If you’re over 65 years old, there is a 1 in 4 chance you are navigating a mental health condition, according to the National Council on Aging, and an even higher chance you’re enrolled in Medicare. But, does Medicare cover mental health treatment? While mental health care is necessary, understanding what Medicare covers can be complex.
Read on to learn more about Medicare mental health coverage, important terminology and how to find Medicare mental health care near you.
[READ How to Choose an Online Therapist]
Medicare Coverage for Inpatient Mental Health Treatment
Medicare Part A (hospital insurance) provides some coverage for your mental health hospital stay, similar to its coverage of other types of inpatient hospital stays.
Part A behavioral health coverage includes:
| Inpatient stay duration | What you pay | Notes |
| Days 1-60 | $1,676 deductible | There’s a one-time deductible for each benefit period. The benefit period starts when you are admitted and ends once you have been discharged for 60 consecutive days. This amount, and the ones below, may change for 2026. |
| Days 61-90 | $419 per day | This applies after day 60 in the same benefit period. |
| Days 91 and beyond | $838 per day | After day 90, you tap into your total lifetime reserve days for additional coverage. You have a total of 60 lifetime reserve days. |
| After lifetime reserve days are used | All costs | After you exhaust all 60 of your reserve days, you pay all costs associated with your inpatient care. |
| Mental health services while you are inpatient | 20% of the Medicare-approved amount | This applies to all outpatient-type services you receive while inpatient, such as group therapy. |
Source: Medicare.gov
Although there is no limit to benefit periods you can have, once you run out of lifetime reserve days, they’re gone forever. However, separate from lifetime reserve days, if you are admitted for psychiatric services, Medicare Part A pays for up to 190 days of inpatient psychiatric hospital services during your lifetime. If you are admitted to a general hospital and get treatment for mental health, those days are counted separately.
Medicare Part B (medical insurance) is also involved with some of your inpatient stay coverage. It covers some of the services offered while you’re admitted for mental health treatment, such as:
— Visits from your psychiatrist to check on your progress
— Consultations between providers, such as a psychiatrist and a pharmacist discussing how two of your mental health medications may interact
— Counseling or therapy you receive while inpatient
[READ: How to Manage Anxiety with Rising Medicare Costs and Potential Coverage Changes]
Medicare Coverage for Outpatient Mental Health Treatment
Medicare Part B also covers some outpatient mental health services, such as:
— Individual or group therapy, including marriage and family therapy if it relates to your mental health condition
— Diagnostic tests, such as cognitive testing or behavioral assessments
— Medication management services, such as a psychiatrist evaluation of an anxiety medication‘s effectiveness
— Preventive services, such as depression screenings or alcohol misuse screenings
— Substance use treatment programs, such as smoking cessation programs or opioid use disorder counseling
— Partial hospitalization programs or intensive outpatient programs
Recently, Medicare began to reimburse licensed counselors for their services. This change could help with the mental health care shortage and allow more people to be seen, says Jessica Topolski, a Medicare specialist at AZ Health Insurance Brokers in Phoenix.
Outpatient mental health treatment may be provided in any of the following settings:
— Doctors’ offices
— Community mental health centers
— A hospital’s outpatient mental health department, such as intensive outpatient programs for mental health treatment
Part B Medicare behavioral health coverage includes:
| Outpatient service coverage | What you pay | Notes |
| Preventive care | $0 | There’s no cost if your provider accepts Medicare. |
| Visits to diagnose or treat mental health conditions | 20% of the Medicare-approved amount after you meet the Part B deductible of $257 in 2025 (though this deductible amount could change in 2026) | The Medicare-approved amount for 45 minutes of psychotherapy, for example, is around $100, depending on location. You would owe $20 after meeting your deductible. |
| Services in a hospital outpatient clinic or department | 20% of the Medicare-approved amount, as well as possible copayments and coinsurance | Additional fees may apply for hospital-based services. |
Source: Centers for Medicare & Medicaid Services
Keep in mind that therapy and counseling may be capped at a set number of sessions and that certain types of counseling services might not be covered at all, adds Gina Harrison, a nurse and faculty of practice of nursing at Wilkes University in Wilkes-Barre, Pennsylvania.
[READ: When to See a Psychiatrist.]
Medicare Prescription Drug Coverage for Mental Health
Medicare Part D (prescription drug coverage) contracts with private insurance companies to negotiate the price of mental health drugs. Psychiatric drug coverage with Medicare Part D varies depending on the drug because medications are sorted into cost tiers. Part D covers some prescription drugs for mental health, including:
— Stimulants, such as Adderall for ADHD treatment
— Antipsychotics, which are medications used to treat conditions such as bipolar disorder or schizophrenia
Here are some tips to ensure maximum coverage:
— Take a formulary drug, if possible. Formulary drugs are a list of specific prescription drugs covered under your Medicare Part D plan. For example, you may save money if you take the generic sertraline for depression versus the brand name, Zoloft.
— Check for prior authorizations. Medicare might require you to submit paperwork, such as a visit to the doctor, mental health assessments and diagnosis codes, to receive coverage approval for your prescription.
— Ask your doctor about step therapy. Sometimes Medicare asks that you try — and fail — a less expensive drug before granting coverage for a more expensive drug.
