Medicare mental health benefits: therapy, hospital care and what you pay

If you or someone you know is struggling or in crisis, call or text 988, the free and confidential Suicide & Crisis Lifeline, or chat at 988lifeline.org. Counselors are available 24 hours a day, 7 days a week. Call 911 if you are in an immediate medical crisis.

Mental health does not retire. Depression, anxiety and substance use problems can start at any age, and life after work brings its own pressures: the loss of a daily routine, the death of a spouse or friends, a new diagnosis, caring for someone else. Many retirees do not realize how much mental health care Medicare covers, from a yearly depression screening to therapy with a licensed counselor to a stay in a psychiatric hospital.

This guide explains that coverage: who you can see, what Original Medicare pays for outpatient and inpatient care, what you pay in 2026, how drug plans must treat mental health medications, help for people with limited income, and where to find support. It is based on the Centers for Medicare & Medicaid Services (CMS) booklet Medicare & Your Mental Health Benefits, September 2026 edition.

When to ask for help

CMS says mental health conditions like depression and anxiety can happen to anyone at any time, and it encourages you to talk to your doctor or another health care provider if you have:

• Thoughts of ending your life, such as a fixation on death or suicidal thoughts or attempts
• Sad, empty or hopeless feelings
• Loss of self-worth, like worries about being a burden, feelings of worthlessness or self-loathing
• Social withdrawal, like not wanting to be with friends, take part in activities or leave home
• Little interest in things you used to enjoy
• Low energy
• Trouble concentrating
• Trouble sleeping, including difficulty falling or staying asleep, oversleeping or daytime sleepiness
• Loss of appetite or weight loss
• Increased use of alcohol or other drugs

Original Medicare, meaning Part A (Hospital Insurance) and Part B (Medical Insurance), covers a wide range of outpatient and inpatient mental health services, including care for substance use disorders, and Medicare drug coverage helps with the prescriptions you may need. If you have a Medicare Advantage Plan, CMS notes it may offer extra benefits Original Medicare does not cover, like certain types of counseling; contact your plan for details.

Who you can see under Part B

Part B helps pay for mental health services you usually get outside a hospital or in a hospital outpatient department: a doctor's or therapist's office, a hospital outpatient department or a community mental health center. Part B covers visits with:

• Psychiatrists or other doctors
• Clinical psychologists
• Clinical social workers
• Clinical nurse specialists
• Nurse practitioners
• Physician assistants
• Marriage and family therapists
• Mental health counselors

Marriage and family therapists and mental health counselors are on the list, which widens the pool of providers you can see under Medicare.

Why "accepts assignment" matters

Providers who participate in Part B must accept assignment. CMS explains that this means the provider agrees to be paid directly by Medicare, to accept the Medicare-approved amount as full payment, and not to bill you more than the Medicare deductible and coinsurance. Most providers accept assignment, but CMS says to always check before you schedule an appointment. Several of the costs below, including free screenings, depend on it.

Outpatient services Part B covers

Screenings and preventive visits

• One depression screening each year. It must be done in a primary care doctor's office or primary care clinic that can provide follow-up treatment and referrals.
• One alcohol misuse screening each year for adults who use alcohol but do not meet the medical conditions for alcohol dependency. If your primary care provider decides you are misusing alcohol, you can also get up to 4 brief, face-to-face counseling sessions each year, in a primary care setting like a doctor's office.
• A one-time "Welcome to Medicare" preventive visit within your first 12 months with Part B, which includes a review of your potential risk factors for depression.
• A yearly "Wellness" visit. CMS suggests talking with your provider about changes in your mental health since your last visit.

Therapy, evaluation and medication management

Part B also helps pay for:

• Individual and group psychotherapy with doctors, or with certain other Medicare-enrolled licensed professionals as your state allows
• Family counseling, if the main purpose is to help with your treatment
• Testing to find out whether you are getting the services you need and whether your current treatment is helping
• Psychiatric evaluation
• Medication management
• Certain prescription drugs that are not usually self-administered, like some injections
• Diagnostic tests
• Safety planning interventions if you are at risk of suicide or overdose
• A follow-up phone call after you are discharged from the emergency department for a behavioral health service or other crisis
• Certain FDA-cleared or FDA-authorized digital mental health treatment devices, including devices that treat attention deficit/hyperactivity disorder, if you get them from your doctor or certain other qualified providers and meet other conditions
• Mental health services you get as part of substance use disorder treatment

Partial hospitalization

Partial hospitalization is a structured outpatient program offered as an alternative to inpatient psychiatric care. It is more intensive than office visits and usually includes between 4 and 8 hours of care each day. CMS says you may benefit if your care plan states you need at least 20 hours of therapeutic services each week.

