Medicare covers many mental health services. Part A handles most inpatient services, while Part B covers office visits. Part D will cover most take-home prescriptions, and some out-of-pocket costs may apply.
Mental health services can be vitally important in helping Medicare beneficiaries with mental health conditions, such as anxiety or depression.
Medicare covers mental health treatment under both Part A and Part B. Coverage includes:
- psychiatric treatment involving hospital stays, known as inpatient treatment
- therapy
- lab tests
- partial hospitalization services
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part A covers the medical services that a person may require during an inpatient stay at a general hospital, psychiatric hospital, or medical facility.
This coverage includes services and supplies relating to a person’s care, such as:
- a semiprivate hospital room
- meals
- nursing care
- medication
There are limits to a person’s stay according to a defined benefit period, as follows:
- Deductible: A person first pays the Part A deductible, which is $1,676 in 2025.
- Days 1 to 60: They pay $0 coinsurance per day of this benefit period.
- Days 61 to 90: The 2025 coinsurance is $419 for each day of this benefit period.
- Day 91 and up to 60 days over a person’s lifetime: A person has 60 “lifetime reserve” days on which a $838 daily coinsurance is payable. If they have already used all of their lifetime reserve days during previous hospital stays, they must cover the costs themselves.
- After day 150: A person needs to pay all costs.
An individual can have multiple benefit periods in a year, including separate stays in a psychiatric hospital.
A person may be responsible for copayments under Medicare Part B for doctors who see them when they are an inpatient.
Medicare Part B is the portion of Medicare that pays for medical services, such as doctor’s visits, durable medical equipment, and some prescription medication.
Part B helps pay for several services relating to mental health conditions. This part pays for visits to a variety of healthcare professionals, including:
- psychiatrists
- clinical social workers
- nurse practitioners
Examples of the mental health services that Medicare Part B covers include:
- diagnostic testing
- family counseling
- individual and group psychotherapy
- medication management
- annual depression screening in a primary care setting
- partial hospitalization, where a person attends a daily treatment program
- psychiatric evaluation
Part B may also cover some types of prescription medications for mental health conditions. These are usually medications that doctors give by injection in their office rather than those that individuals take themselves.
Additionally, Part B will cover outpatient mental health services for those with an alcohol or drug use disorder. They can also obtain telehealth services from their home, either online or over the phone.
What are the costs under Part B?
Most people will pay 20% of the Medicare-approved amount for their doctor’s visits or healthcare services.
A person must first meet the Part B deductible, which in 2025 is $257, before they pay the 20% coinsurance. Sometimes, they may have to pay an additional copayment or coinsurance if they receive care in the hospital or an outpatient clinic.
One cost exception is for an annual depression screening, which is free as long as the healthcare facility or professional accepts Medicare.
Private insurance companies offer Medicare Advantage plans, which people may call Medicare Part C.
If a person has Medicare Advantage, they should receive all of the benefits that Part A and Part B offer. It will also usually have additional benefits.
Medicare Advantage plans can vary, and a person may wish to examine all the options available before deciding which one to purchase.
Most people qualify for Medicare when they turn 65 years of age. If individuals paid Medicare taxes while working for at least 10 years, they could receive Medicare Part A benefits free from premiums.
Some people may qualify for Medicare at a younger age due to a medical condition or disability. Examples of conditions that may qualify someone for Medicare before they turn 65 include:
- amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease
- end stage renal disease
- disability
A doctor must officially certify that a person has a disability. A person qualifying for Medicare due to a disability typically has a 24-month waiting period before they are eligible for Medicare benefits.
For people with end stage renal disease or ALS, the waiting period is much shorter.
There are some exceptions to coverage for mental health conditions.
Inpatient care
Medicare does not cover certain aspects of care for an inpatient psychiatric-related stay, such as:
- a private room unless a doctor deems it medically necessary
- private duty nursing
- a phone or television in the room
- personal care items, such as socks, razors, or toothpaste
Prescribed medication
While Medicare may pay for some long-term medications, coverage does not extend to all mental health-related prescription drugs.
Medicare Part D offers the broadest coverage for prescription medication. It will pay for most take-home oral drugs that doctors prescribe.
Medicare requires that all Part D drug lists, also called formularies, cover at least two of the following medications:
People may wish to review their prescription drug formulary carefully with their doctor, as this may help healthcare professionals prescribe the most cost-effective medications.
Some individuals who may have difficulty paying for medications due to a low income might qualify for Medicare’s Extra Help. They can find out more about Extra Help by calling Medicare at 800-633-4227.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare covers a variety of mental health services for its beneficiaries.
Part A covers most inpatient services, while Part B covers most office visits and some medications.
Part D usually covers a wider range of prescription medications relating to mental health and well-being.
Medicare Advantage will offer all of the benefits of Part A and Part B and may also have some further coverage options.
A person can call Medicare at 800-633-4227 to obtain pre-authorization for mental health services or to ask a question about a particular cost within their Medicare coverage.
