Q: Does Medicare cover therapy?

A: Yes. Part B covers outpatient therapy, and you pay 20% of the Medicare-approved amount after the annual Part B deductible, which is $283 in 2026.¹ If someone told you Medicare only covers half of mental health care, they are quoting a rule that finished phasing out in 2014 — mental health coinsurance has been the same 20% as everything else in Part B for over a decade.² A Medigap supplement usually covers that 20%.

The change most people have not heard. Since 1 January 2024, marriage and family therapists and mental health counselors — which includes California's LPCCs — can enrol in Medicare and bill it directly, alongside psychologists and clinical social workers.³ That roughly doubled the kinds of California therapist a Medicare patient can see. If a therapist told you "I can't take Medicare" before 2024, ask again.

Two things inside that change. Medicare pays those newer provider types 75% of what it allows a clinical psychologist for the same service⁴ — which slightly lowers your 20%, and is part of why some therapists still have not enrolled. And the benefit requires a full state licence: a California registered associate (AMFT, ASW, APCC) cannot bill Medicare, supervised or not.⁵

Telehealth, with the dates. For mental health, the geographic and site restrictions are gone permanently — your home counts, anywhere in California — and audio-only is allowed where you cannot use or do not consent to video.⁶ From 1 January 2028, a mental health telehealth service will require an in-person visit with that clinician in the preceding six months, and periodically after; Congress has moved that date four times, most recently in February 2026.⁶

Worked example: Medicare approves $100 for the session. You have met the deductible, so you owe $20 — or $0 with most Medigap plans, and $0 with no bill permitted at all if you are a Qualified Medicare Beneficiary on both Medicare and Medi-Cal.⁷

Do this: ask any prospective therapist two questions, because they are different — "Are you enrolled in Medicare?" and "Are you accepting new Medicare patients?" Start from Medicare's own Care Compare rather than a plan directory. The full Medicare walkthrough, with the Advantage traps →

Sources

  1. CMS, "2026 Medicare Parts A & B Premiums and Deductibles," 14 November 2025 — standard Part B premium $202.90, annual deductible $283 — cms.gov; confirmed at 90 Fed. Reg. 52063 (19 November 2025). Coinsurance: Medicare.gov, outpatient mental health care — "After you meet the Part B deductible, you pay 20% of the Medicare-approved amount" — medicare.gov.
  2. 42 U.S.C. §1395l(c)(1) — the outpatient mental health treatment limitation, phased out on a schedule ending at subparagraph (E), "for expenses incurred in 2014 or any subsequent calendar year, 100 percent of such expenses." The old 62.5% expense recognition is what produced the roughly 50% effective coinsurance people remember, and it applied to years before 2010.
  3. Consolidated Appropriations Act, 2023, Pub. L. 117-328, div. FF, tit. IV, §4121, adding 42 U.S.C. §1395x(s)(2)(II) and §1395x(lll); §4121(c) applies it to services furnished on or after 1 January 2024. The statutory definition of "mental health counselor" expressly covers an individual licensed as "a mental health counselor, clinical professional counselor, or professional counselor."
  4. 42 U.S.C. §1395l(a)(1)(FF) — payment is 80% of the lesser of the actual charge or "75 percent of the amount determined for payment of a psychologist."
  5. 42 U.S.C. §1395x(lll)(2)(B) and (4)(B) require the individual to be "licensed or certified … by the State"; 42 C.F.R. §§410.53 and 410.54 add at least two years or 3,000 hours of post-degree supervised clinical experience and contain express prohibited-billing provisions. California's AMFT, ASW and APCC are pre-licensure registrations, so they do not meet the licence condition.
  6. 42 U.S.C. §1395m(m)(7)(A) (permanent removal of geographic requirements for mental health telehealth, from Pub. L. 116-260 §123); §1395m(m)(7)(B)(i) (in-person condition for services furnished "on or after January 1, 2028," date last amended by Pub. L. 119-75, 3 February 2026); §1395m(m)(9) and 42 C.F.R. §410.78(a)(3) (audio-only, and the general any-location originating-site rule, through 31 December 2027) — uscode.house.gov. Do not rely on 42 C.F.R. §410.78's own dates: the regulation still carries superseded 2024–2025 text.
  7. 42 U.S.C. §1396a(n)(3) — for a Qualified Medicare Beneficiary the Medicare payment is "payment in full" and "the beneficiary shall not have any legal liability to make payment to a provider." Other dual-eligible statuses do not carry that protection.

All figures and dates checked 17 August 2026.

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