Medicare Mental Health Coverage: What Parts A, B and D Pay For, and What You Owe

Under Original Medicare, a therapy or psychiatry visit costs you 20% of the Medicare-approved amount once you've paid the 2026 Part B deductible of $283. Your yearly depression screening costs nothing if the provider accepts assignment. And since January 1, 2024, licensed marriage and family therapists and mental health counselors can bill Medicare directly, which widened the pool of therapists people on Medicare can see.

The traps are in the details: a 190-day lifetime cap in one type of psychiatric hospital, daily coinsurance in partial hospitalization and intensive outpatient programs, and a telehealth in-person visit rule scheduled for 2028. Here's how it works, with CMS's 2026 dollar figures.

Source: CMS, 2026 Medicare Parts A & B premiums and deductibles; Medicare.gov, Depression screening; Medicare.gov, Mental health care (inpatient). CMS had not announced 2027 Part A or Part B amounts as of Nov. 11, 2026.

What Original Medicare covers and what you pay

Medicare splits mental health care the same way it splits everything else. Part A pays the hospital when you're admitted. Part B pays for outpatient care and for the professionals who treat you, inpatient or not. Part D pays for most prescriptions you fill at a pharmacy. Medicare.gov's outpatient mental health page lists what Part B covers: individual and group psychotherapy, family counseling when the main purpose is your treatment, psychiatric evaluation, medication management, diagnostic tests, safety planning if you're at risk of suicide or overdose, and a follow-up call after an emergency department visit for a behavioral health crisis.

Source: Medicare.gov, Mental health care (outpatient); Mental health care (inpatient); Partial hospitalization; Intensive outpatient program services; Opioid Use Disorder treatment; Alcohol misuse screenings; Behavioral health integration; Part D costs; CMS, 2026 Parts A & B amounts.

Two words in that table do a lot of work. "Medicare-approved amount" is the fee Medicare sets for the service, not what the office lists on its price sheet. "Accepts assignment" means the provider takes that approved amount as full payment and won't bill you more than the deductible and coinsurance. Medicare's own booklet, Medicare & Your Mental Health Benefits, says most providers accept assignment but tells you to check before you schedule. Do that. What a provider who doesn't accept assignment can add on top is covered in our post on Part B excess charges in Washington.

A note on 2027: CMS usually releases next year's Part A and Part B amounts in November. It published the 2026 figures on November 14, 2025. As of today, the 2027 numbers aren't out, so every dollar figure here is a 2026 figure. I'll update this post when CMS publishes 2027.

Who can treat you under Part B

For years, a practical gap in Medicare mental health wasn't coverage. It was finding a therapist who could bill Medicare at all. Licensed mental health counselors and marriage and family therapists couldn't, until 2024.

That changed with section 4121 of the Consolidated Appropriations Act, 2023. CMS's provider enrollment FAQ says payment for their services under Part B began January 1, 2024. Addiction counselors and alcohol and drug counselors who meet every requirement for a mental health counselor can enroll as one.

Source: Medicare.gov, Mental health care (outpatient); CMS MLN booklet, Medicare & Mental Health Coverage (March 2026); CMS, MFT and MHC enrollment FAQ; 42 CFR 410.53; 42 CFR 410.54.

"Long-standing" means they billed Medicare well before 2024. What matters more is the fine print in 42 CFR 410.53 and 410.54: the counselor and therapist benefit doesn't cover services to a hospital inpatient. If you're admitted, your care inside the hospital comes from the hospital's staff and the physicians and other professionals who bill there.

Every one of these providers still has to be enrolled in Medicare. A licensed counselor who never signed up can't bill Medicare for you, no matter how good they are. Ask "Are you enrolled in Medicare, and do you accept assignment?" on the first call. Medicare.gov's mental health and substance use page has a link to find mental health providers.

Example: what a year of therapy costs

Say you start weekly therapy in January with a counselor who accepts assignment, and the Medicare-approved amount for each session is $140. That fee is a made-up round number for the math; the real amount depends on the service code and where you live. You haven't used any Part B services yet this year.

Source: CMS, 2026 Part B deductible; Medicare.gov, Mental health care (outpatient). Visit fee is hypothetical.

