What Original Medicare covers for mental health
Outpatient mental health (Part B)
Medicare Part B covers outpatient mental health services. After the $283 Part B deductible (2026), you generally pay 20% of the Medicare-approved amount; hospital outpatient clinics may charge an additional copayment or coinsurance. Covered services include:
- Visits with psychiatrists and other doctors
- Visits with clinical psychologists
- Visits with clinical social workers
- Visits with clinical nurse specialists, nurse practitioners and physician assistants
- Visits with marriage and family therapists, covered since January 1, 2024
- Visits with mental health counselors, covered since January 1, 2024
- A yearly depression screening, at no cost to you if your provider accepts assignment
- A review of your risk of depression during your "Welcome to Medicare" preventive visit, and mental health in your yearly Annual Wellness Visit
- Substance use disorder screening and counseling
- Group therapy, and family counseling when the main purpose is to help with your treatment
- Intensive outpatient programs (at least 9 hours of services a week) and partial hospitalization (at least 20 hours a week), when you meet the requirements
Inpatient mental health (Part A)
Medicare Part A covers inpatient mental health care:
- In a general hospital: the same Part A rules as any inpatient stay ($1,736 deductible per benefit period in 2026)
- In a psychiatric hospital: Part A pays for up to 190 days of inpatient psychiatric hospital care during your lifetime
The 190-day limit doesn't apply to mental health care you get as an inpatient in a general hospital.
Prescription medicines (Part D)
Mental health medicines, such as antidepressants, antipsychotics, mood stabilizers and anti-anxiety medicines, are covered through Medicare Part D drug plans and Medicare Advantage plans with drug coverage, according to each plan's formulary. In 2026, out-of-pocket costs for covered Part D drugs are capped at $2,100 a year. See Prescription drug costs in Washington.
Recent changes you should know about
- Marriage and family therapists and mental health counselors can bill Medicare directly since January 1, 2024. In Washington, these are licensed marriage and family therapists and licensed mental health counselors who enroll with Medicare, which adds to the providers you can see.
- Mental health telehealth at home is a permanent part of Medicare under federal law. Separately, through December 31, 2027, Medicare covers many other telehealth services from anywhere in the U.S.
- Audio-only visits are allowed for mental health care in some cases, which helps people without reliable video or a private space.
- Intensive outpatient programs have been covered since 2024, for people who need more than weekly therapy but not full-day care.
- Opioid use disorder treatment through Medicare-enrolled opioid treatment programs, including methadone, has been covered under Part B since 2020.
Telehealth for mental health in Washington
In Washington's rural counties, such as Okanogan, Pend Oreille, Ferry, Wahkiakum and San Juan, a local psychiatrist or therapist may be a long drive or a ferry ride away. Medicare's coverage of mental health telehealth from home makes ongoing care easier to keep up.
You can have therapy, medication management and substance use counseling by secure video (or audio-only in some cases) with a provider who accepts Medicare, or who is in your plan's network if you have Medicare Advantage. The provider must generally be licensed to treat you where you are. See Telehealth and rural Medicare in Washington.
Medicare Advantage and mental health
Medicare Advantage plans must cover all the mental health services Original Medicare covers, though costs and rules (such as prior authorization) differ by plan. Medicare Advantage plans may offer extra benefits that Original Medicare doesn't cover, such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
The trade-off: most Medicare Advantage plans use provider networks, and HMOs generally cover only in-network care except emergencies. If you have a therapist you want to keep, check whether they're in the plan's network before you join. To look at plans offered where you live, you can see plans in your ZIP code, or call (206) SENIORS (206-736-4677), TTY 711 to reach a licensed insurance agent with Benefits Life, at no cost to you.
Substance use disorder treatment
Medicare covers a range of treatment for substance use disorders:
- Inpatient treatment in a hospital
- Outpatient counseling (individual and group)
- Medications for opioid use disorder, such as methadone, buprenorphine and naltrexone, including through opioid treatment programs
- Yearly alcohol misuse screening, and up to 4 brief counseling sessions a year if you qualify, at no cost to you when your provider accepts assignment
- Tobacco cessation counseling, up to 8 sessions in 12 months, at no cost to you when your provider accepts assignment
- Intensive outpatient and partial hospitalization programs
Washington mental health resources
- 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org, 24 hours a day
- Veterans Crisis Line: dial 988 and press 1, or text 838255
- Washington Recovery Help Line: call or text 1-866-789-1511, 24 hours a day, for mental health, substance use and problem gambling support and referrals anywhere in Washington (a Health Care Authority-funded service)
- NAMI Washington, the state organization of the National Alliance on Mental Illness, for peer and family support groups
- Community Living Connections (1-855-567-0252), for aging and long-term care services, including help for caregivers
If you're in crisis
If you or someone you care about is in immediate danger, call 911 or go to the nearest emergency room. Medicare covers emergency care at any hospital in the U.S. The 988 Suicide & Crisis Lifeline is available 24 hours a day by call, text or chat.
Where to get help with Medicare questions
- 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), for coverage questions, and Medicare.gov to find providers who accept Medicare
- Your plan's member services, if you have Medicare Advantage or Part D, for networks, prior authorization and formularies
- A licensed insurance agent with Benefits Life, at (206) SENIORS (206-736-4677), TTY 711, at no cost to you, to compare plans from the companies they work with, or an independent licensed insurance agent near you
Sources
- Medicare.gov — Mental health care (outpatient)
- Medicare.gov — Mental health care (inpatient)
- Medicare.gov — Mental health and substance use disorder services
- Medicare.gov — Telehealth
- Medicare.gov — Counseling to prevent tobacco use
- Medicare.gov — Alcohol misuse screenings and counseling
- CMS — Medicare & Mental Health Coverage (MLN1986542, March 2026)
- Washington Health Care Authority — Washington Recovery Help Line fact sheet
- 988 Suicide & Crisis Lifeline
Frequently asked questions
Does Medicare cover therapy in Washington?
Yes. Original Medicare Part B covers outpatient mental health services from psychiatrists and other doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, and, since 2024, marriage and family therapists and mental health counselors. After the Part B deductible, you generally pay 20% of the Medicare-approved amount.
Is telehealth therapy covered by Medicare?
Yes. Medicare covers mental health telehealth visits, including from your home, and audio-only visits are allowed in some cases, which helps people without reliable video or a private space. Ask your provider whether an in-person visit is also required for your care.
Is there a limit on Medicare mental health coverage?
Outpatient mental health care has no yearly visit limit when it's medically necessary. Part A pays for up to 190 days of inpatient care in a psychiatric hospital during your lifetime. That limit doesn't apply to mental health care you get as an inpatient in a general hospital.
Are antidepressants covered by Medicare?
Antidepressants, antipsychotics, mood stabilizers and other mental health medicines are covered through Medicare Part D drug plans and Medicare Advantage plans with drug coverage, according to each plan's formulary. In 2026, out-of-pocket costs for covered Part D drugs are capped at $2,100 a year.
Does Medicare cover substance use treatment?
Yes. Medicare covers inpatient and outpatient treatment for substance use disorders, including counseling, intensive outpatient and partial hospitalization programs, and medications for opioid use disorder through opioid treatment programs. Yearly alcohol misuse screening and up to 8 tobacco cessation counseling sessions a year are covered at no cost to you when your provider accepts assignment.
Medicare in your Washington county
Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima
