Medicare Mental Health Services

At least one in five Americans has a mental health condition. The most common conditions among Medicare beneficiaries ages 65 and older are depression and anxiety. Due to the growing aging population, demand for services that evaluate and treat mental health and substance use disorders is expected to continue to grow.

Mental and physical health conditions are often present together. For example, depression is associated with increased risk of coronary heart disease and premature death. Depression also often co-occurs with substance use disorders and other chronic illnesses such as Alzheimer’s disease, cancer, and arthritis.

Mental health conditions are frequently undiagnosed or misdiagnosed in older patients. Primary care practitioners provide most mental health care under Medicare and they often have insufficient training in assessing and treating mental health disorders in older adults. Although some geriatric mental health assessment tools exist, researchers need to develop and evaluate more age-appropriate screening tools and clinicians need to use evidence-based tools during routine practice. Perceived social stigma and denial can also impede accurate diagnosis and treatment.

Americans ages 75 and older have the highest rates of suicide among all age groups. Many older adults are reluctant to seek counseling for mental health conditions and other challenges of later life, such as bereavement, disability, loneliness, and isolation.

Medicare’s coverage of mental health and substance use disorders has improved over the years. However, Medicare is not subject to the 2008 Mental Health Parity and Addiction Equity Act. As a result, restrictions that do not apply to other health services continue to be used for mental health care, including a lifetime limit of 190 days for psychiatric care in freestanding psychiatric hospitals.

Medicare covers some mental health-related preventive services with no cost-sharing, including annual screenings for depression and alcohol use disorder screening. But coverage for subsequent services can be limited. For those who screen positive for alcohol use disorder, Medicare will cover four brief, face-to-face behavioral counseling interventions per year. Medicare covers counseling, therapy services, and periodic assessments both in person and, in certain circumstances, by virtual delivery, for opioid use disorder treatment.

Medicare covers outpatient mental health services provided by physicians (especially psychiatrists), clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, marriage and family therapists, and mental health counselors. Medicare Part B allows 20 outpatient individual or group therapy sessions per year, but additional sessions may be authorized if deemed medically necessary by a clinician.

Medicare no longer has geographic and originating-site restrictions for mental health services delivered via telehealth (video conference), though it will require an in-person visit within six months prior to the telehealth services after the current telehealth waivers end on September 30, 2025.

For a broader discussion of mental health, see Specific Needs and Services—Mental Health.