The deductible is annual and shared across all your Part B care, so if you'd already met it at a doctor's visit or lab test, you'd pay $28 starting with the first session. Medicare.gov is plain about it: Original Medicare has no yearly limit on what you pay out of pocket. Weekly therapy for a full year adds up. Medicare.gov lists Medigap as one way to help pay those out-of-pocket costs. Our Medicare Supplement guide for Washington explains how those plans are standardized; the Washington Medicare Supplement page covers the basics too.

Partial hospitalization and intensive outpatient

Between a weekly therapy appointment and a hospital admission there are two structured outpatient programs. Medicare covers both under Part B. The difference is intensity and who qualifies.

Source: Medicare.gov, Intensive outpatient program services; Medicare.gov, Partial hospitalization; CMS, CY 2024 OPPS final rule press release.

IOP is the newer benefit. CMS created it in the 2024 hospital outpatient payment rule, effective January 1, 2024, for both mental health conditions and substance use disorders. The fact that you don't have to be "sick enough for the hospital" to qualify is the point: it's a step up from weekly therapy, or a step down after a stay.

Partial hospitalization has one rule that catches people: Medicare covers it only if both the doctor and the program accept assignment. Ask before the intake. Medicare.gov also lists what it doesn't pay for in a PHP: meals, transportation, social support groups (group psychotherapy is covered), and job-skills training that isn't part of treatment.

In both programs you can owe daily coinsurance on top of your share of each professional's bill. Get a written per-day estimate before you start.

Inpatient care and the 190-day limit

When you're admitted, Part A covers the hospital stay the same way it covers any other admission. You pay the $1,736 deductible for each benefit period, then nothing for days 1 through 60. Days 61 through 90 cost $434 a day. After that you can draw on 60 lifetime reserve days at $868 a day. After day 150 in a benefit period, you pay everything. Part B separately covers the doctors and other providers who treat you while you're there, at 20%.

A benefit period starts the day you're admitted and ends when you've been out of the hospital for 60 days in a row. It isn't a calendar year. Two admissions eight months apart mean two deductibles. Medicare's booklet says there's no limit to the number of benefit periods you can have.

Then there's the rule that's unique to mental health. Under 42 CFR 409.62, Part A pays for no more than 190 days of inpatient psychiatric hospital care in your lifetime. Once you've used them, Medicare won't pay for more care in that kind of facility, ever.

What Part A doesn't pay for during any inpatient stay: private duty nursing, a phone or TV if the hospital charges separately, personal items, and a private room unless it's medically necessary.

Substance use and opioid treatment

Medicare treats substance use disorders as part of its mental health coverage. Outpatient therapy, IOP and inpatient care all include substance use treatment, and Part B covers medications used for substance use disorder.

For opioid use disorder, Medicare.gov's OUD treatment page lists coverage for methadone, buprenorphine and naltrexone, plus naloxone and nalmefene to reverse an overdose. Part A covers those medications during a hospital stay, Part B covers them at a doctor's office or through an opioid treatment program (including mobile units), and Part D plans may cover buprenorphine, naltrexone and overdose reversal drugs.

The cost difference between settings is real. At a Medicare-enrolled opioid treatment program that meets the program rules, you pay no copayments, although the Part B deductible still applies. Get the same care from a doctor's office and you pay the deductible and copayments. If you have both Medicare and Medicaid, you pay nothing for services you get through the state Medicaid program.

Therapy by video or phone

Mental health is the one area where Medicare telehealth from home is permanent. CMS's Telehealth FAQ says the Consolidated Appropriations Act, 2021 permanently removed geographic and location limits for behavioral health telehealth, so you can see a therapist or psychiatrist by video from home whether you live in Seattle or a rural part of Okanogan County. Phone-only visits are allowed for behavioral health too. Medicare.gov says you'll pay the same for most telehealth services as you would in person: 20% after the deductible.

The catch is an in-person visit requirement written into section 1834(m) of the Social Security Act. The Consolidated Appropriations Act, 2026 postponed it, and the CY 2027 Physician Fee Schedule final rule that CMS released on November 4, 2026 adds the matching regulation: the in-person rule doesn't apply to any mental health services furnished through December 31, 2027. I checked for newer action from Congress or CMS today and didn't find any.