Part B may cover partial hospitalization through a hospital outpatient department or community mental health center if you meet certain requirements and your doctor or other qualified mental health professional certifies that you would otherwise need inpatient treatment. As part of the program, Medicare may cover occupational therapy that is part of your mental health treatment, individual training and education about your condition, caregiver training services and principal illness navigation services.

Intensive outpatient programs

Intensive outpatient programs sit between traditional once-a-week therapy and inpatient or partial hospitalization care. They are for mental health conditions, including substance use disorders, and may include group and individual therapy, mental health education and medication management. CMS says you may benefit if your care plan states you need at least 9 hours of therapeutic services each week. You can get these services at a hospital, community mental health center, Federally Qualified Health Center or Rural Health Clinic, and Part B also covers them at Opioid Treatment Programs when you are being treated for opioid use disorder.

Opioid use disorder treatment

Medicare covers medications for opioid use disorder and treatment services from a doctor or other provider, or through an Opioid Treatment Program, including its mobile units. Services may include:

• Medications for opioid use disorder, like methadone, buprenorphine and naltrexone
• Medications to rapidly reverse an opioid overdose, like naloxone and nalmefene
• Preparation and help taking medications that are part of your recovery
• Substance use counseling
• Drug testing
• Individual and group therapy
• Intake activities and other periodic assessments
• Intensive outpatient program services
• Coordinated care and referral services
• Peer recovery support services

Counseling, therapy and periodic assessments are covered in person and, in certain circumstances, by audio and video, like your phone or a computer. Medicare may also cover periodic assessments by audio only. Ask your provider where you can get these services.

What you pay for outpatient care

In general, after you pay your yearly Part B deductible, you pay 20% of the Medicare-approved amount for visits to diagnose or treat your condition, if your provider accepts assignment. If you get services in a hospital outpatient clinic or department, you may also owe the hospital an additional copayment or coinsurance. The current deductible is on our Part B premium page.

A few details behind that table. For opioid treatment, you usually pay no copayments at an Opioid Treatment Program provider that participates in Medicare and meets other requirements, but the Part B deductible applies, including to supplies and medications. If you get opioid use disorder services from a regular health care provider instead, you pay the usual copayments after the deductible. For partial hospitalization and intensive outpatient programs, you pay a percentage of the Medicare-approved amount for each service from a qualified mental health professional who accepts assignment, and after the deductible you also pay coinsurance for each day of services in a hospital outpatient setting or community mental health center.

What outpatient coverage does not include

• Meals
• Transportation to or from mental health services
• Support groups that bring people together to talk and socialize (group psychotherapy, by contrast, is covered)
• Testing or training for job skills that is not part of your mental health treatment

Inpatient mental health care under Part A

Part A covers mental health care when you are admitted as a hospital inpatient, either in a general hospital or in a psychiatric hospital, which CMS describes as a facility that mainly cares for people with mental health conditions. Covered services include a semi-private room, meals, general nursing, drugs (including methadone to treat opioid use disorder), and other hospital services and supplies that are part of your inpatient treatment. Part B covers the services you get from doctors and other providers while you are in the hospital.

Benefit periods

Medicare measures inpatient care, including care in a psychiatric hospital, in benefit periods. A benefit period begins the day you are admitted as an inpatient and ends once you have been out of the hospital for 60 days in a row. If you are admitted again after those 60 days, a new benefit period begins and you pay a new deductible. There is no limit to the number of benefit periods you can have in a year.

What you pay in 2026

For each benefit period in 2026, CMS lists these hospital inpatient costs:

You also pay 20% of the Medicare-approved amount for mental health services from providers while you are an inpatient. Lifetime reserve days are extra days Medicare pays for when you are in the hospital for more than 90 days. You have 60 of them for your whole lifetime, and Medicare pays all covered costs on those days except the daily coinsurance. Our Part A costs page has these amounts with prior years.

The 190-day lifetime limit for psychiatric hospitals

This is the rule families most need to know. In a general hospital, inpatient mental health care follows the same benefit-period rules as any other hospital stay. But in a psychiatric hospital, CMS says Part A only pays for up to 190 days of inpatient psychiatric hospital services during your lifetime. That limit does not reset with each benefit period. For someone with a long history of psychiatric hospital stays, where the care is given can matter as much as how long it lasts.

What inpatient coverage does not include

• Private duty nursing
• A phone or television in your room, if there is a separate charge
• Personal care items like toothpaste, razors or slipper socks
• A private room, unless medically necessary

If you have a Medigap policy or other coverage, tell your providers so your bills are paid correctly. Our guide to Medigap plans shows which plans cover the Part A and Part B cost sharing above.

Drug coverage for mental health medications

To get Medicare drug coverage, you must join a Medicare-approved plan: a stand-alone drug plan or a Medicare Advantage Plan with drug coverage. Private companies run these plans under Medicare's rules, and each plan's costs and covered drugs vary.

