Mental Health and Medicare The Vital Connection

Introduction

If you are living with depression, anxiety, grief, or stress related to chronic illness, you are not alone. As our video explains, the number of people facing depression, anxiety, and other psychiatric concerns continues to rise. Many older adults experience added risk due to chronic pain, heart and lung disease, diabetes, mobility problems, and the loss of family or friends. If you have felt isolated or overwhelmed, there are real supports available through Medicare, and you deserve care that meets you where you are

Good news. Medicare covers a wide range of mental health services. You can talk with a therapist, a social worker, or a psychiatrist. You can receive care in person or through tele-health. You can also get help with medications, screening, and intensive treatment when needed. This guide explains what Medicare covers and how an advocate can make the process simpler

Throughout this article you will see links to helpful Understood Care pages. External source links are listed in the References section at the end

What the video highlights and how it connects to you

In the video you heard that rising rates of depression and anxiety affect many people each year. The video also notes that chronic medical problems and chronic pain can raise the risk of depression, and that grief and isolation after the loss of loved ones can deepen anxiety or low mood. Finally, the video emphasizes that therapy by phone or video is widely available and that you can talk with a therapist, social worker, or psychiatrist without having to travel if you prefer

Here is how those points map to practical next steps for you

• Depression and anxiety are common and treatable. Medicare covers evaluation and ongoing care so you can talk with a professional and make a plan
• Chronic conditions and pain can affect mood. You can combine mental health treatment with care for pain and other conditions to improve day to day life
• Grief and isolation deserve attention. Coverage includes counseling that helps you process loss and rebuild routines and support
• Telehealth is here for behavioral health. You may receive mental health care by video and in many cases by phone, which can be especially helpful if travel is difficult

If you want help getting started, an advocate can listen to your story, match you with the right clinician, and coordinate appointments and follow up. Learn more at https://understoodcare.com/advocates and https://understoodcare.com/how-advocates-support

How Medicare covers mental health care

Part A hospital coverage

Part A helps cover mental health care when you are admitted as an inpatient. This can be in a general hospital or in a psychiatric hospital. Part A benefits include your room, meals, nursing care, and necessary services while you are admitted. If you receive care in a freestanding psychiatric hospital, Part A includes a lifetime limit of 190 days. If you are treated in a psychiatric unit within a general hospital, the 190 day limit does not apply

If you need a hospital stay, your care team and advocate can work together so discharge plans include follow up therapy, medication support, and community resources. Learn how we coordinate across providers at https://understoodcare.com/care-types/care-coordination

Part B outpatient coverage

Part B covers most outpatient mental health services. Common examples include

• Individual and group therapy with psychiatrists, psychologists, clinical social workers, and other licensed professionals who are enrolled in Medicare
• Family counseling when the primary goal is to support your treatment
• Evaluation and management visits with a psychiatrist or other clinician for diagnosis and medication management
• Depression screening once every year in a primary care setting that can provide follow up
• Intensive Outpatient Program services when you need a higher level of support without a hospital stay

Starting in 2024, marriage and family therapists and mental health counselors can enroll and bill Medicare. This change increases the number of professionals available to you, especially in communities with fewer psychiatrists. If you are looking for a therapist who accepts Medicare, an advocate can help you search, confirm participation, and set the first appointment. Get step by step help at https://understoodcare.com/healthcare-info/talking-with-your-healthcare-provider

Part D prescription drug coverage

Part D covers medications used to treat many mental health conditions, including antidepressants, antipsychotics, and mood stabilizers. Antidepressants and antipsychotics are part of Medicare’s protected drug classes, which means plans generally must include them on formularies with limited exceptions. Your exact copay depends on your chosen plan

If high copays or prior authorizations are getting in the way, we can help you compare plan options and find lower cost alternatives or assistance programs. See options at https://understoodcare.com/care-types/lower-costs-of-medication and https://understoodcare.com/healthcare-info/disability-benefits-made-simple

