Medicare for Therapy

Medicare is a federal health insurance program. People over 65 years old and people with disabilities are eligible for Medicare. Medicare differs from Medicaid, which offers coverage to low-income families and individuals. While each state has different policies, Medicare generally provides medical and behavioral health plans for its members. Read on for information on how to use Medicare to pay for therapy.

Does Medicare Cover Therapy?

Yes, Medicare covers therapy services. While the coverage rate depends on your Medicare plan — many people receive their Medicare benefits through a health insurance company instead of directly from the government — Medicare will typically help you pay for your therapy sessions.

With the federal Medicare plan, members enrolled in Part B receive coverage for outpatient mental health services. Medicare Part B is the medical coverage that helps pay for mental health screenings, diagnosis, and treatment, including psychiatrist visits and medication management.

How Do I Check if My Medicare Plan Covers Therapy?

Check your Summary of Benefits document to verify if your Medicare plan covers therapy. This document features a table describing how much coverage your health insurance provides based on the service. For Medicare, it’s important to determine if you receive Medicare directly from the government or through a third-party health insurance company. Either way, you will receive coverage information when you enroll in Medicare. If you can’t discern if your Medicare plan covers therapy, call the customer service number on the back of your Medicare card to ask about outpatient mental health services coverage.

How Much Does Therapy Cost With a Medicare Plan?

Therapy with Medicare will cost different amounts depending on your location, plan, and provider:

Location: Even though Medicare is a federal health insurance program, each state is responsible for its own Medicare policies. This means that Medicare plans look different across state lines.
Plan: Receiving your Medicare coverage directly from the state or through a health insurance company will impact your coverage. Sometimes, health insurance companies offer different benefits and have access to different resources.
Provider: Not all therapists take Medicare — for the therapists that do not, you will have to pay the session costs.

Expect to pay a copayment or coinsurance for each visit to your therapist if they are in-network. Medicare copayments are generally around $20, and coinsurance rates around 20%, though these will vary based on your situation. For out-of-network therapists, you will typically be responsible for a larger portion of the session fee. Seeing a non-Medicare therapist also may require preauthorization from your Medicare plan.

It is important to note that some Medicare plans limit the number of therapy sessions for which a person receives coverage. Some plans have a number or cost limit (6 visits or $2,000 reimbursement). Before starting therapy, learn if your plan limits your care — so you don’t have to stop in the middle of your treatment.

What Types of Mental Health Conditions Does Medicare Cover?

Medicare covers all diagnosis-based mental health conditions. This means your therapist will need to provide Medicare with a diagnosis of a mental health condition to receive reimbursement for their services.

Examples of diagnosable mental health conditions include:

What Types of Therapy Does Medicare Cover?

Medicare covers all therapy services provided by a credentialed mental health professional. This could include psychologists, psychiatrists, social workers, licensed professional counselors, nurse practitioners, and more.

Therapists must provide evidence-based, clinically rigorous treatments appropriate for the client’s diagnosis. This includes the following therapeutic modalities:

What Types of Therapy Does Medicare Not Cover?

Medicare does not cover certain therapies that are not evidence-based or based on a mental health diagnosis. This includes career counseling and life coaching. It also includes holistic therapies like massage therapy, aromatherapy, or reiki healing.

Does Medicare Cover Online Therapy?

Yes, Medicare covers online therapy. Medicare began covering telehealth visits between mental health professionals and clients during the coronavirus pandemic. The same copayment and coinsurance rates apply, whether in-person or online.

While unlikely, this may change in the future. Before seeing a therapist online, ensure Medicare still covers online sessions.

Does Medicare Cover Couples Therapy?

Yes, Medicare provides coverage for couples therapy, but only in certain circumstances. Medicare specifies what type of therapist will receive payment for couples therapy. For example, Medicare can cover couples therapy provided by a psychologist or clinical social worker, but couples therapy provided by a marriage and family therapist is not. Medicare also establishes that couples therapy needs to be part of an individual’s treatment plan and that including the client’s partner in sessions is helpful for their diagnosable mental health condition.

Because it’s nuanced who receives coverage for couples therapy, speak with your prospective couples therapist about whether or not they receive Medicare reimbursement for their services. You might also consider calling your Medicare plan’s customer service hotline to verify.

Do I Need to See My Primary Doctor Before Starting Therapy?

You do not need to see your primary doctor before starting therapy with a therapist who is in-network with Medicare. This is because Medicare does not require a referral before seeing a specialist, including a therapist.

However, this only applies to Medicare providers. If you plan to see a non-Medicare-accepting therapist, you must request prior authorization from Medicare before you begin your sessions. Once you receive authorization, you’ll understand how much coverage you’ll have, how much of the bill you are responsible for, and how long you’ll have access to this therapist’s services.

Why Choose Zencare to Help You Find an In-Network Therapist?

Regardless if it's your first time seeking therapy or one of many, Zencare is a great choice to find a supportive therapist while staying within your insurance network. Some of the many reasons thousands of people turn to us to find their therapist include:

Personalized Matching

We offer a unique matching platform that considers the following criteria to help you find a therapist who understands your circumstances and can provide the support you need:

Therapist specialty
Gender, cultural background, and other identity factors important to you
Therapeutic approach

Vetted Providers

Zencare takes the guesswork out of finding a qualified therapist, as we vet all providers so you can feel confident you are choosing from a pool of trustworthy and skilled professionals. Our vetting process includes:

Credential verification: We verify the credentials of each therapist in our network. We'll confirm they have the right degrees and any specialized training so you receive care from a professional who meets the highest standards.
Background checks: Safety and trust are vital when seeking therapy, and our background checks include a thorough review of each provider's history, including any disciplinary actions or red flags that could impact their ability to provide care. Our thorough process allows us to confidently refer you to a therapist with a responsible record.
Client reviews: We value the experiences of those who have used our platform for therapy services, and we examine client reviews and feedback to understand how effective each therapist is. By considering the perspectives of our past clients, we can ensure our network includes providers with the necessary qualifications and a proven track record of positive outcomes.

Free Consultations

Reduce the anxiety of seeing a new therapist with our free consultation feature. Some of the many benefits of our consultation services include:

Comfort assessment: Feeling comfortable with your therapist is essential, and our free consultations provide a low-pressure way to see if you and your therapist are a good team.
Opportunity for questions: Our consultations allow you to ask questions about your therapist's style, experience, and how they would help you on your mental health journey.
Trial sessions: Since our consultations are free, you can meet a therapist without financial commitment for an affordable way to see if their approach aligns with your needs.

Insurance Compatibility

Navigating insurance can be complicated. Let us make it better through services like:

Listing in-network therapists: Filter therapists based on your insurance provider to ensure you find someone in-network.
Cost transparency: We provide information about therapy costs, potential out-of-pocket expenses, and the reimbursement process to make it easier for you understand all financial expectations.
Resource guidance: Our resources and articles on navigating insurance make it easier to manage costs.

Resourceful Content

We go beyond just matching you with a therapist by providing a wealth of resources such as informative blog articles. Our blog covers a wide range of mental health topics, including what to expect in therapy, tips for coping with specific issues, and advice on choosing the right therapist.

Find Your Therapist Today

The right therapist is waiting for you, let Zencare help you find them. Take our matching quiz or select your state below to find vetted therapists who are in-network with Medicare: