Does Medicare Cover Therapy? Tips to Find a Covered Provider
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Getting Medicare can be such a relief. It can open doors to care that was hard to get before you had it.
Now that you have time and insurance coverage, you might be thinking about going back to therapy—or going for the first time. There’s a lot to talk about, after all.
You might be dealing with illness or chronic health issues that are affecting your mental health. You might be facing changes in your relationships. You could be providing care for someone you love—or receiving care—and need a place to go to talk about how it affects you.
You might be trying to figure out what you want to do now that you’re in a different phase of your life. You might be confronting fears, questions, or uncertainty about health, aging, or mortality. You might even be struggling with questions about the meaning of life.
Therapy is a place for all these things. Going to therapy can help you recover a sense of direction, hope, self, and meaning.
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How Can Therapy Help?
Therapy can help you with your mental health. It can ease depression or help you cope with stress.
Therapy is more than just mental healthcare, though. It’s a place where you can sort through tangled thoughts or explore difficult questions. It’s a place where you can start to understand yourself and your needs better. This supports better and more satisfying relationships as you learn how to express your needs and get them met more easily.
Getting therapy covered by Medicare is easier than it’s ever been, but it can be trickier than you’d expect. It can be hard to figure out who accepts Medicare. It can be frustrating to research and call therapists and not get an answer, to get told there’s a waiting list, or to be told they don’t accept your insurance.
We’re here to help. Not all therapists accept Medicare, but many do, and there are a few different ways to find them. Read on to learn how to start your search. We’ll also help you understand what Medicare covers, what it doesn’t, and how you can use it to get affordable mental health care no matter what kind of care you need.
Does Medicare Cover Counseling ?
Medicare covers counseling and therapy as well as a range of other outpatient mental health services. The part of Medicare that covers outpatient care—Medicare Part B—covers the same range of medical and mental health services. Specifically, it covers the following kinds of outpatient mental health care:
- Diagnostic testing
- Psychiatric evaluation
- Medication management
- Partial hospitalization programs
- Substance use disorder treatment
- Group and individual psychotherapy
- Activity therapies like art, dance, and music therapy
- Family counseling to address a mental health condition
- Drugs that usually aren’t self-administered (like injections)
- An annual depression screening with a primary care physician
- An annual alcohol misuse screening with a primary care physician
There are some exceptions to what Medicare covers. Specialty services like art therapy are usually only covered if a doctor prescribes them as medically necessary to treat a mental health condition or issue.
How Much Does Medicare Part B Cost?
Medicare Part B has an annual deductible that changes over time. It was $183 in 2018 and is $226 in 2023. After the deductible, Medicare covers 80% of outpatient services. You have to pay 20% coinsurance on the Medicare-approved amount for the service you are receiving.
The standard monthly premium for Medicare Part B is $164.90 in 2023. This amount is usually deducted from your Social Security check.
However, while Medicare covers therapy, it can sometimes be a challenge to find providers who accept it. Many therapists don’t accept Medicare—or other kinds of insurance—because of low reimbursement rates and the amount of unpaid time they have to spend on complicated paperwork to file a claim.
Covering psychiatrist visits with Medicare can be especially tricky. Due to how frequently psychiatrists opt out of Medicare, you may find it impossible to find one in your area who accepts it. As a result, you may have no choice but to see one who doesn’t accept Medicare and to have to pay out of pocket for it.
If you’re having a hard time finding providers who accept traditional Medicare, you may be able to expand your options by signing up for a Medicare Advantage plan (Medicare Part C).
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How to Expand Your Options with Medicare Part C
You might be able to gain access to covered care from therapists and psychiatrists who don’t accept Medicare by signing up for a Medicare Advantage plan (Medicare Part C). Sometimes, providers who don’t accept traditional Medicare can accept Medicare Part C if they accept insurance from the private insurance company that governs the Medicare Advantage plan.
We recommend checking with any providers you’re interested in (and providers you’re already seeing) before you change your Medicare plan. Make sure to compare your options and choose the plan that best helps you get all of your healthcare needs met.
While it can be a little bit tricky to get therapy or psychiatric services covered by Medicare, it’s getting easier. Recent laws have expanded what Medicare covers. Now that Medicare covers LPCs and LMFTs as well as LCSWs, psychologists, and psychiatrists, you can see more therapists with Medicare than ever before.