Medicare Advantage plans

Medicare Advantage plans must cover the same core mental health benefits as Original Medicare, and many plans offer extra features such as enhanced tele-health networks or case management. You still need to follow plan rules such as using in network clinicians and getting prior authorization when required. If you are unsure which plan gives you the best access to mental health providers, our team can walk you through choices at https://understoodcare.com/pricing

Telehealth for mental health care

You can receive many mental health services through tele-health. For behavioral health, federal policy allows you to receive services from home. Audio and video visits are common, and certain services may be delivered by audio only when clinically appropriate. Rules about in person visits connected to telehealth are changing in late 2025. The bottom line for you right now

• You can get therapy and many psychiatry visits by video or by phone
• Care from home is allowed for behavioral health which makes access easier if transportation is a challenge
• Check with your clinician and your plan since network rules and in person visit timing can vary

If you want to try tele-health but have concerns about technology, an advocate can help you set up your device, test the connection, and prepare your questions so the visit feels smooth. Learn more at https://understoodcare.com/care-types/appointments

How mental and physical health connect as we age

Chronic illness and chronic pain

Chronic pain and long term medical conditions such as heart disease, lung disease, diabetes, stroke, and kidney disease can increase the risk of depression and anxiety. When pain and mood problems occur together, treatment works best when clinicians address both. That may include therapy approaches that teach pain coping skills, gentle movement or physical therapy plans approved by your medical team, and careful use of medications. If you notice that pain control and mood tend to worsen together, tell your clinician. Medicare covers both physical and mental health services and your plan of care can link them

Grief, loneliness, and isolation

The death of loved ones is a painful reality for many older adults. Most people move through grief over time with support from family, friends, faith communities, peer groups, or counseling. If grief feels stuck and does not ease, or if you feel unable to resume daily activities, specialized therapy can help. Isolation can also worsen mood and anxiety. Small steps that rebuild connection are part of treatment, and a care advocate can help arrange safe transportation, social support, and local groups that fit your interests

When to seek help

Reach out if you notice persistent sadness, worry that is hard to control, loss of interest in activities you used to enjoy, changes in sleep or appetite, low energy, trouble concentrating, or thoughts that life is not worth living. Call 988 for the Suicide and Crisis Lifeline in an urgent situation. For ongoing care, ask your primary care clinician for a referral or contact us to connect with a therapist or psychiatrist who takes Medicare

What you can expect to pay

Costs vary by service and plan

• With Original Medicare, many outpatient services are covered by Part B after the Part B deductible. You usually pay 20 percent of the Medicare approved amount if your clinician accepts assignment
• Depression screening once per year in qualified primary care settings is covered with no cost to you if your clinician accepts assignment
• Part D drug costs depend on your specific plan and the medications you take. Many plans offer tiered copays and mail order options
• Medicare Advantage plan costs depend on plan rules such as copays, deductibles, and out of pocket limits. Use your plan’s provider directory and summary of benefits to confirm details

If cost is a barrier, we can help you understand benefits, compare plans during enrollment periods, and look for patient assistance options. Start a conversation at https://understoodcare.com/

Step by step path to care

If you want someone to talk to

• Decide whether you prefer in person or tele-health visits
• Ask your primary care clinician for a referral or search for a therapist or psychiatrist who accepts Medicare
• Prepare for your first visit by listing your main concerns, medications, and goals

If mood and pain are linked

• Tell your clinicians in both areas. Share how your symptoms interact
• Ask about combined approaches such as therapy, safe activity plans, and pain coping skills training
• Review medications regularly to balance benefits and side effects

If grief or isolation is heavy

• Consider individual counseling and a peer support group
• Build small routines that add connection such as weekly calls, a faith or community group, or senior center activities
• Ask your advocate to arrange transportation and reminders so it feels easier to follow through

How Understood Care supports your mental health journey

• Listen first. We listen to your story, your values, and what a better day looks like for you
• Make a simple plan. Together we set clear next steps for evaluation and therapy, and we coordinate with your primary and specialty clinicians
• Handle the legwork. We schedule visits, help with telehealth setup, organize notes and reminders, and follow up after appointments
• Lower barriers. We work on transportation, medication costs, and benefit questions so you can focus on feeling better