Medicare Part D coverage is sorted into coverage phases. As you progress through these phases, the amount you pay for your medications changes based on your total drug spending.
Part D Medicare behavioral health coverage includes:
| Prescription drug coverage phase | What you pay | Notes |
| Deductible phase | A maximum of $595 in 2025 (though this amount could change in 2026) | At the beginning of your benefit year, which begins January 1 and ends December 31, you will need to meet your deductible before coverage kicks in. |
| Initial coverage phase | Variable copayments or coinsurance based on the drug tier (tiers 1-3 or specialty tier), up to the initial coverage limit | After you meet your deductible, you pay a copayment or coinsurance for each prescription, and Medicare Part D covers the rest. This continues until you meet the 2025 out-of-pocket maximum of $2,000. |
| Catastrophic coverage | $0 | Once you hit you out-of-pocket maximum, your cost is $0 for the remainder of the year. |
Source: Medicare.gov
In 2025, Medicare plans implemented a lowered $2,000 out-of-pocket maximum for prescription drugs. This effectively eliminated the “donut hole,” when beneficiaries had used their initial coverage but hadn’t tapped into catastrophic coverage, leaving them to pay significant cost-sharing out of pocket.
Challenges With Medicare Mental Health Coverage
While Medicare does provide mental health coverage, there are some key issues to be aware of. One study, published in JAMA Health Forum, of nearly 4,000 adults over the age of 65 with psychological distress investigated mental health outcomes for seniors transitioning to Medicare. The researchers concluded Medicare eligibility was associated with decreased outpatient mental health visits, increased emergency department visits and decreased psychotropic medication fills.
Although further research is needed to determine the root causes of challenges as seniors transition to Medicare mental health care, it could be due to the following:
— Technology literacy gaps. During COVID-19, Medicare expanded telehealth access, which helped connect patients and providers. “However, many seniors may struggle with video platforms, patient portals and online scheduling systems. Limited access to reliable internet or smart devices can further complicate participation in virtual care,” Harrison says.
— Lack of providers who accept Medicare. “Medicare has improved what they cover for mental health, but it’s not a perfect system,” Topolski says. “A lot of mental health providers do not take Medicare, and we have a shortage of psychiatrists across the country. They use a cash-based system instead of having to deal with billing Medicare.”
— Difficulty when dually enrolled in Medicare and Medicaid. Medicare is the primary payer if you are enrolled in both Medicare and Medicaid. Medicare has different rules on coverage and reimbursement than Medicaid, which can create challenges with continuity of care once you have dual coverage.
— Complexity of health insurance. Medicare itself can be challenging to navigate. “Multiple plan options, coverage rules and requirements often feel overwhelming, making it hard to identify the best fit for mental health needs,” Harrison says.
How to Access Mental Health Resources
If you don’t know where to start, one resource is a family support service.
Bonnie Lane, a principal consultant with Family Support Services in Northbrook, Illinois, specializes in supporting families whose loved ones suffer from severe mental illness or substance addiction. One family, for instance, once contacted Lane about an older man who needed Medicaid and Medicare to support his health. Lane worked with this family to coordinate those benefits and helped him move into a senior care facility that helped meet his care needs.
“He is now living a safer, more fulfilling life,” Lane says. “He is getting all that he needs and more. Medicare and Medicaid pay for his housing, treatment team and future hospitalizations.”
Other mental health resources for seniors include:
— Therapy, both individual and group therapy. Geriatric psychotherapy is tailored to older adults.
— Support groups, such as grief and loss groups or substance use support groups.
— Social groups, such as local community events or clubs.
— Various mental health apps and helplines, such as the Suicide and Crisis Lifeline, which you can call at 1-800-273-8255 (TALK) or text 988.
Explore Top-Rated Mental Health Professionals and Medicare Advantage Plans With U.S. News & World Report
By understanding the mental health resources available to you, you can ensure that you get the mental health care you need. Don’t miss the opportunity to enroll in Medicare or shop for a Medicare Advantage plan. The annual Medicare open enrollment period runs from October 15 to December 7.
Start your search for the best plan for you with U.S. News’ Best Insurance Companies for Medicare Advantage 2025 and Best Medicare Part D Companies. You can look for and compare Medicare Advantage, Medicare Part D, bundled Medicare Advantage and Part D plans and Medicare supplement plans near you with the U.S. News search and compare tool.
To determine the top-rated insurance companies, U.S. News consulted with Medicare experts to identify and weigh the most important quality measures for Medicare Advantage consumers, applied these weights to data from the Centers for Medicare & Medicaid Services and then adjusted for enrollment.
To connect with mental health providers, look at U.S. News and World Report’s suggestions for psychiatrists near you.
If you’re looking to compare psychiatric hospitals, check out the U.S. News and World Report’s list of top psychiatric hospitals. The seven mental health hospitals ranked in psychiatry or psychiatric care were recommended by at least 5% of the psychiatric specialists responding to U.S. News surveys in 2022, 2023 and 2024. An additional 26 hospitals were recommended by at least 1% of the respondents.
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Does Medicare Cover Mental Health Treatment? originally appeared on usnews.com
Update 08/14/25: This story was published at an earlier date and has been updated with new information.