You can also get online therapy using Medicare. This means that if there aren’t any therapists in driving distance from you who accept Medicare, you may be able to find one online. (Note that they usually still have to be licensed to practice in the state where you live, but this means you can expand your search statewide instead of just locally.)
Does Medicare Cover Marriage Counseling?
It’s not always possible, but it’s getting easier to get marriage counseling with Medicare.
In the past, it was tough. Not only did couples therapy have to be associated with the treatment of a mental health condition, Medicare didn’t cover any care (individual or couples counseling) provided by marriage and family therapists (MFTs). This has recently changed.
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When Is Marriage Therapy Covered by Medicare?
Medicare still only covers marriage or family therapy if it’s for the treatment a mental health condition. This means your therapist has to link your care with a primary psychiatric diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
So, if you want to get couples counseling to address communication or other relationship issues that aren’t related to a mental health diagnosis, Medicare won’t cover it.
However, if you have a mental health condition, the issues you’re having in your relationships are likely affected by it, so there’s a good chance a professional will be able to link that care to your diagnosis.
Thanks to the passage of the Mental Health Access Improvement Act in 2022, Medicare now covers therapy—both individual and couples therapy—provided by MFTs. The law will go into effect in January 2024. This adds to a law passed in 2019 that allows MFTs to get reimbursed by Medicare for services provided to people with a primary substance use disorder diagnosis.
Does Medicare Cover Online Counseling?
Medicare didn’t use to cover online therapy, but it does now. In 2020, Medicare removed many long-standing restrictions on its coverage of telemedicine for mental health. In 2021, these changes were made permanent by the Consolidated Appropriations Act.
In the past, Medicare only covered telehealth services provided in rural locations and other federally designated Professional Shortage Areas. It also only covered telehealth services when they were provided in a medical facility like a hospital or clinic. This ruled out in-home telehealth services like online counseling.
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How Do You Find an Online Provider Who Accepts Medicare?
It can be surprisingly easy to find a provider who offers online sessions and who accepts Medicare.
The easiest way to do it is to go to Medicare’s Physician Compare page and enter your zip code to search for “doctors and clinicians” near you. Enter a keyword related to mental health or therapy, such as a mental health provider type (for example, clinical psychologist or clinical social worker) or a mental health condition you’re seeking to treat (for example, depression or anxiety disorder).
After you do that, and get to the search results page, you can filter the search results by whether the provider offers telehealth services.
For more information about how to find online platforms that accept insurance, you can read our article, “Does Insurance Cover Online Therapy?”
Thanks to the changes made to Medicare policy in 2020 and 2021, Medicare no longer limits telehealth coverage to rural areas and now covers online mental health services provided in your home no matter where your home might be.
For more information, you can go to Medicare’s telehealth coverage information page.
Medicare Mental Health Provider List
To see a list of mental health providers near you who accept Medicare, you can visit Medicare’s Physician Compare page or call 1-800-MEDICARE.
Medicare does cover therapy, but coverage is restricted to specific types of therapy providers. Covered provider types include:
- Psychiatrists
- Other doctors
- Nurse practitioners
- Physician assistants
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
Recent legislature has added marriage and family therapists (MFTs) and licensed professional counselors (LPCs) to the list, but not quite yet. You’ll be able to see MFTs and LPCs using Medicare starting in 2024.
However, while Medicare covers all of these provider types in general, professionals in any of these categories can choose not to accept Medicare. (Psychiatrists often opt out of Medicare.) If you want to see someone who doesn’t accept your plan, you’ll need to use a supplemental plan or pay out of pocket for their services.
So, if you want to pay for therapy using Medicare, check with the provider first to confirm that they have not opted out of accepting Medicare and that they are a participating or non-participating provider.
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What Are Participating and Non-Participating Providers?
Participating providers accept Medicare and always accept Medicare’s approved amount for their services. They submit a bill to Medicare for your care and you are responsible for 20% of that amount.
Non-participating providers accept Medicare but choose whether to accept Medicare’s approved amount for services on a case-by-case basis. They can charge up to 15% more than Medicare approves. This means you need to pay as much as 35% coinsurance when you see a non-participating provider.
