Does Medicare Cover Mental Health Counseling?
Medicare covers certain types of mental health counseling, including individual and group psychotherapy and counseling for substance use disorders. It will also cover family counseling in some cases. Medicare Advantage plans may provide coverage for counseling services that are not included in Original Medicare benefits.
Does Medicare Pay for Mental Health Counseling?
Original Medicare — Medicare Part A and Part B — covers a variety of mental health counseling services, whether they’re received in a hospital or in an outpatient setting. Medicare typically refers to mental health services as behavioral services.
- Alcohol misuse counseling — for adults who use alcohol but don’t qualify as dependent
- Alcohol use counseling as part of a Medicare-approved inpatient or outpatient treatment program
- Substance use disorder (SUD) counseling
- Medication-assisted treatment (MAT) — which incorporates medication and behavioral therapy with counseling to treat substance use disorders
- Tobacco use cessation counseling
Covered services may be provided in a doctor’s or other health care provider’s office, a hospital setting, hospital outpatient department, clinic or at a community mental health center.
- Psychiatrists or other medical doctors
- Clinical psychologists
- Clinical nurse specialists
- Clinical social workers
- Nurse practitioners
- Physician assistants
Medicare does not cover all types of counseling services. For instance marriage counseling and pastoral counseling are not covered by Original Medicare.
Does Medicare Cover Psychotherapy?
Original Medicare covers certain types of psychotherapy beyond basic mental health counseling. Psychotherapy — or talk therapy — has some similarities to counseling but addresses conditions that may not be treatable through counseling.
- Substance use counseling and psychotherapy
- Family psychotherapy — with or without the patient present, if it is medically necessary for the patient’s treatment
- Group psychotherapy
- Multi-family group psychotherapy
- Individual psychotherapy
- Interactive psychotherapy — a type of group psychotherapy for people with intellectual disabilities and chronic psychiatric disorders
Psychotherapy services may be provided by psychiatrists and other health care professionals specified by Medicare.
Counseling vs. Psychotherapy
While most people may use the terms counseling and psychotherapy interchangeably, there are several key differences in the services offered by each.
Mental health counseling involves a counselor and patient working together to treat the patient’s short-term issues or problems. The counselor provides advice, guidance and support to the patient.
Psychotherapy tends to be used for long-term treatment focused on chronic emotional, behavioral and physical conditions.
Your Costs for Mental Health Counseling Under Original Medicare
Your share of the cost for psychotherapy services or mental health counseling under Original Medicare depends on where and how you receive those services.
If it is in an inpatient setting, Medicare Part A pays for it. If it is in an outpatient setting, Medicare Part B pays for it. Your share of the cost depends on which Medicare part applies.
In each case, Medicare uses the same basic formula it applies to any other type of health care services covered under Medicare.
- Medicare Part A hospital insurance
- Medicare Part A covers approved counseling services you receive in a hospital setting if you are admitted as an inpatient. You are responsible for:
- Your Part A deductible — $1,484 in 2021 — for each benefit period
- Coinsurance if your stay exceeds 60 days
- Days 61 to 90 — $371 per day
- Days 91 and beyond — $742 per day for each lifetime reserve day (you have only 60 of these in your lifetime)
- Beyond your limit of lifetime reserve days — all costs
- Facility copayment — 20 percent of the Medicare-approved amount for the mental health services you receive from doctors and other health care providers
- Medicare Part B medical insurance
- Medicare Part B covers mental health counseling services you receive in an outpatient setting. It also covers outpatient care for other mental health or behavioral services. You must be enrolled in Medicare Part B. You are responsible for:
- Your Medicare Part B deductible — $203 in 2021
- 20 percent of the Medicare-approved amount for counseling visits
- Potentially, an additional copayment or coinsurance to the hospital or other facility if you receive your counseling services through a hospital outpatient clinic or department
- Medigap (Medicare Supplement insurance) policies
- Medigap policies are sold by private insurers to supplement your Original Medicare benefits. These optional policies can help cover your out-of-pocket expenses for Medicare-approved services. Depending on the plan, they may cover some or all of your deductible, copayment and coinsurance costs for mental health counseling services. Ask your plan’s administrator about the specific benefits of your Medigap plan.
Medicare covers mental health counseling only if the health care provider is enrolled in Medicare and accepts assignment — meaning the provider agrees to be paid directly by Medicare and to accept the Medicare-approved amount for the services provided.
Medicare Advantage Plans and Mental Health Counseling
Medicare Advantage plans are sold by private insurers and cover everything that Original Medicare does, but these plans may provide you with additional benefits when it comes to mental health counseling options.
- Conflict resolution
- Counseling for life changes — such as job loss or divorce
- Grief counseling
- Telehealth benefits beyond those provided by Medicare Part B
Most Medicare Advantage plans also include Medicare Part D prescription drug benefits that can help with prescription medication costs associated with your counseling services.
Medicare Advantage plans vary from one to another, and you may have to receive mental health counseling services from doctors, hospitals or other health care providers in your plan’s network. You should contact your plan’s administrator to find out exactly what mental health counseling benefits your plan provides.
8 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2021, April). Medicare Mental Health. Retrieved from https://www.cms.gov/files/document/medicare-mental-health.pdf
- Leonard, J. (2020, August 31). How Can Mental Health Counselors Help? Retrieved from https://www.medicalnewstoday.com/articles/mental-health-counselor
- U.S. Centers for Medicare & Medicaid Services. (2020, March). Medicare and Your Mental Health Benefits. Retrieved from https://www.medicare.gov/Pubs/pdf/11358-Medicare-Mental-Health-Getting-Started.pdf
- American Psychiatric Association. (2019, January). What is Psychotherapy? Retrieved from https://www.psychiatry.org/patients-families/psychotherapy
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Mental Health Care (Inpatient). Retrieved from https://www.medicare.gov/coverage/mental-health-care-inpatient
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Mental Health Care (Outpatient). Retrieved from https://www.medicare.gov/coverage/mental-health-care-outpatient
- Wake Forest University. (n.d.). What Is Clinical Mental Health Counseling, and Why Is It Important? Retrieved from https://counseling.online.wfu.edu/blog/what-is-clinical-mental-health-counseling-and-why-is-it-important/
- Wake Forest University. (n.d.). What Is the Difference Between a Counselor and a Psychologist? Retrieved from https://counseling.online.wfu.edu/blog/difference-counselor-psychologist/