Does Medicare cover a psychiatrist? What you’ll pay for visits and meds

In this article:

• Does Medicare cover a psychiatrist?
• Costs
• Antidepressant coverage
• Antidepressant cost
• How to save
• Original Medicare vs. Medicare Advantage
• Bottom line
• FAQs

In this article

• Does Medicare cover a psychiatrist?
• Costs
• Antidepressant coverage
• Antidepressant cost
• How to save
• Original Medicare vs. Medicare Advantage
• Bottom line
• FAQs

Twenty-six percent of Medicare beneficiaries have been diagnosed with depression at some time in their lives, according to the Centers for Medicare & Medicaid Services, and that’s just one part of the picture. Mental health treatment also covers conditions like anxiety, bipolar disorder, PTSD, and schizophrenia, so, a significant share of Medicare beneficiaries will need psychiatric care at some point.

You may hear that “Medicare covers it,” but what does that mean? That’s not the same as “Medicare covers all of it,” and it is certainly not reassuring unless you have a better idea of the actual numbers. In this article we will walk through Medicare costs of psychiatrists and antidepressants, and offer tips on how to lower your costs.

Does Medicare cover a psychiatrist?

Yes, Medicare Part B (medical insurance) covers outpatient mental health care, including psychiatric evaluation, psychiatrists, and related mental health professionals. This may include clinical psychologists, social workers, nurse practitioners, physician assistants, and therapists or counselors.

Under Medicare Part B, many preventive services and treatment options are covered. Here are just a few examples:

• Annual depression screenings by a primary care provider in a doctor’s office or clinic
• Yearly wellness visit
• One-time “Welcome to Medicare” preventive visit, which reviews risk factors for depression
• Psychiatric evaluation and other diagnostic tests
• Medication management
• Prescription drugs that may be administered by a healthcare provider, such as certain injections
• Mental health services and medications for substance use disorder
• Psychotherapy with Medicare-enrolled professionals
• Family counseling

If you are admitted to the hospital as an inpatient, your Medicare Part A (hospital insurance) covers mental health services while you are in the hospital, while Medicare Part B covers healthcare provider services.

What you’ll pay for a psychiatrist visit

The 2026 Medicare Part B deductible is around $280, which means that unless you have a supplemental plan, you will pay this amount before coverage kicks in. After meeting the deductible, you pay a coinsurance of 20% of the Medicare-approved amount (the amount that Original Medicare sets for a covered service). When your provider “accepts assignment,” this means they accept the Medicare-approved amount as payment in full for a covered service.

For example, say your psychiatrist’s Medicare-approved amount is $250 for a visit, then you would pay 20% of that amount, or $50, after meeting your  deductible.

If you have Medicare Supplement Insurance (Medigap), your plan may help cover your out-of-pocket costs such as deductibles and coinsurance, depending on the specific plan. If you have a private Medicare Advantage Plan (Part C) instead of original Medicare, your out-of-pocket cost will depend on the plan.

Not all psychiatrists accept Medicare or accept new Medicare patients. To keep your out-of-pocket costs lower, ask for a referral to a psychiatrist who accepts Medicare assignment and is taking new Medicare patients.

Does Medicare cover antidepressants?

Yes, the good news is that antidepressants are one of six protected drug classes under

Medicare Part D. This means that Medicare Part D plans are required to cover most drugs in these classes, although some exclusions may apply and specific costs vary based on the individual plan you are enrolled in. (Besides antidepressants, other protected classes include antipsychotic medications, anticonvulsants, immunosuppressants, antiretrovirals, and antineoplastics.)

Your insurance plan’s formulary (the list of covered drugs and their cost) has detailed information on specific drugs, such as coverage of brand versus generics and which coverage tier each antidepressant falls under. For example, a generic SSRI antidepressant such as fluoxetine may cost much less than a brand-name one (Prozac). Both may be listed on the plan’s formulary, or, if an equivalent generic is available, the brand-name drug may not be covered at all.

What you’ll pay for antidepressants under Medicare

The cost of your antidepressant medication depends on your specific Medicare Part D plan. Each plan has its own formulary, deductible, and cost-sharing requirements to consider.

Each plan sets its own deductible, and some plans do not have a deductible at all. Recent maximum deductibles range from approximately $600 to $700.

