Paying for Mental Health Care

Does Medigap Pick Up the 20% on Therapy Visits?

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Medigap plans generally cover the Part B coinsurance that Original Medicare leaves on outpatient therapy visits, the roughly 20 percent share you would otherwise owe. This article explains which plans help, the deductible nuance to watch, and the one-time enrollment window that can make joining later much harder.

Last updated: July 2026

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What does Medigap actually pay on a therapy visit?

Medigap is private insurance that pays part of the out-of-pocket costs Original Medicare leaves behind, and it works only alongside Parts A and B 1. On outpatient mental health care, Original Medicare covers most of the approved amount and leaves you a coinsurance share for each visit after the Part B deductible 23. Most standardized Medigap letters pay that Part B coinsurance, which is the piece people mean when they ask about the 20 percent on therapy 1. So for a covered therapy session with a provider who accepts Medicare, a supplement typically zeroes out or sharply reduces what you owe per visit. For the underlying cost math, see how therapy costs work under Medicare.

Do all Medigap plans cover the coinsurance the same way?

The core Part B coinsurance is a benefit every standardized Medigap plan is built around, so on that piece they behave similarly 1. Where they differ is around the edges, such as whether a plan also covers the Part B deductible; some newer plans require you to pay that deductible yourself before coverage kicks in 2. Plans are sold by letter, and the same letter offers the same core benefits from any insurer, so the practical comparison is usually price and the insurer's service, not the coinsurance coverage itself. Reading the standardized benefits chart for the letters sold in your state is the reliable way to confirm what a specific plan pays.

How does the enrollment window change your options?

This is the part that catches people. You get a one-time, six-month Medigap open enrollment period that starts when you are 65 and enrolled in Part B, and during it insurers must sell you a policy without medical underwriting 1. Outside that window, in most states an insurer can review your health and charge more or decline you, which can make joining late harder if therapy or another condition is already part of your history. That is why the supplement question is often best settled early rather than after a coverage gap appears. If you are weighing paths, compare Original Medicare versus Advantage for mental health.

Does Medigap help if your therapist opted out of Medicare?

Not usually, and this is a common surprise. Medigap fills the gaps on care that Original Medicare covers, so it generally does not pay when a clinician has formally opted out of Medicare and sees you under a private contract instead 1. In that case you are typically responsible for the full agreed fee, and neither Medicare nor your supplement pays its share. Knowing whether a provider accepts Medicare, does not accept assignment, or has opted out entirely changes what your supplement can do for you. The distinctions are unpacked in what it means when your therapist opted out of Medicare.

When it helps to talk to someone

If the per-visit coinsurance on therapy is what is straining your budget, a concrete next step is to check which Medigap letters are sold in your state, note whether you are still inside your open enrollment window, and compare prices for the same letter across insurers. Confirming that your therapist accepts Medicare assignment tells you whether a supplement will apply. Gale can help you estimate what a year of therapy would cost with and without a supplement. If cost worry is keeping you from care you need now, the resources below are available immediately, and the general primer on copays and costs for therapy sessions can help you plan.

Common questions

Generally yes. Most standardized Medigap plans pay the Part B coinsurance that Original Medicare leaves on covered outpatient therapy after the Part B deductible, which is the roughly 20 percent share people ask about 12.

The Part B coinsurance is a core benefit of every standardized Medigap plan, so they cover it similarly. Differences are mostly around extras like whether the plan also covers the Part B deductible 12.

You can try, but outside your six-month open enrollment window most states let insurers use medical underwriting, so they may charge more or decline you. Buying during the open window avoids that 1.

Usually not. Medigap fills gaps on care Original Medicare covers, so it generally does not pay for a provider who opted out and bills you under a private contract 1.

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If cost is standing between you and care

  • —Skipping therapy sessions specifically because of the per-visit coinsurance
  • —Thoughts of suicide or of not wanting to be alive
  • —A mental health crisis that cannot wait on a coverage answer

Medigap plan availability, benefits, and underwriting rules are standardized federally but vary by state and change over time; this article describes general patterns, not the terms of a specific policy. This is general information, not insurance or clinical advice. If you are in crisis, call or text 988 (Suicide & Crisis Lifeline), free and available 24/7.

References

  1. 1.Centers for Medicare & Medicaid Services (2024). Learn How Medigap Works. Medicare.gov (CMS). link ✓medigapcoinsuranceopen-enrollment
  2. 2.Centers for Medicare & Medicaid Services (CMS) (2025). Outpatient Mental Health Coverage. Medicare.gov. link ✓outpatient-mental-healthpart-b-deductiblecoinsurance
  3. 3.Centers for Medicare & Medicaid Services (2024). What does Medicare cost?. Medicare.gov (CMS). link ✓cost-structurepart-b

3 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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