Does Medicare Cover Therapy? What Part B Pays For

Medicare Part B covers outpatient mental health care, including individual and group psychotherapy, when it is provided by a professional whose services Medicare recognizes. That includes psychiatrists and other doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners and physician assistants. Since January 1, 2024, it also includes marriage and family therapists and mental health counselors. So if the question is whether Medicare covers therapy, the answer for most people with Part B is yes, with the cost-sharing and rules described below.

Which professionals count as a Medicare therapist

Medicare mental health coverage is tied to the type of provider, not to a single job title. A marriage and family therapist or a mental health counselor can be a Medicare therapist for Part B purposes as of 2024, provided they meet Medicare’s enrollment requirements. A psychiatrist can also prescribe medication, while psychologists, social workers, counselors and marriage and family therapists generally cannot. If medication comes up, a prescriber (a psychiatrist, a psychiatric nurse practitioner or another doctor) can talk about whether medication is an option.

Coverage of a particular visit still depends on the service being medically necessary and on the provider being enrolled in Medicare. A provider who has opted out of Medicare is a different situation, and the plan or the provider’s office can explain it.

What you pay under Part B in 2026

After the Part B deductible, a person pays 20% of the Medicare-approved amount for therapy visits. The Part B deductible is $283 in 2026. That 20% is coinsurance, not a flat copay, so the dollar amount depends on the approved amount for the service.

A provider who accepts assignment takes the Medicare-approved amount as full payment. Under Medicare’s billing rules, clinical psychologists, clinical social workers, nurse practitioners, clinical nurse specialists, physician assistants, marriage and family therapists and mental health counselors must accept assignment on Medicare claims. For a doctor, such as a psychiatrist, accepting assignment is a choice, and one who does not accept it can generally charge up to 15% above the approved amount. Asking a psychiatrist’s office whether it accepts assignment is one of the practical questions that changes what a visit costs.

Medicare also covers one depression screening per year in a primary care setting, at no cost when the provider accepts assignment. That screening is separate from ongoing therapy.

Telehealth therapy with Medicare

Medicare telehealth therapy is covered. Since the Consolidated Appropriations Act, 2021, people with Medicare can get behavioral health telehealth at home, and audio-only is allowed for behavioral health. Through December 31, 2027, Medicare covers telehealth from anywhere in the US, and behavioral health is excluded from the limits that return after that date. An in-person visit within 6 months before the first mental health telehealth service is required only after December 31, 2027.

State lines still matter for the therapist’s license, even when Medicare pays. Whether a provider may treat someone in another state depends on state law. A full license from a state board permits practice in that state, and other routes include temporary practice laws, reciprocity, licensure compacts and telehealth registration where a state offers them. Providers should verify the patient’s location before an appointment. The comparison of online therapy versus in-person therapy covers how to weigh the two formats.

Medicare Advantage and the parity law

Medicare Advantage plans are run by private insurers under Medicare rules, and their mental health benefits can differ from Original Medicare in practical ways such as networks and prior authorization. Check with the plan about coverage, in-network providers and any referral requirements.

The Mental Health Parity and Addiction Equity Act, signed on October 3, 2008 and applying to plan years beginning on or after October 3, 2009, generally requires that mental health benefits be no more restrictive than medical and surgical benefits where a plan offers them. That law does not apply to Medicare. It also does not require a plan to cover mental health at all, it does not apply directly to small employers’ group plans (fewer than 51 employees) or to retiree-only plans, and there is an increased-cost exemption. A plan must give its medical-necessity criteria for mental health benefits on request.

If Medicare is not your coverage

Medicare is one route to paying for therapy, not the only one. Employer plans, Marketplace plans, Medicaid and self-pay each work differently. The overview of how to pay for therapy compares insurance, self-pay and lower-cost options. For public coverage, Medicaid and CHIP mental health coverage explains how state-by-state benefits work, including that children under 21 on Medicaid are entitled under EPSDT to comprehensive care, including mental health services and all medically necessary treatment Medicaid can cover.

For anyone uninsured or not using insurance, the No Surprises Act gives a right to a Good Faith Estimate of cost when care is scheduled at least 3 business days in advance, or on request. For recurring care such as counseling, one estimate can cover the expected sessions for up to 12 months. If the bill is $400 or more above the estimate, a dispute can be started; the bill must be dated within the last 120 calendar days, and there is a $25 administrative fee. A bill cannot be disputed without an estimate.

What goes wrong with Medicare therapy coverage

A few misunderstandings come up again and again.

• Assuming every therapist takes Medicare. Enrollment is not automatic, and a licensed therapist may not be a Medicare provider. Ask before the first appointment.
• Confusing the 20% with a fixed copay. Coinsurance is a share of the approved amount, so the amount varies by service and provider.
• Missing the assignment question. A doctor who does not accept assignment can generally charge up to 15% above the Medicare-approved amount, which changes the bill; non-physician therapists enrolled in Medicare must accept assignment.
• Expecting parity protection. The parity law does not apply to Medicare, so the comparison with medical benefits is not the same safeguard.
• Forgetting the license rule for telehealth. Medicare may pay for a video visit, but the therapist still needs to be licensed where the person is located, and state rules differ.
• Treating the yearly depression screening as therapy. It is a primary care screening covered once a year, not ongoing treatment.
• Assuming Medicare covers couples or family therapy automatically. Coverage depends on the service and the documentation; check with the plan or the provider.

Questions to ask before the first visit

A short list makes the cost side clearer:

1. Does this provider accept Medicare assignment?
2. Is the service covered as outpatient psychotherapy under Part B?
3. For telehealth, is the therapist licensed in the state where you will be during the session?
4. If the plan is Medicare Advantage, is this therapist in network, and is prior authorization needed?
5. What will the 20% coinsurance apply to, and is a secondary plan involved?

Medicare covers a great deal of outpatient therapy, but the details sit with the provider and the plan. A few questions before the first session can help avoid billing surprises.