Medicare Mental Health Benefits: Outpatient, Inpatient, and Drug Costs

Adapted from Medicare & Your Mental Health Benefits, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Mental health care & Medicare

Mental health conditions, like depression and anxiety, can happen to anyone at any time. If you think you may have problems that affect your mental health, you can get help. Talk to your doctor or other health care provider if you have:

• Thoughts of ending your life (like 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)
• Symptoms of social withdrawal (like you don’t want to be with friends, engage in activities, or leave home)
• Little interest in things you used to enjoy
• Low energy
• Trouble concentrating
• Trouble sleeping (like difficulty falling or staying asleep, oversleeping, or daytime sleepiness)
• Loss of appetite or weight loss
• Increased use of alcohol or other drugs

Mental health care services and programs help diagnose and treat people with mental health conditions (including substance use disorders). Original Medicare (Part A (Hospital Insurance) and Part B (Medical Insurance)) covers a wide range of outpatient and inpatient mental health care services, as well as prescription drugs you may need to treat mental health conditions.

If you have a Medicare Advantage Plan, it may offer extra benefits that Original Medicare doesn’t cover, like certain types of mental health counseling. Contact your plan for details.

If you or someone you know is struggling or in crisis and would like to talk to a trained crisis counselor, call or text 988, the free and confidential Suicide & Crisis Lifeline. You can also connect with a counselor through web chat at 988lifeline.org.

The 988 Suicide & Crisis Lifeline is a national network of local crisis centers that provides free and confidential emotional support if you or someone you know is having thoughts of suicide or experiencing a mental health or substance use crisis. You can talk to a counselor 24 hours a day, 7 days a week in the U.S. Call, text, or chat:

• To talk to someone who cares
• If you feel you might be in danger of hurting yourself
• If you’re concerned about a family member or friend
• To find mental health treatments and services in your area

Call 911 if you’re in an immediate medical crisis.

Outpatient mental health care

What does Original Medicare cover?

Medicare Part B (Medical Insurance) helps pay for mental health services you usually get in a hospital outpatient department or outside of a hospital (like in a doctor’s or therapist’s office, a hospital outpatient department, or a community mental health center). Part B also 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

Providers who participate in Part B must accept assignment. This means your doctor, provider, or supplier agrees to be paid directly by Medicare, to accept the Medicare-approved amount as full payment for covered services, and not to bill you for any more than the Medicare deductible and coinsurance. Most health care providers accept assignment, but always check to make sure before you schedule an appointment.

Alcohol misuse screening & counseling Medicare covers one alcohol misuse screening each year for adults who use alcohol, but don’t meet the medical conditions for alcohol dependency. If your primary care provider determines you’re misusing alcohol, you can also get up to 4 brief, face-to-face counseling sessions each year. You must get counseling in a primary care setting (like a doctor’s office).

Visit Medicare.gov/coverage/alcohol-misuse-screenings-counseling for more information.

Opioid Use Disorder treatment services Medicare covers medications for Opioid Use Disorder and treatment services you get from a doctor or other health care provider, or through a more comprehensive Opioid Treatment Program (including Opioid Treatment Program mobile units). Services may include:

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

Medicare covers counseling, therapy services, and periodic assessments both in person and, in certain circumstances, virtually (using audio and video communication, like your phone or a computer). Medicare may also cover periodic assessments that use audio-only communication. Talk to your provider to find out where you can get these services.

Visit Medicare.gov/coverage/opioid-use-disorder-treatment-services for more information.

Partial hospitalization Partial hospitalization is a structured program that provides outpatient psychiatric services as an alternative to inpatient psychiatric care. The services are more intensive than care you get in a doctor’s or therapist’s office, and usually include between 4-8 hours of care each day. You may benefit from partial hospitalization if your care plan states that you require at least 20 hours of therapeutic services each week.

Part B may cover partial hospitalization services you get 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 your partial hospitalization program, Medicare may cover:

• Occupational therapy that’s part of your mental health treatment
• Individual patient training and education about your condition
• Caregiver training services
• Principal illness navigation services

Visit Medicare.gov/coverage/mental-health-care-partial-hospitalization for more information.

