Does Medicare Cover Psychotherapy? 

Psychotherapy is a type of mental health care that helps patients make changes to certain behaviors, thoughts, and emotions, so they can overcome psychological disorders such as depression, anxiety, insomnia, and others.  

According to scientific and medical studies in the United States, seniors have a higher risk of developing mental health issues like depression and anxiety disorders. Many elderly people also experience mobility problems, chronic pain, dementia, and other health conditions that can contribute to mental health issues. Psychotherapy may help with the transitions through the aging process. It can also give patients access to support groups who can discuss relevant issues.

Medicare provides many mental health care services for enrollees to get proper diagnoses and treatments for a range of mental health conditions. Here’s a look at how your Medicare coverage can help you. 

Does Medicare cover psychotherapy?

Original Medicare Part B (medical insurance) covers its share of the costs for outpatient mental health care services for those who qualify. Preventive services include a “Welcome to Medicare” preventive visit to evaluate your risk factors for depression. This is a one-time visit that is available for new Medicare enrollees. Medicare benefits also include an annual “Wellness” visit where you discuss changes in your mental health status with your health care provider.

• One annual depression screening done in a primary care physician’s office or clinic that can provide follow-up care and referrals. 
• Individual and group psychotherapy sessions with physicians or other licensed medical professionals that your state of residence allows. 
• Family counseling sessions if your physician certifies that they will help you with your mental health treatments. 
• Psychiatric evaluations
• Prescription medication management
• Prescription drugs that aren’t normally self-administered, like certain injections.
• Diagnostic tests
• Partial hospitalization if you meet Medicare requirements and your physician certifies that you’d need inpatient treatment as the alternative. 
• Testing to evaluate whether your current treatment is helping.
• Outpatient mental health services that may be a part of substance use disorder treatments. 
• Intensive outpatient program (IOP) services are available beginning January 1, 2024, in hospitals, community mental health centers, federally qualified health centers, and rural health clinics. IOPs are geared toward people with mental health issues and substance use disorders. To qualify for an IOP, your physician must certify that it is medically necessary, and you must be cognitively and emotionally able to take part in the treatment. 

If you qualify for any of the above-mentioned mental health care services, Medicare Part B covers your visits with any of the following types of health care professionals if they accept Medicare assignment:

• Psychiatrists 
• Licensed physicians 
• Clinical psychologists 
• Clinical social workers 
• Clinical nurse specialists 
• Nurse practitioners 
• Physician assistants 
• Marriage and family therapists (as of January 1, 2024) 

How much will psychotherapy cost with Part B?

Medicare Part B covers medically necessary mental health care services that are provided in physician or health care provider’s offices, hospital outpatient facilities, or community mental health centers. If you are enrolled in Original Medicare Part B , Medicare pays 100 percent of the cost for your annual depression screening if the health care provider accepts Medicare assignment. For other mental health care services in a physician’s office, Medicare Part B pays 80 percent of the final approved cost, and you pay the remaining 20 percent after meeting your annual Part B deductible. If you receive mental health care in a hospital outpatient facility, you are responsible for paying any additional copayment or coinsurance amount charged by the facility. 

How does a Medicare Advantage plan cover psychotherapy?

If you’re enrolled in a Medicare Advantage (MA) plan, you’ll have at least the same benefits as Original Medicare. You may be required to use health care professionals, medical facilities, or outpatient hospital clinics that your plan includes in its network of providers to be eligible for coverage. Because this depends on the type of MA plan you have, you should ask a representative for help if you aren’t sure about restrictions.

Your out-of-pocket costs for mental health services also depend on what Medicare Advantage plan you’re enrolled in, so ask your provider for assistance if you don’t know what charges to expect.