Medicare and Mental Health Counseling in Washington State
A Warm, Simple Guide for Clients
If you’re here, you might be wondering:
Does Medicare cover therapy?
Can I use my benefits with a counselor in Washington?
What will it cost me?
Let’s walk through this together in a clear, calm way. 💛
Yes, Medicare Covers Therapy
If you have Medicare Part B, outpatient mental health counseling is typically covered when it is medically necessary and provided by a Medicare-approved clinician.
That includes:
Individual therapy
Group therapy
Mental health assessments
Treatment for depression, anxiety, trauma, grief, and more
Medicare’s outpatient mental health coverage details are explained here:
👉 https://www.medicare.gov/coverage/mental-health-care-outpatient
You deserve support, and Medicare recognizes mental health as healthcare.
What This Means in Washington State
Medicare is a federal program, so coverage rules are mostly the same nationwide. In Washington State, licensed mental health professionals (like Licensed Mental Health Counselors and Marriage & Family Therapists) are recognized under state law to provide therapy.
Good news:
As of January 1, 2024, Medicare began allowing licensed mental health counselors (LMHCs) and licensed marriage & family therapists (LMFTs) to enroll and bill Medicare directly.
CMS (Centers for Medicare & Medicaid Services) confirms this update here:
👉 https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/marriage-and-family-therapists-mental-health-counselors
If you were ever told “Medicare doesn’t cover counselors,” that information may be outdated.
How Much Will It Cost?
For Original Medicare (Part A + Part B):
You pay your annual Part B deductible first.
After that, Medicare typically covers 80% of the approved amount.
You usually pay 20% coinsurance.
Medicare’s cost structure is explained here:
👉 https://www.medicare.gov/basics/costs/medicare-costs
If you have a supplement plan (Medigap), it may cover some or all of that 20%.
If you have a Medicare Advantage (Part C) plan, costs depend on your specific plan. These plans often:
Have provider networks
Require copays instead of coinsurance
May require prior authorization
If you’re unsure, your plan’s member services line can clarify your therapy benefits quickly.
What About Telehealth?
Many Washington clients prefer virtual therapy, especially during busy seasons of life.
Medicare does allow telehealth mental health services, including sessions from your home. However, there may be requirements about occasional in-person visits depending on current federal policy.
CMS telehealth guidance is available here:
👉 https://www.cms.gov/files/document/telehealth-faq-updated-02-04-2026.pdf
Because telehealth rules can change, your therapist can help you understand what applies to you.
How to Find a Medicare-Approved Therapist in Washington
Here’s a simple checklist:
1️⃣ Confirm which type of Medicare you have
Original Medicare
Medicare Advantage
2️⃣ Ask the therapist:
“Are you enrolled in Medicare?”
“Do you accept assignment?” (for Original Medicare)
“Do you take my specific Advantage plan?”
3️⃣ You can also search Medicare’s official provider directory here:
👉 https://www.medicare.gov/care-compare/
A Gentle Reminder
Starting therapy can feel vulnerable enough. Insurance questions shouldn’t add to that stress.
If something feels confusing:
Ask your therapist’s office for help.
Call your Medicare plan directly.
Request clarification in writing if needed.
You are allowed to ask questions.
You are allowed to understand your benefits.
You are allowed to receive care.
Frequently Asked Questions
Does Medicare cover therapy for anxiety, depression, or trauma?
Yes, when it is medically necessary and provided by a Medicare-enrolled clinician.
Can I use Medicare for couples therapy?
Medicare typically covers services tied to a diagnosable mental health condition for an identified client. If you’re interested in couples work, ask your provider how it would be billed.
What if my claim gets denied?
Denials often relate to provider enrollment or plan network issues, not because therapy isn’t important. You can request an explanation and appeal if needed.
You Deserve Support
Mental health care isn’t a luxury. It’s healthcare.
If you’re in Washington State and considering counseling, Medicare likely provides a path forward. And if you ever feel unsure, a good provider will help you navigate it with clarity and compassion.
APA References
Centers for Medicare & Medicaid Services. (2026). 2026 Medicare Parts B premiums and deductibles. https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
Centers for Medicare & Medicaid Services. (2026). Marriage and family therapists and mental health counselors. https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/marriage-and-family-therapists-mental-health-counselors
Centers for Medicare & Medicaid Services. (2026). Telehealth frequently asked questions. https://www.cms.gov/files/document/telehealth-faq-updated-02-04-2026.pdf
Medicare.gov. (n.d.). Mental health care (outpatient). U.S. Department of Health & Human Services. https://www.medicare.gov/coverage/mental-health-care-outpatient
Medicare.gov. (n.d.). Medicare costs. U.S. Department of Health & Human Services. https://www.medicare.gov/basics/costs/medicare-costs
Medicare.gov. (n.d.). Care Compare. U.S. Department of Health & Human Services. https://www.medicare.gov/care-compare/
Washington State Legislature. (n.d.). RCW 18.225.010: Definitions (Licensed mental health counselors). https://app.leg.wa.gov/rcw/default.aspx?cite=18.225.010
Washington Administrative Code. (n.d.). WAC 246-809-010: Definitions. https://www.law.cornell.edu/regulations/washington/WAC-246-809-010