Does Medicare cover mental health?

Kimberly Lankford,

AARP

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En español

Published February 07, 2023

/ Updated December 22, 2023

Yes, Medicare covers inpatient mental health services under Part A, and under Part B, it covers outpatient mental health services, including evaluation and visits with a mental health provider.

Previously, Medicare charged beneficiaries more for outpatient psychiatric treatment than other physicians’ services. But in 2008, Congress passed a law that gradually reduced the copayment for those services from 50 percent to 20 percent of the Medicare-approved cost. Now Medicare pays the same share of the cost, 80 percent, for outpatient mental health services that it pays for other Part B medical services.

Does Medicare cover inpatient mental health?

Medicare Part A covers mental health services if you’re admitted as a hospital inpatient, whether at a general or a psychiatric hospital. The coverage and cost sharing are typically the same as other inpatient hospital stays.

For each benefit period in 2024, you’ll pay:

Part A hospital deductible of $1,632.

No coinsurance for days 1 to 60.

$408 daily coinsurance for days 61 to 90.

You’ll also pay $816 coinsurance for each lifetime reserve day after 90 days for each benefit period. You can use up to 60 reserve days over your lifetime.

A benefit period begins the day you’re admitted to a hospital as an inpatient or become a patient in a skilled nursing facility. It ends when you’ve been out of the hospital or skilled nursing facility for 60 consecutive days.

Medicare treats billing for mental health differently in one key way: It will cover only 190 days total over your lifetime in a psychiatric hospital that specializes in mental health conditions. Days spent in a general hospital — even if you’re being treated for a mental health condition — don’t count toward the 190-day lifetime limit.

Need help now for suicidal thoughts, other self-harm?

If you or a loved one is considering self-harm, go to your nearest crisis center or hospital or call 911.

The 988 Suicide & Crisis Lifeline, formerly known as the National Suicide Prevention Lifeline, is the federal government’s free 24-hour hotline. The nonprofit Crisis Text Line also has 24/7 counselors. Both use trained volunteers nationwide, are confidential and can be reached in ways most convenient to you:

Dial or text 988. A phone call to 988 offers interpreters in more than 240 languages.
Call 800-273-TALK (8255), a toll-free phone number, to reach the same services as 988.
For hearing-impaired users with a TTY phone, call 711 and then 988.
Text HOME to 741741, the Crisis Text Line.
In WhatsApp, message 443-SUP-PORT.
Go to crisistextline.org on your laptop, choose the Chat With Us button and stay on the website.

Does Medicare cover outpatient mental health?

Medicare Part B covers mental health services you receive when you’re not a hospital inpatient, such as in a doctor’s or therapist’s office, hospital outpatient department or community health center. Medicare generally covers mental health services and visits with psychiatrists, other doctors, clinical psychologists, clinical nurse specialists, clinical social workers, nurse practitioners and physician assistants.

Starting Jan. 1, 2024, licensed marriage and family therapists and mental health counselors, including addiction counselors, will be able to enroll in the Medicare program and get reimbursed for their services.

What you pay for outpatient mental health services. Once you’ve met the standard Part B deductible, $240 in 2024, you’ll pay 20 percent of the Medicare-approved amount for the services.

You can receive one depression screening each year as a Part B preventive service that’s not subject to the deductible or coinsurance if you go to a primary care provider — physician, physician assistant or nurse practitioner — who accepts the Medicare-approved amount.

Coverage for partial hospitalization. Medicare will cover partial hospitalization if you need more intense treatment than you can get in a doctor’s or therapist’s office. It’s designed for people who need at least 20 hours of treatment per week, which is usually provided in a hospital outpatient department or mental health center where you don’t stay overnight.

Medicare Part B covers these services, but your doctor must certify that you would otherwise need inpatient treatment.

Starting Jan. 1, 2024, Medicare will cover intensive outpatient program services, which are designed for patients who need nine to 20 hours of outpatient treatment. With this type of service, your doctor does not have to certify that you would otherwise need inpatient treatment.

Does Medicare cover therapy?

Yes. Medicare Part B covers individual and group psychotherapy with doctors or other licensed professionals that your state allows. It also covers a variety of other mental health services, such as:

Depression screening, one free each year.

Diagnostic tests.

Family counseling, if the purpose is to help with your treatment.

Medication management.

Psychiatric evaluation.

Where can I find Medicare mental health providers?

With traditional Medicare, you can see any eligible mental health provider who accepts assignment, but finding a psychiatrist who accepts Medicare patients can be a challenge. A 2022 analysis by KFF found that 60 percent of psychiatrists accept new Medicare patients, compared with almost 90 percent of physicians (who aren’t pediatricians), while other psychiatrists and mental health professionals refuse patients paying with Medicare or private insurance.

To find a psychiatrist or other physician in your area who accepts Medicare, go to Medicare’s physician compare website. It helps that Medicare relaxed some of its restrictions on using telehealth services during COVID-19. Access to mental health providers has improved and will continue to do so through 2024.

Does Medicare cover mental health prescription drugs?

Yes. You can buy a separate Medicare Part D policy or get drug coverage through a private Medicare Advantage plan. Both plans list all drugs covered in their formularies. They’re also required to cover all anticonvulsant, antidepressant and antipsychotic medications with limited exceptions.

The Medicare Plan Finder can help you compare out-of-pocket costs for your drugs for all Part D and Medicare Advantage plans in your area when choosing a plan or switching during the annual open enrollment period.

Keep in mind

You can buy a Medicare supplement policy, better known as Medigap, to help pay Medicare’s deductibles and copayments or coinsurance.

If you get coverage through Medicare Advantage instead of original Medicare, the plan must cover Medicare Part A and Part B services and often Part D, but the out-of-pocket costs can be different. For example, some plans charge a daily copayment for the first several days in the hospital, such as $325 for days one to four, rather than a hospital deductible.

These plans usually have provider networks that include mental health providers. A proposed regulation would add a coverage category, called Outpatient Behavioral Health, which would include therapists and counselors covered by Medicare starting in 2024.

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Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.