You Can Now See a Licensed Counselor with Medicare—But Not All Plans Make It Obvious

Key Takeaways

• Medicare now covers services provided by licensed counselors, including marriage and family therapists (LMFTs) and mental health counselors (MHCs), which expands your access to qualified mental health providers starting in 2025.

• Not all Medicare plans clearly identify these professionals in their directories or networks, so it’s essential to verify provider eligibility and plan coverage before scheduling visits.

More Providers, More Possibilities

As of 2025, Medicare includes coverage for services from licensed counselors such as LMFTs and MHCs. This long-awaited change is part of broader efforts to increase mental health access, especially for older adults and people with disabilities.

Previously, Medicare only covered a narrower range of mental health professionals, such as psychiatrists, clinical psychologists, and clinical social workers. The addition of LMFTs and MHCs means you now have more options for outpatient therapy, relationship counseling, and support for anxiety, depression, PTSD, grief, and other mental health needs.

This expansion came into effect on January 1, 2024, under the Mental Health Access Improvement Act. However, for many beneficiaries, the real impact is being felt now in 2025, as more providers have enrolled in Medicare and are seeing patients.

What This Means for Your Care

You now have the option to:

• Book therapy sessions with a wider variety of licensed professionals.

• Seek relationship and family therapy under Medicare Part B.

• Get ongoing mental health care without long waitlists or referral loops.

The services covered must still be medically necessary and provided by a Medicare-enrolled provider. Each session typically falls under Part B, meaning you’ll pay 20% coinsurance after meeting the $257 annual deductible.

If you’re hospitalized for mental health reasons, Part A applies. For medications, Part D or your Medicare Advantage plan’s drug benefit will be relevant.

Barriers Still Remain

Even with new coverage rules in place, finding a counselor who takes Medicare isn’t always simple. One of the biggest issues in 2025 is that many Medicare Advantage plans and even Original Medicare provider directories haven’t updated their systems to clearly label LMFTs and MHCs as in-network, covered providers.

This means you might:

• Not see these providers listed in your plan’s directory.

• Have to call your plan or the provider directly to confirm eligibility.

• Face confusion around billing if a provider is newly enrolled in Medicare.

So while the law has changed, the infrastructure around it is still catching up.

How to Know if a Counselor Is Covered

Here’s how to verify if a mental health counselor is covered under your Medicare plan:

• Check with Medicare: Use Medicare’s official online provider search tool to confirm that a provider is enrolled and eligible.

• Call your plan: If you have Medicare Advantage, speak directly to your plan to verify the provider’s network status.

• Ask the provider: Call the counselor’s office and ask if they accept Medicare assignment. If they’re unsure, ask for their National Provider Identifier (NPI) number and verify with Medicare.

• Review billing codes: Make sure your provider plans to bill Medicare using approved CPT codes for psychotherapy.

Why It’s Worth the Effort

You may be wondering whether it’s worth navigating this complexity. If you’ve been delaying mental health care due to cost, access, or stigma, this new rule can make a real difference. Seeing a licensed counselor through Medicare means:

• You may pay less than private pay therapy.

• Sessions are covered on an ongoing basis as long as they’re medically necessary.

• You don’t need to wait for a crisis to get support.

Medicare doesn’t impose a limit on the number of sessions per year, provided the treatment remains necessary and is appropriately documented.

What’s Covered Under Part B

Part B covers outpatient mental health care, including services from:

• Psychiatrists

• Clinical psychologists

• Clinical social workers

• Nurse practitioners with psychiatric training

• Licensed marriage and family therapists (LMFTs)

• Licensed mental health counselors (MHCs)

These services include:

• Individual and group therapy

• Family counseling (when the primary purpose is to treat your condition)

• Psychiatric evaluation and medication management

• Depression screenings and other preventive services

Part B does not cover life coaching, couples therapy not tied to a diagnosis, or holistic/non-clinical treatments.

Mental Health and Medicare Advantage Plans

If you’re enrolled in a Medicare Advantage (Part C) plan, you are entitled to at least the same mental health coverage as Original Medicare. Many Advantage plans also offer extra benefits, such as care coordination or virtual therapy options.

