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7 things to know about working with Medicare patients in mental health

Learn more about Medicare and the patient population with this type of insurance.

December 9, 2024 • Updated on August 29, 2025

8 min read

Specifying the types of clients you most want to work with can help you better serve patients as you build your private practice. By now, you’ve likely begun carving out a niche as a therapist, so the idea of adding different types of clients — such as people insured by Medicare — might feel a bit intimidating. 

No matter how you spin it, deciding whether to accept a new form of insurance or adding a type of client to your roster can be a difficult choice. Learning more about Medicare and the patient population with this type of insurance on the front end can help you decide whether it could be a fit for your practice — and take the steps required to ensure you provide the best possible care in therapy.

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There are over 67 million Medicare patients.

As of May 2024, more than 67 million Americans were enrolled in Medicare — that’s roughly 20% of the U.S. population. To qualify for Medicare, a person must be either over 65 years old or have a disabling condition, such as end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). Some Medicare patients are beneficiaries of deceased parents. It’s also possible for Medicare patients to have multiple insurance carriers. A process called coordination of benefits determines which insurance pays first, up to a certain limit, before the other insurance kicks in. 

No matter a Medicare patient’s age or insurance situation, comorbid medical conditions are common in this patient population (more on that below). As for mental health diagnoses, about one in four Medicare beneficiaries live with mental illness, which means psychotherapy is often just as important as reliable medical care.

Psychoeducation is vital.

Given their health status, adults aged 50 or older are very likely to interact with the healthcare system in some way — but they’re the least likely to access mental health care, says Innocent Turner, a LCSW in Delaware. “For older adults, the idea of therapy is often not something that’s normalized,” she says. If you’re beginning to see a Medicare client, keep in mind you may need to spend more time providing psychoeducation about mental health in general.

It might also be beneficial to carve out a session or two to explain the client’s diagnosis and intervention — for example, how depression can affect their mental and physical well-being, and why you’re choosing to use cognitive behavioral therapy to treat it.

More than 1/4 of adults 65 and older are considered socially isolated.

Medicare clients are likely to be affected by social isolation or loneliness. “These clients may be lonely in the sense they’re the only person in their house who doesn’t work, or they’re the oldest person in their family and everyone has their own life,” says Turner. As you create your treatment plan, and as therapy progresses, consider conducting a social isolation assessment with your Medicare clients.

You may need to update some practices for better inclusion.

With Medicare patients who may be older or have a physical disability, it’s important to consider mobility, vision and/or hearing loss as well as social differences, such as socio-economic status  and difference in access to technology. These are crucial factors to understand, as they may have a direct impact on how you manage your administrative tasks. For example, with an older client, you may need to mail paperwork rather than expecting them to complete forms online. 

Your office is likely already handicap accessible, but you should also take extra steps to make sure it’s safe for your Medicare clients. “Make sure there are no trip hazards outside the practice, ensure wheelchair accessibility, always tack down rugs in the office and waiting room, and make sure your stairs are cleared of any debris,” says Kimberly Parker, a private practice therapist who accepts Medicare.

There may be medical comorbidities at play.

By nature, Medicare clients will probably have more comorbid medical conditions your younger clients don’t. It’s important to keep these conditions in mind during your initial assessment and treatment. 

“We don’t often ask about medical diagnoses in talk therapy, but physical health goes hand in hand with mental health,” says Turner. “You may not be able to assess for or advise on these things, but you can allow space for how it impacts their mental health.”

Keep in mind, too, that Medicare clients may have different needs due to their health conditions, which makes it even more important to be accommodating. For example, Parker explains, they may not be able to drive and may use Medicare transportation for appointments — so you may need to adjust appointment times or be more flexible with cancellation policies with these patients. 

Some treatment modalities are excluded.

As of January 1, 2024, thousands of additional licensed therapists became eligible to see Medicare clients when marriage and family therapists (MFT) and mental health counselors (MHC) were added to the list of therapists who can provide care to Medicare clients. Still, you may need to make special considerations when developing your treatment plan for these patients. Certain treatment modalities can’t be billed to Medicare, including: 

  • Biofeedback training (regardless of modality)
  • Marriage counseling 
  • Pastoral counseling 
  • Any modality considered experimental, such as art therapy, dance therapy, or equestrian therapy 

Best practices for treatment include checking local Medicare guidelines in your area to ensure coverage, and documenting medical necessity (thus demonstrating a tie from the treatment plan to a recognized mental health condition, as well as progress in treatment).

Any diagnosis can be billed to Medicare.

No matter the diagnosis you determine when treating a Medicare client, you can bill the payer, as long as you utilize accepted treatment modalities. Given the social complexities often involved in treating Medicare clients, you may use Z codes in addition to primary diagnosis codes. Also called Social Determinants of Health Codes, Z codes highlight social determinants of health like problems related to education or literacy, economic circumstances, or negative life events in childhood. In other words, Z codes indicate situations that are not due to a mental health diagnosis, but may affect mental health.

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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.

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