Source: CMS Telehealth FAQ, Q5, Q6 and Q11 (updated Oct. 2026); CMS, CY 2027 PFS final rule fact sheet (Nov. 4, 2026); Medicare.gov, Telehealth; 42 U.S.C. 1395m(m)(7)(B).

If the in-person visit comes, CMS says a practitioner of the same specialty in the same group can do it when your regular clinician isn't available. The broader telehealth picture, including what happens to non-mental-health visits in 2028, is in our Medicare telehealth coverage post.

Prescription drugs: Part D

Most mental health medications you pick up at a pharmacy fall under Part D, through a stand-alone drug plan or a Medicare Advantage plan with drug coverage. Some drugs a provider gives you, like certain injections, fall under Part B instead.

Part D has a protection that matters here. Medicare's mental health booklet says plans aren't required to cover every drug, but they are required to cover all (with limited exceptions) antidepressant, anticonvulsant and antipsychotic medications. That doesn't mean every plan covers your drug at the same cost or under the same rules, so check each plan's formulary against your list. If your prescriber thinks you need a drug your plan doesn't cover, you can ask the plan for a coverage determination, including an exception.

For 2026, no plan's deductible can exceed $615, and your out-of-pocket spending on covered Part D drugs is capped at $2,100 for the year. CMS has already set the 2027 figures: a maximum deductible of $700 and a cap of $2,400. Our Part D 2027 explainer walks through what changes January 1, and the Washington Part D page has the basics.

If you have Medicare Advantage

Everything above describes Original Medicare. A Medicare Advantage plan has to cover all medically necessary services Original Medicare covers; federal rules at 42 CFR 422.101 require it. So the services in the first table are covered either way.

What changes is how you get to them and what you pay. Medicare.gov's comparison page notes that with an Advantage plan you may need to use providers in the plan's network for non-emergency care, you may need a referral to see a specialist, and you may need prior authorization before the plan covers certain services. In most cases, Original Medicare doesn't require prior authorization. Cost-sharing is set by each plan. Advantage plans also have a yearly limit on what you pay for covered services; Original Medicare has no yearly out-of-pocket limit unless you add coverage like Medigap or Medicaid. Medicare's booklet adds that some plans offer extra benefits Original Medicare doesn't, like certain types of mental health counseling.

If you're in therapy now, the practical question is whether your therapist is in the plan's network for next year. Open enrollment runs through December 7, 2026. Check your Annual Notice of Change and the plan's provider directory, then call the therapist's office to confirm.

Washington: Apple Health, SHIBA and 988

Apple Health. If you have both Medicare and Apple Health (Washington's Medicaid), Apple Health may cover more than Medicare does. Medicare.gov says people with both may have more coverage than Medicare alone lists, and that if you're in the Qualified Medicare Beneficiary (QMB) program, Medicare providers aren't allowed to bill you for Medicare-covered services, including deductibles and coinsurance. Bring both cards to every appointment. Our post on Apple Health and Medicare explains who qualifies and how the two fit together.

SHIBA. Washington's Statewide Health Insurance Benefits Advisors, a program of the Office of the Insurance Commissioner, are volunteers who give unbiased, confidential Medicare help at no cost. The OIC says they can help you understand the different parts of Medicare, assess your needs, and help you enroll in Medicare and assistance programs. Call 800-562-6900 or use the OIC's SHIBA page. More in our SHIBA guide.

988. The 988 Suicide & Crisis Lifeline works the same in Washington as everywhere else: call or text 988, or chat at 988lifeline.org. The Washington State Department of Health says it's free, confidential and available 24/7/365, with live service in English and Spanish and interpretation in more than 240 languages and dialects. TTY users can dial 711 and then 988. DOH also notes 988 adds to Washington's existing crisis center network rather than replacing it.