However, the challenge in 2025 is that not all plans have updated their directories to reflect the inclusion of LMFTs and MHCs. That’s why it’s crucial to:

• Review your plan’s updated Evidence of Coverage (EOC) documents.

• Look for Annual Notice of Change (ANOC) letters that outline mental health updates.

• Contact your plan directly to verify mental health provider availability.

Prescription Drugs for Mental Health

If you need medication as part of your mental health treatment, that falls under:

• Medicare Part D, if you have a standalone drug plan.

• Your Medicare Advantage plan’s drug coverage, if integrated.

In 2025, out-of-pocket costs for prescription drugs are capped at $2,000 annually under Part D. This change makes it more affordable to manage ongoing medication needs related to mental health.

Covered medications typically include antidepressants, antipsychotics, anti-anxiety medications, mood stabilizers, and medications for sleep or ADHD. Each plan has its own formulary, so check that your prescriptions are listed and see if prior authorization is required.

Telehealth: A Continuing Option

Telehealth remains a permanent option for mental health visits under Medicare. You can access therapy from home via video or audio calls. However, starting October 1, 2025, Medicare requires an in-person visit every 12 months if you’re receiving telehealth services for mental health.

Exceptions apply if:

• You have documented transportation challenges.

• Your provider practices entirely virtually and meets specific rural/underserved criteria.

This hybrid model is designed to ensure continuity of care while maintaining flexibility. Always ask your provider how they handle this requirement and whether your plan covers telehealth sessions.

Coverage Gaps to Be Aware Of

Even with the rule change, some gaps persist:

• Not all states allow LMFTs and MHCs to bill independently under Medicaid or private insurance. This doesn’t affect Medicare coverage, but it may confuse providers new to federal billing.

• Some Medicare Advantage plans may still be processing the change in provider types and could require appeals or prior authorizations.

• If a provider hasn’t yet updated their enrollment status with Medicare, they may be unable to bill until approved.

You should always:

• Confirm the provider’s Medicare status.

• Get written confirmation of costs.

• Review your Explanation of Benefits (EOB) statements.

Mental Health Preventive Services You Can Use

In addition to treatment, Medicare covers a number of preventive mental health services that you may be eligible for:

• Annual depression screening: Covered at no cost if done by a Medicare-eligible provider during a wellness visit.

• Alcohol misuse screening and counseling: Includes up to four brief counseling sessions per year.

• Cognitive impairment assessment: Included in the yearly wellness visit.

• Welcome to Medicare visit: Offers a baseline evaluation of your mental and physical health within 12 months of enrolling.

These screenings are key to identifying mental health concerns before they escalate.

Know Your Rights and Options

You have the right to access mental health services, and you also have:

• The right to appeal denials of coverage.

• The option to switch plans during Medicare Open Enrollment (October 15 to December 7).

• The ability to request a case review if you believe your mental health needs are being under-supported.

If your plan denies coverage for services provided by LMFTs or MHCs, ask for a written reason and file an appeal. You can also contact 1-800-MEDICARE for assistance or work with a licensed agent listed on this website.

Better Access Starts with Clear Information

Medicare’s expansion of mental health provider types is a significant step forward. But accessing this care still requires persistence, especially when plan directories are incomplete or outdated. If you’re not sure where to begin:

• Start with your Medicare ID number and current plan details.

• Contact the plan’s customer service for clarity on mental health coverage.

• Ask your primary doctor for a referral to an in-network counselor.

• Document all your communications and billing.

This clarity helps you avoid surprise costs and ensures you get the care you deserve.

Take Charge of Your Mental Health Options

Medicare now gives you the option to see licensed mental health counselors, but it’s up to you to confirm that your provider and plan are aligned. Don’t assume your plan has done the legwork. Take the time to verify coverage, ask questions, and make sure your provider is fully Medicare-enrolled.

You deserve accessible, affordable care. If you’re uncertain about your mental health coverage or want help understanding which services you’re entitled to, get in touch with a licensed agent listed on this website.