Medicare covers many services used to diagnose and treat mental health and substance use disorders. Coverage can come from Part A, Part B, and Part D. The service must be medically necessary and provided by a professional or facility that is eligible to bill Medicare.
Outpatient and inpatient coverage
Part B covers outpatient counseling and psychotherapy, psychiatric evaluation, medication management, certain preventive screenings, behavioral health integration, and other covered services. Covered professionals can include psychiatrists, other doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, marriage and family therapists, and mental health counselors.
Part B also covers eligible intensive outpatient programs and partial hospitalization programs. These structured programs have specific hour and setting requirements. Part A covers mental health care during an inpatient admission to a general or psychiatric hospital. Medicare applies a lifetime limit of 190 days to inpatient care in a freestanding psychiatric hospital. Inpatient psychiatric care received in a general hospital is not counted toward that limit.
Part D covers many outpatient prescription drugs used to treat mental health conditions. The drug must be on the plan’s formulary or approved through the plan’s coverage determination or exception process.
Costs and Medicare Advantage
For most Part B mental health services, the Part B deductible applies and the person pays 20 percent of the Medicare-approved amount when the provider accepts assignment. Inpatient deductibles and daily coinsurance can apply under Part A. Prescription costs depend on the drug plan.
Medicare Advantage plans must cover Medicare-covered mental health services. A plan can use networks, referrals, and prior authorization. Emergency and urgently needed care have separate protections. Check the plan before starting routine treatment.
What to do next
- Confirm that the professional accepts Medicare or is in the Medicare Advantage network.
- Ask whether a referral or prior authorization is required.
- Check prescribed drugs on the plan formulary.
- For immediate crisis support, call or text 988. Call 911 for an immediate medical emergency.
- Review Medicare’s mental health and substance use disorder coverage.
Sources
Coverage and costs can change each calendar year. Check current Medicare rules and current plan documents before receiving care. A provider’s estimate is not a Medicare coverage decision. Final payment depends on the claim and the applicable coverage requirements.
Last reviewed: August 2026. Medicare rules and plan benefits can change.