What to do

1. Start with the yearly screening. Ask your primary care provider for the yearly depression screening; it's $0 with assignment. The one-time Welcome to Medicare visit also reviews your risk factors for depression, and the yearly Wellness visit is a good time to raise changes in your mood (more in Medicare preventive services).
2. Ask two questions before the first session: "Are you enrolled in Medicare?" and "Do you accept assignment?" If the answer to the first is no, Medicare won't pay.
3. Look at counselors and family therapists too. Since 2024 they can bill Medicare directly, which widens the pool beyond psychiatrists, psychologists and social workers.
4. Get a per-day estimate before starting an IOP or partial hospitalization program, and confirm the program accepts assignment.
5. Track psychiatric hospital days if you or a family member has had long stays. The 190-day limit is lifetime.
6. In therapy by video? Nothing changes before 2028 under current law. If the in-person rule takes effect, plan on one in-person visit a year.
7. On an Advantage plan? Before December 7, confirm your therapist and prescriber are in network for 2027 and your medications are on the formulary.
8. Not sure what fits? Call SHIBA at 800-562-6900, or read our overview of Medicare in Washington.

FAQ

Does Medicare cover therapy?

Yes. Part B covers individual, group and family psychotherapy with Medicare-enrolled psychiatrists, psychologists, clinical social workers, nurse practitioners, physician assistants, clinical nurse specialists, marriage and family therapists and mental health counselors. In 2026 you pay 20% of the Medicare-approved amount after the $283 Part B deductible.

Does Medicare cover licensed counselors and marriage and family therapists?

Yes, since January 1, 2024. They must be licensed in their state and enrolled in Medicare. Their Part B benefit doesn't cover services to hospital inpatients.

What is the 190-day limit for psychiatric hospitals?

Part A pays for no more than 190 days of inpatient care in a freestanding psychiatric hospital over your lifetime. CMS says the limit doesn't apply to certified psychiatric units in general hospitals.

Does Medicare pay for depression screening?

Medicare covers one depression screening a year in a primary care setting, and you pay nothing if the provider accepts assignment. Follow-up treatment can involve coinsurance.

Does Medicare cover mental health telehealth from home?

Yes, permanently, including phone-only visits when you can't or won't use video. Under current law, an in-person visit requirement starts January 1, 2028; it doesn't apply to services furnished through December 31, 2027.

Medicare rules, your plan's Evidence of Coverage or Medigap policy wording, and state law control your actual coverage. Confirm your situation with a licensed agent, SHIBA or 1-800-MEDICARE, and for legal questions, an attorney.

Sources

1. Medicare.gov: Mental health care (outpatient)
2. Medicare.gov: Mental health care (inpatient)
3. Medicare.gov: Partial hospitalization
4. Medicare.gov: Intensive outpatient program services
5. Medicare.gov: Depression screening
6. Medicare.gov: Alcohol misuse screenings and counseling
7. Medicare.gov: Behavioral health integration services
8. Medicare.gov: Opioid Use Disorder treatment services
9. Medicare.gov: Mental health and substance use disorders
10. Medicare.gov: Telehealth
11. Medicare.gov: Part D costs
12. Medicare.gov: Medicare Savings Programs (QMB)
13. Medicare.gov: Compare Original Medicare and Medicare Advantage
14. Medicare & Your Mental Health Benefits, CMS Product No. 10184 (Sept. 2026, PDF)
15. CMS: 2026 Medicare Parts A and B premiums and deductibles
16. CMS MLN booklet: Medicare & Mental Health Coverage, MLN1986542 (March 2026, PDF)
17. CMS: Marriage and Family Therapists and Mental Health Counselors enrollment FAQ (PDF)
18. CMS: CY 2024 Physician Fee Schedule final rule press release (Nov. 2, 2023)
19. CMS: CY 2024 OPPS final rule press release, intensive outpatient services (Nov. 2, 2023)
20. CMS: Telehealth FAQ, updated October 2026 (PDF)
21. CMS: CY 2027 Medicare Physician Fee Schedule final rule fact sheet (Nov. 4, 2026)
22. 42 CFR 409.62, Lifetime maximum on inpatient psychiatric care
23. 42 CFR 410.53, Marriage and family therapist services
24. 42 CFR 410.54, Mental health counselor services
25. 42 CFR 422.101, Medicare Advantage basic benefits
26. Social Security Act §1834(m), 42 U.S.C. 1395m (Cornell LII)
27. CMS: 2027 Medicare Advantage and Part D landscape state fact sheets (PDF)
28. Washington OIC: Get free Medicare help from SHIBA
29. Washington State Department of Health: 988 Suicide & Crisis Lifeline