The Therapist You Want Might Not Accept Medicare—Here’s What to Do When That Happens

Key Takeaways

• In 2025, Medicare now covers more mental health professionals, including licensed marriage and family therapists and mental health counselors, but access remains limited due to provider shortages and reimbursement challenges.

• If your preferred therapist does not accept Medicare, you still have several options, including telehealth services, community clinics, and Medicare Advantage plans with broader provider networks.

Why Many Therapists Still Don’t Accept Medicare

Medicare has expanded its coverage for mental health services in recent years, most notably in 2024 with the inclusion of licensed marriage and family therapists (LMFTs) and licensed mental health counselors (MHCs) under Part B. However, many therapists still do not accept Medicare as payment in 2025. This is often due to low reimbursement rates, complex administrative requirements, and the burden of becoming a Medicare-enrolled provider.

While the federal government continues to encourage participation, there is no requirement for therapists to enroll in Medicare. As a result, you may find that your preferred provider simply isn’t part of the program.

What Medicare Covers for Mental Health in 2025

To understand your alternatives, it helps to know what Medicare currently offers:

Under Part A (Hospital Insurance):

• Inpatient psychiatric hospital care (up to 190 lifetime days)

• Coverage for general hospitals with psychiatric units

• Standard Part A deductible of $1,676 per benefit period

Under Part B (Medical Insurance):

• Psychiatric evaluations

• Individual and group therapy

• Family counseling related to your mental health treatment

• Medication management

• Partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs)

• Services by LMFTs and MHCs, added in 2024

Part B requires you to meet the annual deductible ($257 in 2025), after which you typically pay 20% coinsurance for outpatient services.

Under Part D (Prescription Drug Coverage):

• Coverage for medications used to treat mental health conditions

• Annual deductible cap of $590

• Out-of-pocket maximum of $2,000 for the year

Steps to Take When Your Preferred Therapist Doesn’t Accept Medicare

1. Confirm Medicare Participation

Before assuming your therapist doesn’t accept Medicare, confirm their participation status:

• Ask if they are a Medicare-enrolled provider

• Check on the official Medicare.gov website under “Find Care”

Even if they accept Medicare, some may choose to “opt out,” meaning they don’t bill Medicare at all. In those cases, you will be fully responsible for their charges.

2. Explore Other Medicare-Accepting Providers

You can search for providers who do accept Medicare, including those newly added in 2024 like LMFTs and MHCs. You can use the following resources:

• Medicare.gov Care Compare tool

• Your state’s licensing board or professional associations

• Local clinics or mental health organizations

Keep in mind that many areas, especially rural regions, still have a shortage of Medicare-participating therapists.

3. Consider Telehealth Services

Telehealth is a permanent part of Medicare’s mental health benefits. You can receive services from home via:

• Video calls

• Phone calls (in specific situations)

In 2025, Medicare continues to cover telehealth for mental health, provided that:

• The provider accepts Medicare

• You have an in-person visit at least once every 12 months (with exceptions for hardship cases)

Telehealth can help you access therapists outside your immediate geographic area, expanding your options.

4. Look Into Federally Qualified Health Centers (FQHCs) and Community Clinics

These centers receive federal funding to provide care to underserved populations. They typically accept Medicare and offer:

• Behavioral health counseling

• Crisis support

• Medication-assisted treatment

• Coordination with primary care

FQHCs usually have income-based sliding scale fees if you need additional services not fully covered.

5. Consider a Medicare Advantage Plan

Medicare Advantage (Part C) plans often have broader provider networks and may offer:

• Access to therapists not available under Original Medicare

• Additional mental health benefits

• Lower copays for mental health services

You should check the provider directory of any plan you’re considering and confirm whether your preferred therapist is in-network. Enrollment is only allowed during specific periods, such as the Annual Enrollment Period (October 15 to December 7).

6. Ask Your Current Therapist About Referral or Sliding Scale Options

Even if your therapist doesn’t accept Medicare, they may:

• Offer a sliding scale payment option

• Refer you to a Medicare-accepting provider with similar training

• Supervise another provider in their practice who accepts Medicare

Don’t hesitate to ask about arrangements that could make continuing therapy more affordable.

Challenges You May Face

Despite available options, you may still encounter difficulties in securing the care you need. These include:

• Provider Shortages: Even with the inclusion of LMFTs and MHCs, there is still a national shortfall of Medicare-accepting therapists, particularly in rural and low-income areas.

• Network Restrictions: Medicare Advantage plans may require you to stay within their network. If your therapist is out-of-network, you might not get reimbursed.

• Limited Appointments: High demand and short staffing can make it hard to find therapists with availability, especially for ongoing care.

• Confusion Around eligibility: Not all services are covered equally. For example, couples counseling is only covered if it directly relates to a Medicare-eligible individual’s diagnosis and treatment plan.

How to Avoid Paying Unexpected Out-of-Pocket Costs

To protect yourself financially, follow these steps:

• Verify Coverage in Advance: Confirm the provider’s Medicare status and whether the service is covered before your appointment.

• Understand Coinsurance: After you meet your deductible, most Part B services require you to pay 20% of the Medicare-approved amount.

• Check Part D Formulary: Make sure your mental health medications are on your plan’s drug list. Not all plans cover the same medications.

• Use In-Network Providers for Advantage Plans: Avoid surprise costs by confirming your provider participates in your plan’s network.

What to Expect Moving Forward in 2025

While Medicare has made significant improvements in mental health access, several efforts are still in progress:

• Expanded Provider Pool: LMFTs and MHCs are now included, but it may take time for many to enroll and begin accepting Medicare.

• Increased Focus on Telehealth: Telehealth is growing as a solution to provider shortages, and rules are expected to remain flexible beyond 2025.

• New Mental Health Initiatives: CMS continues to pilot mental health integration projects in primary care, especially in underserved areas.

• Greater Outreach and Education: Many beneficiaries are still unaware of their full mental health benefits. Outreach efforts aim to bridge this gap.

When You Should Seek Immediate Help

If you are experiencing a mental health crisis, you should not wait for Medicare logistics to sort themselves out. Immediate options include:

• 988 Suicide & Crisis Lifeline: Call or text 988 for free support 24/7

• Emergency Room: Go directly to your nearest ER for immediate evaluation

• Mobile Crisis Units: Some areas have rapid-response mental health teams available

While Medicare will cover emergency services, do not delay care due to coverage concerns.

Staying Proactive About Your Mental Health Benefits

You are your best advocate. To stay on top of your mental health benefits in 2025:

• Review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) regularly

• Track deductible progress and coinsurance costs

• Contact Medicare directly at 1-800-MEDICARE for clarification on coverage

• Reach out to a licensed agent listed on this website for personalized support

Finding the Care That Works for You

Finding the right therapist under Medicare in 2025 may take more time and persistence than you expect, but the right support is within reach. If your preferred therapist doesn’t accept Medicare, you still have options through telehealth, community resources, or Medicare Advantage networks.

You don’t have to navigate this alone. Get in touch with a licensed agent listed on this website to help you explore plans, find eligible providers, and understand what mental health services you can access today.