Intensive outpatient program services Intensive outpatient programs offer a level of care for mental health conditions including substance use disorders. This level of care falls between traditional once-weekly therapy or counseling, and inpatient or partial hospitalization psychiatric care. The services are more intensive than care you’d get in a doctor’s or therapist’s office and may include things like group and individual therapy sessions, mental health education, and medication management.

You may benefit from intensive outpatient program services 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. Part B also covers these services at Opioid Treatment Programs (when you’re getting treatment for Opioid Use Disorder).

Visit Medicare.gov/coverage/mental-health-care-intensive-outpatient-program-services for more information.

Other outpatient mental health services

Part B also helps pay for many other outpatient mental health services, including:

• One depression screening each year. You must get the screening in a primary care doctor’s office or primary care clinic that can provide follow-up treatment and referrals. Visit Medicare.gov/coverage/depression-screening for more information.
• Individual and group psychotherapy with doctors (or with certain other Medicare-enrolled licensed professionals, as the state where you get the services allows).
• Family counseling, if the main purpose is to help with your treatment.
• Testing to find out if you’re getting the services you need and if your current treatment is helping you.
• Psychiatric evaluation.
• Medication management.
• Certain prescription drugs that aren’t usually “self-administered” (drugs you would normally take on your own), like some injections.
• Diagnostic tests.
• Safety planning interventions if you’re at risk of suicide or overdose.
• A follow-up phone call after you’re 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 mental health providers and you meet other conditions.
• A one-time “Welcome to Medicare” preventive visit within the first 12 months you have Part B. This visit includes a review of your potential risk factors for depression. Visit Medicare.gov/coverage/welcome-to-medicare-preventive-visit for more information.
• A yearly “Wellness” visit. Talk to your provider about changes in your mental health since your last visit. Visit Medicare.gov/coverage/yearly-wellness-visits for more information.
• Mental health services you get as part of substance use disorder treatment.

Visit Medicare.gov/coverage/mental-health-care-outpatient for more information on outpatient mental health services.

What do I pay for outpatient mental health care & services?

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 your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance to the hospital.

Note: If you have a Medicare Supplement Insurance (Medigap) policy or other health coverage, tell your health care provider so your bills get paid correctly.

Screenings You pay nothing for depression and alcohol misuse screenings if your health care provider accepts assignment.

Opioid Use Disorder treatment services

• You usually won’t pay any copayments for these services if you get them from an Opioid Treatment Program provider that participates in Medicare and meets other requirements. The Part B deductible applies for these services, including any supplies and medications you might get as part of your treatment.
• You pay the usual copayments for the services after you meet the Part B deductible, if you get Opioid Use Disorder services from a health care provider.

Partial hospitalization

• You pay a percentage of the Medicare-approved amount for each service you get from a qualified mental health professional if they accept assignment.
• After you meet the Part B deductible, you also pay coinsurance for each day of partial hospitalization services you get in a hospital outpatient setting or community mental health center.

Intensive outpatient program services

• You pay a percentage of the Medicare-approved amount for each service you get from a qualified mental health professional if they accept assignment.
• After you meet the Part B deductible, you also pay coinsurance for each day of intensive outpatient program services you get in a hospital outpatient setting or community mental health center.

What isn’t covered?

• Meals
• Transportation to or from mental health care services
• Support groups that bring people together to talk and socialize (Note: This is different from group psychotherapy, which is covered.)
• Testing or training for job skills that isn’t part of your mental health treatment

Inpatient mental health care

What does Original Medicare cover?

Medicare Part A (Hospital Insurance) covers mental health care services you get when you’re admitted as a hospital inpatient. You can get these services either in a general hospital or a psychiatric hospital (a facility that mainly cares for people with mental health conditions).

Part A-covered services include:

• Semi-private rooms
• Meals
• General nursing
• Drugs (including methadone to treat an Opioid Use Disorder)
• Other hospital services and supplies you might get as part of your inpatient treatment

Part B covers the services you get (like mental health services) from a doctor or other health care provider while you’re in the hospital.