As a standard benefit, after reaching the deductible, you pay 25% of the drug cost as coinsurance until you hit the out-of-pocket spending limit. However, different Part D plans may use different cost-sharing structures, so your actual cost for an antidepressant depends largely on your specific plan. Once you reach the maximum out-of-pocket spending, you receive catastrophic coverage, which means that you do not pay anything out-of-pocket for covered Part D drugs for the rest of the calendar year.

To see how this breaks down, let’s take a look at a common antidepressant in both brand and generic. Looking at a plan called Wellcare Value Script (PDP), generic fluoxetine 10 mg and 20 mg capsules are Tier 1 (preferred generic) and the 40 mg capsules are Tier 2 (generic). At a preferred cost-sharing pharmacy, Tier 1 drugs have a $0 copay, but at a standard cost-sharing pharmacy the copay is $15. And Tier 2 drugs have a $3 copay at a preferred cost-sharing pharmacy, but a $20 copay at a standard cost-sharing pharmacy. Brand-name Prozac capsules are not covered at all under this plan. This is just one example, though. Your plan may have different tiers and costs.

How to lower your psychiatrist and antidepressant costs

The best way to lower your psychiatrist costs is to see a provider who accepts Medicare assignment.

To lower your antidepressant costs, there are a few options to explore:

• Choose generic. Ask your healthcare provider to prescribe an antidepressant that is available in generic, when possible. Generic drugs are equal substitutes to their brand-name counterparts and are just as safe and effective, but often cost a fraction of the price.
• Use a preferred pharmacy. Using certain pharmacies with your Medicare plan may save you money. Preferred in-network pharmacies offer lower out-of-pocket costs for members of certain Medicare plans. Check with your plan to see if they have preferred in-network pharmacies.
• Check the SingleCare price. Using a free SingleCare discount can save you up to 80% (or even more) on the cost of your antidepressant. For example, the price for 30, 50 mg tablets of Zoloft is about $593, but if you use a SingleCare discount, you can pay as low as $3 at Walmart for generic sertraline. You can use SingleCare if you have a Medicare prescription plan, but you have to use one or the other, not both together. (And if you use a SingleCare discount, it won’t count toward your Medicare deductible.) Your pharmacy staff can help you compare prices to find which is less expensive.
• Look into Extra Help. Extra Help is a Medicare program available for people with limited income and resources. This extra coverage can help pay for Medicare Part D premiums, deductibles, coinsurance, and other related costs. If you qualify automatically, you will get a notice in the mail, but you can also apply online.

Original Medicare vs. Medicare Advantage: Which pays more for mental health care?

It depends. Medicare Advantage plans cover the same medically necessary services as Original Medicare (Part A and Part B), but there are various Medicare Advantage plans. Each plan may have different out-of-pocket costs and prescription drug coverage details. Whether you pay more or less for a psychiatrist visit or antidepressant depends on your specific plan. Also, if you have a Medicare Advantage plan you will likely need to see a provider within your plan’s network.

Bottom line

If you are concerned about the costs of psychiatric services and antidepressant prescriptions, it’s reassuring to know that Medicare typically provides coverage for both. However, Medicare prescription plans vary, so knowing the deductible, coinsurance, and formulary tier in advance can help keep your costs predictable.

Frequently asked questions

Does Medicare cover inpatient psychiatric care?

Yes, Medicare covers inpatient mental health services. For those staying in a psychiatric hospital (rather than a general hospital), Part A covers up to 190 days of inpatient psychiatric hospital care during your lifetime. This is different from outpatient mental health services, which falls under Medicare Part B.

Does Medicare cover telehealth visits with a psychiatrist?

Yes, Medicare covers psychiatrist telehealth visits. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for your healthcare provider’s services. Medicare says that for most telehealth services, you pay the same amount as you would pay in person.

Does Medicare cover therapy sessions in addition to a psychiatrist?

Yes, Medicare covers therapy sessions under Part B. This includes individual and group psychotherapy as well as family counseling, with a Medicare-enrolled licensed professional such as a clinical social worker, psychologist, mental health counselor, clinical nurse specialist, or therapist. If a provider has opted out of Medicare, you may need to pay the full cost of the session.