your home if:

• You’ve had an in-person appointment with the provider in the last 12 months

• You maintain an in-person visit every 12 months (exceptions may apply)

This rule started applying broadly in 2024 and continues in 2025. It’s designed to preserve provider-patient relationships while maintaining flexibility.

Teletherapy is often ideal for:

• Rural or homebound patients

• Chronic mental health conditions

• Patients with mobility issues

Medication Management Isn’t the Same as Therapy

Some beneficiaries confuse medication visits with therapy. If you’re only seeing a psychiatrist for a 15-minute medication check-in, that’s considered medication management, not therapy.

To receive true long-term therapy, your visits must:

• Involve structured, evidence-based counseling

• Last at least 30 minutes per session

• Address behavioral and emotional issues

Medication and therapy are often combined, but only the therapy portion counts toward counseling coverage.

What to Do If You Need More Sessions

If you feel that your mental health condition requires ongoing therapy and your provider warns that Medicare coverage may end soon, you can:

• Ask for a treatment plan review: Your provider can submit updated documentation.

• Appeal the decision: If Medicare or your plan denies coverage, you have the right to appeal.

• Switch therapists: Sometimes a fresh clinical approach is more justifiable.

• Request out-of-network exception (MA Plans): If no in-network therapist can see you promptly, you may be able to get out-of-network care covered.

Coverage for Specialized Therapy Types

Some therapies are not covered unless specifically medically necessary. These include:

• Art or music therapy

• Hypnotherapy

• Alternative treatments like reiki or acupuncture (unless for approved medical use)

These are usually excluded unless part of an approved treatment program in a licensed setting.

However, cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and other evidence-based methods are covered if the provider is Medicare-approved.

Inpatient vs. Outpatient Coverage Differences

Inpatient mental health care is covered under Medicare Part A and is subject to:

• A 190-day lifetime limit if in a psychiatric hospital

• Regular inpatient hospital rules if in a general hospital

• Deductibles and coinsurance that differ from Part B

Outpatient therapy, which is what most long-term therapy falls under, has no lifetime cap but requires proof of ongoing medical necessity.

How to Start Therapy Using Your Medicare Benefits

Here’s a step-by-step approach to starting:

1. Talk to your primary care doctor during your wellness visit.

2. Get a referral to a Medicare-approved therapist.

3. Confirm the therapist accepts Medicare (or is in-network if using Part C).

4. Schedule your evaluation, which counts as the first therapy session.

5. Work with your therapist to build a treatment plan.

6. Attend regular sessions and ensure documentation is regularly updated.

7. Use telehealth if it fits your condition and the provider offers it.

Why Medical Necessity Drives Everything

The key to understanding Medicare’s therapy coverage is medical necessity. Medicare doesn’t cover therapy simply because it helps you feel better; it must be shown to treat a diagnosable condition and have a documented, clinically justified reason.

Make sure your therapist:

• Keeps detailed session notes

• Reviews progress and updates your plan

• Submits documentation if coverage is challenged

This is especially important if your therapy extends beyond 6 to 12 months.

Stay Informed, Stay Covered

In 2025, Medicare offers more access to mental health services than ever, but long-term therapy still has limits. Knowing what’s covered, how often, and under what conditions is essential to maintaining consistent care.

If you’re unsure about your options or need help finding a Medicare-approved therapist, speak with a licensed agent listed on this website for personalized advice.