Medicare 2026

Medicare and Mental Health Care: What's Covered

Mental health care is health care, and Medicare treats it that way. Whether you're looking for a therapist, considering a psychiatric evaluation, or supporting a loved one who may need a hospital stay, it helps to know how the pieces of Medicare fit together before you need them. This explainer walks through what's covered under Original Medicare, how Medicare Advantage fits in, what prescription drug coverage adds, and how a few recent changes have widened access.

Outpatient care: what Part B covers

Part B is the outpatient side of Medicare, and it is where most mental health care happens. It covers individual and group therapy, psychiatric evaluations, medication management visits with a psychiatrist, diagnostic testing, and partial hospitalization programs when a doctor certifies they're needed instead of inpatient care. Part B also covers one depression screening per year in a primary care setting at no cost to you when the provider accepts assignment, along with an alcohol misuse screening and brief counseling sessions when appropriate.

A significant expansion took effect on January 1, 2024: Medicare now covers services from licensed marriage and family therapists (LMFTs) and mental health counselors (MHCs), in addition to the psychiatrists, psychologists, clinical social workers, and nurse practitioners it already covered. That change meaningfully widened the pool of providers who can bill Medicare directly, which matters in communities where certain specialties are in short supply.

For outpatient services, you generally pay the Part B deductible and then coinsurance for each covered visit. The 2027 Part B standard premium and deductible had not been announced at the time this was written; CMS typically announces them in the fall. Check Medicare.gov for the current figures.

Inpatient care: what Part A covers

Part A is the hospital side of Medicare. It covers inpatient mental health care the same way it covers other hospital stays, including a semi-private room, meals, nursing, medications given during the stay, and other hospital services and supplies. This applies whether you're admitted to the psychiatric unit of a general hospital or to a freestanding psychiatric hospital.

One rule is specific to mental health: care in a freestanding psychiatric hospital is limited to 190 days in your lifetime. That cap does not apply to psychiatric care delivered in a general hospital. If a long or repeated stay is a possibility, this is worth knowing well in advance, because once those 190 days are used, they're gone.

Prescription drugs: Part D

Many mental health treatment plans include medication, and most outpatient prescriptions are covered under Part D (either a stand-alone drug plan paired with Original Medicare or the drug coverage built into most Medicare Advantage plans). Each plan has its own formulary, so the specific medications covered — and what you pay — vary.

A few national Part D figures for 2027 are worth knowing:

• The annual out-of-pocket cap is $2,400 (up from $2,100 in 2026). Once your out-of-pocket spending on covered drugs reaches that amount, you pay $0 for covered drugs for the rest of the year.
• The most any plan may charge as a deductible is $700, though many plans set theirs lower.
• The base beneficiary premium is $41.33. This is a national figure used to calculate the late-enrollment penalty; the premium your plan actually charges is set plan by plan.

If you take a brand-name medication regularly, the out-of-pocket cap can make a real difference in a year's budget.

Medicare Advantage vs. Original Medicare + Medigap

Medicare Advantage plans are required to cover the same mental health services as Original Medicare, but they may use their own provider networks and set their own cost-sharing and prior-authorization rules. That's a genuine trade-off, not a verdict.

With Original Medicare, you can see any provider in the country who accepts Medicare, and a Medigap policy can help with out-of-pocket costs. You'd typically add a stand-alone Part D plan for drugs. With Medicare Advantage, drug coverage and extras are often bundled and out-of-pocket costs are capped annually, but your choice of therapist or psychiatrist may be limited to the plan's network. Which fits you depends on your providers, your medications, your budget, and how much flexibility you want. Neither is "better" — they're different structures.

Enrollment windows and a note for people with Medicaid or Extra Help

The Annual Enrollment Period runs October 15 – December 7, 2026, with changes taking effect January 1, 2027. This is when most people review drug plans and compare Medicare Advantage options.

Since 2025, people with Medicaid or Extra Help have a monthly Special Enrollment Period they can use to switch to Original Medicare paired with a stand-alone Part D plan, or to change stand-alone Part D plans. Full-benefit dual-eligible individuals can also join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month. This gives people with limited incomes more flexibility to adjust coverage when a provider leaves a network or a medication is no longer covered.

One more thing worth noting

The Social Security Administration announced a 3.6 percent cost-of-living adjustment on October 14, 2026, for benefits payable beginning January 2027. The 2027 Part B premium and deductible, along with IRMAA income-related surcharges, had not been announced as of this writing; CMS publishes those figures in the fall.

Where to go next

For current premiums, to compare plans in your area, or to confirm whether a specific provider or medication is covered, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, available 24 hours a day, seven days a week.