Partial hospitalization (PHP), an intensive outpatient program to treat substance misuse or mental health conditions, is covered by Medicare in certain circumstances.

Partial hospitalization is a mental health treatment program that can help you recover without a hospital stay.

This service is an outpatient treatment, so you’ll sleep in your own home every night. During the day, you’ll receive intensive therapy under the care of licensed professionals.

Medicare will provide coverage if you need this level of care, although your costs will vary depending on your Medicare plan and the facility where you receive treatment.

Medicare will cover partial hospitalization as long as it meets specific requirements. To be covered, you’ll need to:

  • receive your care at a Medicare-approved facility
  • receive your care under the supervision of a licensed physician
  • have a doctor certify that standard outpatient therapy wouldn’t be enough to help you avoid being admitted to the hospital
  • have a doctor certify that you’d need inpatient hospital care if you didn’t participate in a partial hospitalization program or if you’ve recently been discharged from an inpatient hospital stay and need additional support

If your partial hospitalization meets these requirements, Medicare will cover it.

Your Medicare coverage will include all the necessary treatments that are part of the program. However, it won’t include extra services like transportation to and from the program.

When you use Medicare Parts A and B, also known as Original Medicare, your coverage will come from Part B.

All Medicare Advantage (Part C) plans are required to cover the same services as Original Medicare, including partial hospitalization.

Any prescriptions administered to you while you’re at the facility of your partial hospitalization program will be covered under Part B or your Medicare Advantage plan.

If you need to take any prescriptions at home, you’ll need a separate prescription drug plan. Many Medicare Advantage plans include prescription drug coverage.

If you’re using Original Medicare, you can add a Part D plan. Part D is stand-alone prescription coverage that covers any prescriptions you must take at home.

A Medicare supplement (Medigap) plan can also help cover some of your treatment. Medigap plans help you cover the out-of-pocket costs of using Original Medicare, such as copayments and deductibles.

The cost of partial hospitalization depends on the type of treatment you need, the facility you use, and more.

Searching the cost at facilities around the country shows that programs can cost from a few hundred up to a few thousand dollars per day without insurance of any kind.

Your Medicare coverage can help significantly reduce those costs. When you use Part B, you’ll first need to meet your yearly deductible, which is $257 in 2025.

Once you meet the deductible, you’ll pay a coinsurance of 20% of the Medicare-approved cost of your treatment, and Medicare will pay the other 80%.

The Medicare-approved amount is a set amount for treatment that a facility has agreed to accept from Medicare as payments. It’s often lower than the price you’d pay without insurance.

A Medigap plan can lower these costs even further. Medigap plans can cover the cost of your coinsurance. You’ll pay an additional monthly premium for a Medigap plan, but you won’t have out-of-pocket costs for your treatment.

Your cost in a Medicare Advantage plan will depend on the plan. Medicare Advantage plans set their own costs, including deductibles and copayment amounts. If you’re not sure, check the details of your plan.

Partial hospitalization can help you recover from substance misuse or mental health conditions. You can get the treatment and support you need to get better without staying overnight in a hospital.

Medicare will pay for this service as long as it meets the criteria. Generally, this means the program needs to be recommended by a doctor and must be from a Medicare-approved facility.

Your costs will depend on your Medicare plan and your treatment.