Medicare Will Cover Mental Health Counseling—But Only If Your Therapist Meets These Requirements

Key Takeaways

• Medicare now covers mental health counseling from a broader range of professionals, but your therapist must meet specific qualifications to be eligible for reimbursement.

• Even if your provider offers excellent care, Medicare will not pay for the services unless they are properly enrolled and meet licensing criteria.

Why Medicare’s Mental Health Counseling Rules Matter

If you rely on Medicare for your health care in retirement, understanding who can provide your mental health care is essential. While Medicare Part B covers outpatient mental health services, including therapy and counseling, there are strict rules about who is authorized to deliver that care. This can create confusion and limit your access if your chosen provider doesn’t meet Medicare’s specific requirements.

To avoid surprise bills and to get the care you deserve, you need to know exactly what to look for in a mental health professional.

What Medicare Covers for Mental Health Counseling

Medicare Part B includes a broad range of outpatient mental health services. This includes:

• Diagnostic evaluations

• Individual and group psychotherapy

• Family counseling when it relates to your treatment

• Medication management

• Partial hospitalization programs (PHP)

• Intensive outpatient programs (IOP)

• Depression and anxiety screenings

• Alcohol misuse counseling

While coverage for services has expanded over time, the type of provider you see must be recognized and approved by Medicare to receive payment. This is where the real limitations begin.

Who Can Provide Covered Mental Health Services in 2025

As of 2025, Medicare covers services from the following mental health professionals:

1. Psychiatrists

These are medical doctors (MD or DO) who specialize in mental health. They can prescribe medications and provide psychotherapy. Medicare has long recognized psychiatrists as covered providers.

2. Clinical Psychologists

These providers hold a doctoral degree (Ph.D. or Psy.D.) and are trained in diagnosing and treating emotional disorders. They are eligible to deliver therapy services under Medicare.

3. Clinical Social Workers (CSWs)

CSWs must have a master’s degree in social work (MSW) and be licensed or certified by the state to practice independently. They can provide therapy, but cannot prescribe medications.

4. Nurse Practitioners and Physician Assistants

If they are licensed to provide psychiatric services and have a collaborative agreement with a physician when required, they can offer mental health care, including medication management and therapy.

5. Marriage and Family Therapists (MFTs)

New for 2024 and continuing into 2025, Medicare now covers services from licensed MFTs. These professionals are trained to treat emotional and psychological issues within the context of relationships and family systems.

6. Mental Health Counselors (MHCs)

Also covered starting in 2024, licensed MHCs are recognized under Medicare in 2025. These counselors often hold a master’s degree in counseling or a related field and are trained to diagnose and treat a wide range of mental health conditions.

The Qualifications Your Therapist Must Meet

To be eligible for Medicare reimbursement, your therapist must meet several key conditions:

Proper Licensure

The provider must be licensed by the state to practice independently. For example, an MFT must hold a state license in marriage and family therapy. Similarly, MHCs must have a recognized license in mental health counseling.

Medicare Enrollment

Your therapist must be officially enrolled in Medicare. This means they’ve completed the CMS-855I enrollment application and received approval to bill Medicare for their services.

You can verify their status using the Medicare Care Compare tool or by calling 1-800-MEDICARE.

National Provider Identifier (NPI)

Your provider must have a valid NPI number, which is a standard requirement for all health care professionals billing Medicare.

Scope of Practice

The services provided must fall within the legal scope of the provider’s license. For example, a social worker cannot prescribe medications because their scope of practice doesn’t include it.

What Happens If Your Therapist Isn’t Enrolled in Medicare

If you see a therapist who isn’t enrolled in Medicare or is not licensed appropriately, Medicare will not cover the visit. That means you are responsible for the full cost of services, even if the therapist is experienced and qualified in other ways.

Some therapists may choose to “opt out” of Medicare. In that case, they must have you sign a private contract stating you understand Medicare will not reimburse any part of the treatment.

To avoid issues:

• Ask if your provider is enrolled in Medicare before booking

• Confirm they meet licensure and credentialing standards

• Use the Medicare Care Compare directory or speak with a licensed agent listed on this website for help

Covered Costs and Out-of-Pocket Expenses

Even when you see a qualified provider, Medicare doesn’t cover 100% of the costs.

Here’s what you should expect under Medicare Part B in 2025:

• Annual deductible: $257

• Coinsurance: You pay 20% of the Medicare-approved amount for each service

• No cost-sharing for depression screenings: One screening per year is fully covered

• Telehealth parity: Medicare covers mental health services via telehealth, including at-home visits, under the same terms as in-person care

If you are enrolled in a Medicare advantage plan, coverage rules may vary, including which providers are in-network. But these plans are still required to cover at least the same mental health benefits as Original Medicare.

Telehealth Rules for Mental Health Therapy

Since 2020, Medicare has increasingly supported mental health care via telehealth. In 2025, Medicare continues to allow video and audio-only therapy sessions.

However, there are key requirements:

• The first session must be in person, unless you qualify for an exemption

• An in-person follow-up is required every 12 months unless waived due to hardship or provider shortage

• The provider must be licensed in your state and enrolled in Medicare

Telehealth is especially helpful in areas with limited access to mental health professionals. Just ensure your provider meets all Medicare requirements.

Finding a Medicare-Approved Mental Health Provider

To make sure your mental health provider meets Medicare’s rules:

• Ask directly: “Are you enrolled in Medicare and can you bill Medicare for services?”

• Use Medicare’s online Care Compare tool

• Check your local Area Agency on Aging or SHIP (State Health Insurance Assistance Program)

• Talk with a licensed agent listed on this website for assistance in evaluating your mental health coverage

Choosing the right provider not only protects your wallet, but also ensures continuity of care, especially if you need medication management, specialized therapy, or coordination with other providers.

Coordination of Mental and Physical Health

Your mental and physical health are closely linked. If you’re dealing with chronic illnesses, grief, or life transitions, counseling can be essential. Medicare encourages integrated care by:

• Covering depression screenings during Annual Wellness Visits

• Supporting team-based care models like primary care behavioral health integration

• Allowing shared care plans among providers

But none of this coordination is possible unless your providers are properly credentialed and Medicare-eligible.

How to Advocate for the Mental Health Care You Need

You play a key role in accessing and maintaining your mental health care. If your current provider isn’t enrolled in Medicare, you have options:

• Encourage them to enroll

• Seek a referral to a Medicare-enrolled therapist

• Use telehealth services when available

• Explore counseling benefits through other programs like Medicaid, VA, or state-funded clinics if eligible

Remember, even newly covered providers like MFTs and MHCs must complete the enrollment process. Don’t assume they’re eligible unless you’ve confirmed it.

Getting Help With Medicare Mental Health Choices

Navigating Medicare’s mental health rules isn’t always easy, especially when you’re also managing your well-being. That’s why it helps to speak with someone who understands the system. A licensed agent listed on this website can walk you through your options, review your current coverage, and help you find a qualified mental health provider who meets all Medicare requirements.

Medicare Mental Health Rules Are Evolving, But You Still Need to Be Cautious

Medicare is making progress by covering a wider range of mental health professionals, including MFTs and MHCs. However, access still depends on your provider meeting specific licensing and enrollment criteria. It’s not enough for them to be good at what they do; they must be recognized by Medicare.

To protect your mental health and your finances, verify your therapist’s status, ask the right questions, and explore all your care options. If you’re unsure where to start, get in touch with a licensed agent listed on this website for expert help.