Some states limit how much non-participating providers can charge above the Medicare-approved amount. For example, New York limits that amount to 5%. Some Medicare supplement plans, including Medigap Plans F and G, cover these excess charges.
It’s getting easier to use Medicare to cover therapy. Just in the last few years, Medicare has significantly expanded its therapy coverage.
Medicare started covering services provided by licensed professional counselors (LPCs) and marriage and family therapists (MFTs) after the 2018 SUPPORT Act was signed into law. At that point, Medicare only covered their services for treatment of substance use disorders.
Thanks to the Mental Health Access Improvement Act of 2021 (which was signed into law in December 2022), Medicare has further expanded its coverage of care provided by LPCs and MFTs. Starting in January 2024, Medicare will cover their services for treatment of mental health conditions as well.
Medicare started covering telehealth, which includes online therapy, in 2020 due to temporary provisions to Medicare policy in response to the COVID-19 pandemic. Medicare coverage of online mental health care was signed into law permanently by the Consolidated Appropriations Act of 2021.
Does Medicare Cover Inpatient Mental Health?
Medicare Part A covers inpatient mental health care including the following services:
- Lab tests
- Medications
- Nursing care
- Room fees and meals
- Other related services and supplies
- Therapy and other mental health treatment
This means if you experience a mental health crisis or emergency and need to spend a few days in the hospital, Medicare’s got you covered.
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What Is Inpatient Mental Health Treatment Like?
If you need inpatient mental health treatment, being able to get it can save your life. If a mental health condition ever puts you at risk of harm if you don’t get treatment right away, you can go to a local emergency room or call a local mental health crisis hotline to get the care you need.
Inpatient care isn’t as scary as people think it is—and doesn’t last nearly as long as most people think it does. To learn more about what it’s like, you can read our article, “How Inpatient Mental Health Treatment Works.”
You can learn more about the different levels of mental health care by reading our article, “Therapy Options for Everything from a Crisis to a Small Worry.”
There are some tricks and limits to how Medicare covers inpatient mental health treatment that are important to know, though.
Basically, what you pay depends on how long you’re in the hospital. You’ll pay more if you’re in the hospital for more than 60 days during the same benefit period.
A Medicare “benefit period” begins every time you’re admitted to the hospital, continues for as long as you’re there, and ends after you’ve gone without inpatient care for 60 days in a row.
In other words, if you’re discharged from the hospital, and don’t go back for at least 60 days, you’ll start a new benefit period the next time you go and you won’t have to start paying coinsurance until that new stay reaches or exceeds 60 days.
However, if you’re readmitted before 60 days have passed, your care will still be part of the same benefit period and you’ll pay daily coinsurance rates based on that. A benefit period can last for as long as you’re in the hospital, but it is never less than 61 days.
There is no limit to the number of benefit periods you can receive for inpatient care. This includes inpatient medical care and inpatient mental health care received in the psychiatric unit of a general hospital. However, there is a lifetime limit for care received in a psychiatric hospital.
HEADS UP
Limits on Medicare Coverage of Inpatient Mental Health Care
Medicare places a strict limit on care received in a psychiatric facility. It imposes a lifetime limit of 190 days for inpatient treatment in a psychiatric hospital.
Mental health advocacy groups like the National Alliance on Mental Illness (NAMI) are actively lobbying to change this policy that unfairly limits mental health care.
How much you have to pay for inpatient care depends on how long you’re in the hospital during a specific benefit period.
You have to pay a deductible every time you’re admitted to the hospital. The deductible amount per benefit period is $1600 in 2023.
Whether you pay anything beyond that depends on how long you’re in the hospital. Costs go up after the first 60 days.
You don’t have to pay coinsurance for the first 60 days of inpatient care in a benefit period, but after that, you must pay increasing amounts of coinsurance for each day you remain in care.
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What Are the Different Parts of Medicare?
Medicare Part A covers inpatient treatment and Medicare Part B covers outpatient treatment. These two components of Medicare are often called “Original Medicare.”
You can also sign up for a Medicare Advantage Plan, also called Medicare Part C, when you want additional or different coverage. These plans are offered through private insurance companies.
