Medicare 2026

Seeing a Counselor or Family Therapist With Medicare: Who Can Bill and What You Pay

If you've been looking for a therapist and you have Medicare, there's good news that still surprises many people: since January 1, 2024, marriage and family therapists (MFTs) and mental health counselors (MHCs) can enroll in Medicare and bill Part B directly. That change, made by the Consolidated Appropriations Act, 2023, meaningfully widened the pool of outpatient mental health professionals you can see. Here's how it works, what you can expect to pay, and what to confirm before your first appointment.

Who can bill Medicare for mental health care

Medicare recognizes a broad list of outpatient mental health providers: psychiatrists and other doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, marriage and family therapists, and mental health counselors. The 2024 addition of MFTs and MHCs is especially helpful because those professions make up a large share of therapists in community practice.

To enroll in Medicare and bill Part B, an MFT or MHC must:

• Hold a master's or doctoral degree that qualifies for state licensure in their field,
• Be licensed or certified in the state where services are delivered, and
• Have at least 2 years or 3,000 hours of post-master's supervised clinical experience.

Addiction counselors and alcohol and drug counselors who meet the mental health counselor requirements can enroll in Medicare as mental health counselors. That matters if you're seeking support for substance use alongside, or instead of, traditional talk therapy.

One important limit: MFTs and MHCs cannot bill Medicare Part B under this benefit for services provided to an inpatient of a Medicare-participating hospital. Their Medicare billing authority is for outpatient care.

What you'll pay under Part B

Outpatient mental health visits fall under Medicare Part B. After you meet the annual Part B deductible, you typically pay 20% of the Medicare-approved amount for visits to diagnose or treat a mental health condition. If the visit happens in a hospital outpatient clinic, you may owe an additional copayment or coinsurance to the hospital.

For 2026, the Part B deductible is $283. The 2027 Part B standard premium and deductible, along with the IRMAA income-related surcharges, have not yet been announced; CMS publishes those figures in the fall, usually in November. Check Medicare.gov once they're released.

One preventive service is worth knowing about: the yearly depression screening in a primary care setting costs you nothing if the provider accepts assignment. That's a simple, no-cost starting point if you're not sure whether to pursue further care.

Because MFTs and MHCs who bill Medicare must accept assignment, they agree to accept Medicare's approved amount as full payment. You won't be billed extra above the standard Part B coinsurance (aside from the hospital outpatient cost-sharing noted above).

Telehealth: covered in your home

Telehealth has become a mainstay of mental health care, and Medicare has locked in important protections. Mental and behavioral health telehealth is permanently covered in the patient's home. Separately, under the Consolidated Appropriations Act, 2026 (Public Law 119-75), Medicare's in-person visit requirement for mental health services furnished through telehealth does not apply to services furnished before January 1, 2028. In practical terms, you can start and continue therapy by video or, where allowed, audio-only, without being required to come in for a face-to-face visit in that window. Ask your provider which telehealth formats they offer.

Original Medicare vs. Medicare Advantage: a neutral look

Mental health coverage exists whether you have Original Medicare (Parts A and B, often paired with a Medigap policy and a stand-alone Part D plan) or a Medicare Advantage plan (Part C, which bundles Part A, Part B, and usually Part D).

With Original Medicare, you can generally see any provider in the U.S. who accepts Medicare, and Medigap can help with the 20% coinsurance and deductible. Trade-off: you pay a separate Medigap premium, and Medigap doesn't cover drugs.

With Medicare Advantage, your out-of-pocket costs for medical care are capped each year, and extra benefits may be included. Trade-off: you typically use a plan network, may need referrals or prior authorization for certain services, and your choice of therapists can be narrower.

Neither option is "better." The right fit depends on your providers, your budget, and how you like to navigate care. Compare specifics on Medicare.gov before you decide.

When you can enroll or switch

Annual Enrollment runs October 15 – December 7, 2026, with choices taking effect January 1, 2027. If you have Medicaid or Extra Help, you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan (or to switch stand-alone Part D plans). Full-benefit dual-eligible people can also join an integrated D-SNP in any month.

A few other program figures to keep in mind as you plan: the Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027; the maximum Part D deductible any plan may charge in 2027 is $700; and the Part D base beneficiary premium for 2027 is $41.33, which is used in calculating the late-enrollment penalty (plan premiums themselves are set plan by plan). The Social Security Administration announced a 3.6% cost-of-living adjustment for benefits payable beginning January 2027.

Finding a therapist and confirming coverage

Before your first session, ask the provider:

• Are you enrolled in Medicare and will you bill Medicare directly?
• Do you accept assignment? (MFTs and MHCs billing Medicare must.)
• Is the visit in an office or hospital outpatient clinic?
• If I have Medicare Advantage, are you in my plan's network?

For official, up-to-date information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227); TTY users can call 1-877-486-2048. This article is educational and is not affiliated with any government agency.