Visit Medicare.gov/coverage/mental-health-care-inpatient for more information.

What do I pay for inpatient mental health care & services?

When you get inpatient hospital services (including services you get in a psychiatric hospital), Medicare measures your care in benefit periods, which are related to the number of days in a row you get care. A benefit period begins the day you’re admitted as an inpatient in a general or psychiatric hospital. The benefit period ends once you’ve been out of the hospital for 60 days in a row. If you’re admitted to the hospital again after those 60 days, a new benefit period begins. You must pay a new deductible for each benefit period before Medicare starts to pay, and there’s no limit to the number of benefit periods you can have in a calendar year. But if you get care in a psychiatric hospital, Part A only pays for up to 190 days of inpatient psychiatric hospital services during your lifetime.

As a hospital inpatient, you pay this for each benefit period in 2026:

• Days 1-60: After you pay the $1,736 deductible, you pay $0 each day.
• Days 61-90: $434 each day.
• Days 91-150: $868 each day while using your 60 lifetime reserve days. These are additional days that Medicare will pay for when you’re in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime.
• After Day 150: All costs.
• 20% of the Medicare-approved amount for mental health services you get from providers while you’re a hospital inpatient.

Note: If you have a Medicare Supplement Insurance (Medigap) policy or other health coverage, tell your provider so your bills get paid correctly.

What isn’t covered?

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

Medicare drug coverage (Part D)

To get Medicare drug coverage (Part D), you must join a Medicare-approved plan that offers drug coverage, like a Medicare drug plan or a Medicare Advantage Plan with drug coverage. These plans are run by private insurance companies that follow rules Medicare sets. Each plan can vary in cost and the specific drugs it covers. It’s important to know your plan’s coverage rules and your rights.

Will my plan cover the drugs I need?

Most plans have a list of drugs that the plan covers, called a formulary. Plans aren’t required to cover all drugs, but they’re required to cover all (with limited exceptions) antidepressant, anticonvulsant, and antipsychotic medications.

Medicare reviews each plan’s formulary to make sure it includes a wide range of drugs and doesn’t discriminate against certain groups (like people with disabilities or mental health conditions).

If you take prescription drugs for a mental health condition, it’s important to find out if a plan covers your drugs before you enroll.

Visit Medicare.gov/plan-compare to find out which plans cover your drugs. Each time you shop for plans, you can enter the prescription drugs you’re currently taking to get a better estimate of your out-of-pocket drug costs in each plan.

Can my drug plan’s formulary change?

Your plan may change its drug list during the year if drug therapies change, new drugs are released, or new medical information becomes available. If a plan adds a new generic in place of a brand name drug, they can:

• Immediately remove the brand name drug from the formulary (in certain cases).
• Change the cost or coverage rules of the brand name drug.

If the formulary status of a drug you’re currently taking changes, your plan will send you information about the specific changes. For other changes that affect a drug you’re currently taking that will affect you during the year, your plan must do one of these:

• Give you notice at least 30 days before the effective date of the change
• Let you know about the change and give you a month’s supply of the drug under the same plan rules as before the change when you ask for a refill.

What if my prescriber thinks I need a drug that my plan doesn’t cover?

If you’re in a plan with Medicare drug coverage, you have the right to ask for a coverage determination (including an exception). You can appoint a representative to help you. Your representative can be a family member, friend, advocate, attorney, financial advisor, doctor, or someone else who will act on your behalf. You, your representative, or your doctor or other prescriber must contact your plan to ask for a coverage determination.

Learn more about Medicare drug coverage (Part D)

To find out more about Part D:

• Visit Medicare.gov//health-drug-plans/part-d.
• Visit Medicare.gov/plan-compare to find and compare plans in your area. Have your Medicare card, a list of your drugs and their dosages, and the name of the pharmacy you use available.
• Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
• Call your State Health Insurance Assistance Program (SHIP) to get free personalized health insurance counseling. Visit shiphelp.org, or call 1-800-MEDICARE to get the phone number.

Source and further reading

Medicare & Your Mental Health Benefits — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.