Does Medicare Cover Therapy?

Data from the Centers for Disease Control and Prevention (CDC) show that older adults in the U.S. are much less likely to receive mental health care than younger people. In 2019, the National Health Interview Survey found that while nearly one in five U.S. adults reported undergoing treatment such as counselling or taking psychiatric medications in the previous year, that only included 5.7% of the respondents who were over 65. 

In psychotherapy — often called talk therapy — a mental health professional may take a variety of clinical approaches to address mental disorders or emotional problems with a patient. Recent changes to Medicare have made it easier to access therapy and counseling from a broader range of healthcare providers. If you’re a Medicare beneficiary who’s interested in starting or continuing therapy, let’s look at how your insurance can help. 

Why Many Older Americans Don’t Seek Therapy 

Older adults might either avoid or struggle to get mental health treatment for a wide range of reasons. In a Wall Street Journal editorial, geriatric psychiatrist Dr. Marc Agronin noted that one of the main causes is that many just don’t believe that talking about their challenges will help them. They see mental decline as part of aging and feel it’s too late to make changes in their own habits or behaviors. 

However, there’s significant evidence to support the value of therapy for adults of all ages. One analysis of studies conducted on more than 100,000 individuals going through psychotherapy found that when older people did participate, they could experience even greater improvement in issues like depression and anxiety than younger patients. 

Another major concern is cost and whether healthcare providers will accept their insurance. For about 60 million people, most of them 65 or older, that means the healthcare coverage they get through either the Original Medicare program administered by the federal government or a Medicare Advantage plan from a private insurance carrier.  

What Mental Health Professionals Can You See on Medicare? 

Medicare Part B is the part of Original Medicare that covers outpatient medical services like doctor’s appointments. For mental health needs, Part B helps with the costs of visits with professionals who have a range of specializations and qualifications: 

• Clinical psychologist: An expert in mental health who holds a PhD or a doctor of psychology degree and primarily treats patients through psychotherapy. 
• Psychiatrist: A medical doctor who specializes in mental health and can prescribe medications. 
• Clinical social worker: Social work professionals with specialized training in addressing mental illness through individual, group, or family therapy. 
• Clinical nurse specialist: An advanced practice nurse who’s qualified to give specialized medical advice. 
• Nurse practitioner: An advanced practice registered nurse who’s qualified to offer examinations, some medications, and treatments. 
• Physician assistant: A licensed clinician who, depending on state laws, may have various levels of authority to diagnose and treat illnesses and prescribe medications. 
• Marriage and family therapist: A licensed mental health professional who focuses on helping couples and families. 
• Mental health counselor: A professional who works with clients to set goals and manage their mental health challenges. 

Finding a Mental Health Care Provider 

Therapists and counselors have diverse backgrounds and approaches to care. Some of the most widely used forms of therapy are: 

• Cognitive behavioral therapy, a short-term approach focused on helping to identify and stop your problematic thoughts, feelings, and actions. 
• Psychodynamic therapy, which takes a long-term, intensive perspective to address the unconscious processes that affect how you feel and behave. 
• Humanistic therapy, which emphasizes your individual worldview with the therapist helping to achieve your personal goals for a more fulfilling life. 

There are many more examples, and no single type of therapy is right for everyone. You should try to find a mental health professional whose expertise aligns with your needs and who you feel comfortable talking with honestly. Your primary care provider may be able to provide recommendations, and you can explore more possibilities by checking an online database or local community resources. 

Keep in mind, even after the expansion in provider coverage, many mental health professionals don’t take Medicare. Before setting an appointment, contact a provider’s office to check whether they accept assignment, which means they provide services for the amount approved by Medicare. Otherwise, you may have to pay higher out-of-pocket costs. 

You could have a different set of options if you’re on a Medicare Advantage plan, which substitutes for Original Medicare. Plans vary based on where you live and your insurance carrier, but they must match the mental health coverage provided by Part B and, unlike Original Medicare, they set a limit on your annual out-of-pocket costs. However, to make the fullest use of your benefits, most plans require you to see healthcare providers who are in your network. 

Medicare Coverage for Therapy or Counseling 

The outpatient mental health services covered by Medicare Part B include: 

• Individual and group psychotherapy with doctors or other licensed professionals 
• Psychiatric evaluation 
• Diagnostic tests 
• Testing to evaluate if you’re receiving the right services and treatment 
• Partial hospitalization in a day program at a hospital or community mental health center that serves as an alternative to inpatient mental health care  
• Intensive outpatient program services through hospitals, community mental health centers, federally qualified health centers, and rural health clinics 
• Family counseling, but only if it’s primarily intended to help with your mental health treatment 
• An annual depression screening 
• An annual wellness visit when you can discuss any concerns about your mental health with your doctor  
• Substance use disorder treatment 

Part B will not cover most of the medications that a healthcare provider might prescribe to take on your own. For help with these costs, you’ll need a Medicare Part D prescription drug plan from a private insurance carrier. 

Most Medicare Advantage plans include Part D prescription coverage. They may also offer supplemental benefits that could be valuable for your mental health like access to gyms, fitness classes, and companion care services. 

Navigating your options for therapy and other mental health services is complicated, but talking to a professional about the challenges you’re facing can make a huge impact on your well-being. At every stage of your life, it’s worth taking the time to manage your mental and emotional health. 

About GoHealth 

GoHealth is a leading health insurance marketplace and Medicare-focused digital health company. Enrolling in a health insurance plan can be confusing for customers, and the seemingly small differences between plans can lead to significant out-of-pocket costs or lack of access to critical medicines and even providers. GoHealth combines cutting-edge technology, data science, and deep industry expertise to build trusted relationships with consumers and match them with the healthcare policy and carrier that is right for them. Since its inception, GoHealth has enrolled millions of people in Medicare plans and individual and family plans. For more information, visit GoHealth.com.