Plans must cover these three drug classes

Most plans have a formulary, a list of the drugs they cover. Plans are not required to cover all drugs, but CMS says they are required to cover all, with limited exceptions, antidepressant, anticonvulsant and antipsychotic medications. Medicare also reviews each plan's formulary to make sure it includes a wide range of drugs and does not discriminate against groups like people with disabilities or mental health conditions.

If you take medication for a mental health condition, CMS stresses finding out whether a plan covers your drugs before you enroll. Medicare's Plan Finder at Medicare.gov/plan-compare lets you enter the drugs you take for a better estimate of your costs in each plan. Have your Medicare card, a list of your drugs and dosages, and your pharmacy's name ready. Our Part D costs page has the deductible and the yearly out-of-pocket cap.

When a plan changes its drug list

A plan may change its drug list during the year if drug therapies change, new drugs come out or new medical information becomes available. If a plan adds a new generic in place of a brand-name drug, it can, in certain cases, immediately remove the brand-name drug, or change the brand-name drug's cost or coverage rules. If the formulary status of a drug you take changes, the plan will send you information about the change. For other changes that affect a drug you take during the year, the plan must either give you notice at least 30 days before the change takes effect, or tell you about the change and give you a month's supply under the old rules when you ask for a refill.

When your plan will not cover a drug you need

You have the right to ask your plan for a coverage determination, including an exception. A formulary exception asks the plan to cover a drug that is not on its list or to waive a coverage rule; a tiering exception asks it to charge less for a drug on a non-preferred tier. Your doctor or other prescriber must provide a statement explaining the medical reason. The plan must decide promptly: within 72 hours for standard requests and 24 hours for expedited requests. If you disagree, the next step is an appeal; our guide to Medicare appeals walks through every level.

You can appoint a representative to help, such as a family member, friend, advocate, attorney, financial advisor or doctor. You, your representative or your prescriber must contact the plan to ask for the coverage determination.

Help if you have limited income

CMS lists several programs that can lower costs:

• Extra Help pays for Medicare drug costs for people with limited income and resources. CMS says to apply even if you are not sure you qualify, online at SSA.gov, by phone or with a paper application. Our Extra Help page has the income limits.
• State Pharmaceutical Assistance Programs in many states help certain people pay for drugs based on financial need, age or medical condition. Each program sets its own rules.
• Pharmaceutical (patient) assistance programs from many major drug manufacturers help people with Part D who meet certain requirements.
• Medicare Savings Programs can help pay premiums, deductibles and coinsurance through your state. Contact your state Medicaid office even if you are not sure you qualify. Our Medicare Savings Programs page has the limits.
• Medicaid may help with medical costs and covers some things Medicare normally does not, like long-term nursing home care and personal care services. Each state sets its own rules.

Your State Health Insurance Assistance Program (SHIP) offers free, personalized counseling on all of these; find yours at shiphelp.org or through 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).

Where to find mental health support

For Medicare mental health coverage, visit Medicare.gov/coverage/mental-health-substance-use-disorder or call 1-800-MEDICARE. To find care, CMS suggests talking to your provider and lists these resources:

• 988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org. CMS describes it as a national network of local crisis centers offering free, confidential support for anyone having thoughts of suicide or a mental health or substance use crisis, and for people worried about a family member or friend. It can also help you find treatment in your area.
• National Institute of Mental Health: NIMH.nih.gov or 1-866-615-6464 (TTY 1-301-443-8431).
• Substance Abuse and Mental Health Services Administration: SAMHSA.gov/mental-health, FindTreatment.gov to find treatment facilities, or 1-877-SAMHSA-7 (1-877-726-4727; TTY 1-800-487-4889).
• Private organizations CMS lists: Mental Health America (1-800-969-6642), the National Alliance on Mental Illness helpline (1-800-950-6264, or text "helpline" to 62640) and the National Council for Mental Wellbeing.

A short checklist

• Ask for your free yearly depression screening at your primary care office.
• Bring up mental health at your "Welcome to Medicare" visit and every yearly Wellness visit.
• Confirm a therapist or psychiatrist accepts assignment before your first appointment.
• Remember that counselors and marriage and family therapists are covered providers.
• Before choosing a drug plan, enter your mental health medications in Medicare's Plan Finder.
• If a plan denies a drug, ask for an exception and have your prescriber send a supporting statement.
• For inpatient care, know the 190-day lifetime limit applies to psychiatric hospitals.
• If money is tight, apply for Extra Help and ask your state about Medicare Savings Programs.

Asking for help with mental health is as ordinary as asking for help with blood pressure, and Medicare covers it in much the same way. Knowing the rules makes the first call easier.