Does Medicare Cover 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.

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.

Medicare does not cover all types of counseling services. For instance marriage counseling and pastoral counseling are not covered by Original Medicare.

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.

Psychotherapy services may be provided by psychiatrists and other health care professionals specified by Medicare.

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 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 treatments covered under Medicare.

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 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.

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.