Explore more ways we can help at https://understoodcare.com/healthcare-info/why-advocates-matter-for-your-care and https://understoodcare.com/care-types/chronic-care

Frequently asked questions

Can I get therapy by phone or video

Yes. Medicare covers many behavioral health services by telehealth. For some services audio only is allowed when appropriate. Rules about in person visit timing tied to telehealth change in late 2025, so ask your clinician how they handle scheduling

Do I need a referral

Often you can contact a therapist or psychiatrist directly if they accept Medicare. Some clinics or plans may request a referral. If you have a Medicare Advantage plan, network and authorization rules can apply

What if I cannot travel

Telehealth lets you receive care from home. We can also arrange transportation for in person care when needed

Who can provide my therapy

Psychiatrists, psychologists, clinical social workers, psychiatric nurse specialists, and now marriage and family therapists and mental health counselors can provide covered services if they are enrolled in Medicare

The heart of the message

If you have been thinking I just need someone who will listen and offer tools, you are in the right place. Therapy is available, telehealth is widely supported for mental health, and Medicare includes many benefits that you can use now. Reach out to us at any time and we will help you get started on a path that fits your life

References

• Medicare mental health care outpatient coverage
  https://www.medicare.gov/coverage/mental-health-care-outpatient Medicare
• Medicare depression screening coverage
  https://www.medicare.gov/coverage/depression-screening Medicare
• Medicare mental health care inpatient coverage
  https://www.medicare.gov/coverage/mental-health-care-inpatient Medicare
• Medicare inpatient hospital care page with psychiatric hospital limit
  https://www.medicare.gov/coverage/inpatient-hospital-care Medicare
• Medicare intensive outpatient program services
  https://www.medicare.gov/coverage/mental-health-care-intensive-outpatient-program-services Medicare
• Medicare telehealth coverage overview
  https://www.medicare.gov/coverage/telehealth Medicare
• HHS telehealth policy updates for Medicare behavioral health
  https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates telehealth.hhs.gov+2telehealth.hhs.gov+2
• CMS Telehealth FAQ for Calendar Year 2025 including in person visit timing
  https://www.cms.gov/files/document/telehealth-faq-04-09-25.pdf Centers for Medicare & Medicaid Services
• CMS Medicare and Your Mental Health Benefits booklet 2025
  https://www.medicare.gov/publications/10184-medicare-and-your-mental-health-benefits.pdf Medicare+1
• CMS Medicare and Mental Health Coverage MLN booklet 2025
  https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf Centers for Medicare & Medicaid Services+1
• CMS page on marriage and family therapists and mental health counselors as Medicare providers
  https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/marriage-and-family-therapists-mental-health-counselors Centers for Medicare & Medicaid Services
• CMS FAQ on MFT and MHC enrollment
  https://www.cms.gov/files/document/marriage-and-family-therapists-and-mental-health-counselors-faq.pdf Centers for Medicare & Medicaid Services
• CMS fact sheet on Part D protected classes
  https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-part-d-drug-pricing-final-rule-cms-4180-f Centers for Medicare & Medicaid Services
• NIMH chronic illness and mental health
  https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health National Institute of Mental Health
• NIMH older adults and mental health
  https://www.nimh.nih.gov/health/topics/older-adults-and-mental-health National Institute of Mental Health
• Mayo Clinic page on complicated grief
  https://www.mayoclinic.org/diseases-conditions/complicated-grief/symptoms-causes/syc-20360374 Mayo Clinic
• Cleveland Clinic overview of anxiety disorders
  https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders Cleveland Clinic
• Peer reviewed review on comorbid chronic pain and depression
  https://pmc.ncbi.nlm.nih.gov/articles/PMC8072020 PMC
• Recent evidence on poor pain control and depression risk
  https://pmc.ncbi.nlm.nih.gov/articles/PMC11747233 PMC
• NCBI Bookshelf overview of chronic pain and suicide risk
  https://www.ncbi.nlm.nih.gov/books/NBK553030 NCBI

This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.