Medicare Part D covers prescription drugs. It is administered by private insurance companies and is an optional part of Medicare that was created by the 2003 Medicare Modernization Act.
Who Is Eligible For Medicare?
You pay into Medicare during your working years through a payroll tax, then you’re eligible to enroll when you turn 65 years old. You’re eligible for premium-free Medicare Part A if you worked and paid into Medicare for at least ten years.
It’s possible to get Medicare Part A at age 65 even if you haven’t worked, but you’ll probably have to pay out of pocket to cover your premium. The exception is if you are married to someone who paid into Medicare for ten years or more. In that case, you should still be able to get Part A without paying a premium. (Everyone who gets Medicare Part B has to pay the monthly premium for it.)
DEEP DIVE
How Long Have We Had Medicare?
Medicare was passed in 1965 to increase access to healthcare for America’s senior citizens. Most people in America enroll in Medicare when it becomes available to them at retirement age. Before Medicare was passed, 54 percent of people who were 65 and over had health insurance. Now, 98.4 percent of elders in America have health insurance through Medicare.
Medicare also covers people who are younger than 65 when they have disabilities. If you have end-stage renal disease or Lou Gehrig’s disease, you can enroll in Medicare before you turn 65 years old.
If you qualify for Social Security Disability Income (SSDI) for any reason, you’re eligible for Medicare 24 months after you start receiving SSDI.
You can inquire about your Medicare eligibility at your local Social Security office.
What Can You Do If Medicare Doesn't Cover the Care You Need?
Fortunately, it’s easier to get therapy covered by Medicare than it’s ever been. Changes in Medicare policy in the last several years have expanded options for Medicare-covered therapy. You can now use Medicare to get therapy from LPCs and MFTs as well as LCSWs, MDs, and PhDs. You can get in-home online therapy with Medicare now, too.
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Medicare Policy Can Change
Advocacy can make a difference. For example, the 2008 Patients and Providers Act changed the unfair Medicare policy that made people pay 50% coinsurance for outpatient mental health services. It lowered the coinsurance rate over time until it came into parity with the 20% coinsurance rate for outpatient medical services in 2014.
The biggest challenge nowadays in getting therapy with Medicare is finding a therapist who accepts it. Many therapists don’t accept Medicare or any other types of insurance because of low reimbursement rates and the unpaid hours they have to spend filling out complicated paperwork—only to have some claims get denied and go unpaid anyway.
However, as policies and practices continue to change, more therapists are accepting Medicare and it’s becoming easier for you to find one who does. You may be able to find a local therapist you can see in-office who accepts Medicare, or you may be able to find a therapist who’s licensed to practice in your state who offers Medicare-covered online sessions.
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How Can You Find a Therapist Who Accepts Medicare?
To search for mental health providers near you who accept Medicare, you can visit Medicare’s Physician Compare page or call 1-800-MEDICARE.
On the Physician Compare page, just enter your zip code or address and a keyword for what you’re looking for. Select “Doctors and clinicians” as the provider type.
Keywords related to therapy that you can use to search for a therapist who accepts Medicare include psychiatry, mental health services, clinical psychologist, clinical social worker, mental health and social services, depression, anxiety disorder, and adjustment disorders, among other terms for mental health specialists or conditions.
In addition to location, provider type, and keyword, you can apply additional filters to your search. You can filter by distance, sex, board certification, and whether the provider offers telehealth services.
If you’re having a hard time finding a therapist who accepts Medicare, we encourage you to be creative and to explore your options. In many cases, you can make Medicare work for you, even if you have to jump through a few hoops first, like spending time on a waitlist or going online instead of local.
If you can’t find a local private practice therapist who accepts Medicare, consider searching for a provider who offers free or low-cost therapy on OpenCounseling. You may be able to get affordable mental health care from the public mental health system, which generally accepts Medicare, from a community counseling agency, or from a therapist who offers sliding-scale rates.
You can also consider signing up for online counseling with BetterHelp (a sponsor) if you want online therapy but aren’t finding an online provider who accepts Medicare. With the income-based discounts they offer, you may be able to get therapy from a BetterHelp therapist that fits your budget.
Whichever option seems right for you, please reach out—the care you need may be only a call or click away.
