With therapy serving as an effective treatment option for an estimated 80% of people, you may be looking to visit a therapist or psychiatrist yourself. But seeing as therapy usually entails seeing a qualified medical professional on a weekly, biweekly, or monthly basis, you may also be hesitant to commit due to the potential costs associated with it.
Does health insurance cover therapy? And if yes, how much should you expect to pay for each session? This page answers those two key questions and others to help you understand if therapy is a financially viable treatment option for you in particular.
When selecting an insurance company to get your health insurance plan from, be sure to pick one that provides an easy, transparent, and digital-first approach to accessing and managing the details of your plan. That way, you’ll know exactly what you’re covered for at a glance, without needing to spend time navigating the fine print.
Find in this article:
- Do Insurance Companies Need to Cover Therapy?
- What Kinds of Treatments Are Typically Covered?
- What Kind of Insurance Plan Do You Have?
- What if I Can’t Afford My Deductible?
- How Do I Find the Right Therapist?
- Does Insurance Cover Online Therapy?
- Does Public Health Insurance Cover Therapy?
- How Does My Therapist Bill My Health Insurance?
- When Is the Soonest I Can See a Therapist?
- Does Insurance Cover Couples’ Counseling?
Do Insurance Companies Need to Cover Therapy?
Are insurance companies required to cover therapy? The answer is almost always yes.
The Affordable Care Act (ACA) built on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to put requirements on what Marketplace plans must provide coverage for. The Marketplace is a health insurance shopping and enrollment service managed by the federal government at healthcare.gov.
In summary, all Marketplace plans must provide coverage for 10 essential health benefits. Mental health is one of these health benefits, and therapy is a very common treatment option for mental health problems.
Therefore, at a minimum, plans purchased from the Marketplace, which include Individual, Family, and some small business health insurance plans, are required to offer coverage for therapy if you receive an official medical diagnosis for your problem, and the diagnosis you receive is for a disease or condition that falls under the umbrella of mental health.
Due to the popularity of therapy as a treatment option, many plans outside the Marketplace, such as employer-sponsored plans, will offer coverage for therapy either with or without an official medical diagnosis.
If you’re covered by your health insurance company for therapy, you will likely be responsible only for a copay, which usually costs between $10 and $30. You will need to settle this copay every time you see your therapist or psychiatrist for an appointment. Without coverage, an appointment can cost between $70 and $250, depending primarily on the length of the session and the cost of living in your area.
What Kinds of Treatments Are Typically Covered?
Mental health is a broad subject, and it may not be immediately apparent what type of mental health disease or ailment an individual suffers from when they first describe their symptoms. Therefore, many types of mental health problems are usually covered by health insurance plans.
Some of the commonly covered mental health problems include depression and anxiety, but you can also usually receive coverage for therapy if you suffer from phobias, a lack of sleep, or other mental health problems.
What Kind of Insurance Plan Do You Have?
Even if therapy is covered by your health insurance plan in general, there may be restrictions regarding which therapists you can visit if you want to receive coverage.
Some types of health insurance plans, such as Health Maintenance Organizations (HMOs), give you a list of therapists to choose from. If you don’t see one of these “in-network” therapists, you receive no coverage.
Other types of plans may provide partial coverage if you go outside of the approved network of therapists. And, some plans may provide full or partial coverage for out-of-network therapists, but only if you get a referral from your primary care physician before you book the appointment.
What if I Can’t Afford My Deductible?
When discussing whether or not insurance covers therapy, it’s important to keep in mind a key element of any health insurance policy: your deductible.
Your deductible is a fixed amount you need to pay all by yourself before your insurance coverage starts to kick in. If you haven’t yet met your deductible for this year, you won’t receive assistance from your insurance company. Instead of just paying the copay, you’ll have to pay for the full cost of the session.
If you can’t afford your deductible and therefore can’t afford therapy, consider purchasing gap health insurance for next year or searching for a therapist who is willing to work with you on payments.
How Do I Find the Right Therapist?
The “right” therapist is one whom you trust and who is effective in treating your mental health problems. However, the right therapist is also one whom you can afford.
To make therapy affordable, you will sometimes need to find an in-network therapist. The most effective way to find in-network therapists is by asking your insurance company for a list of in-network therapists directly.
If you don’t have coverage and you’re looking for a therapist who can work with you on costs, use a therapist search engine like the one from Psychology Today and look for therapists who offer sliding scale payments. With a sliding scale payment structure, the therapist charges you based on your income, instead of a flat fee or hourly rate regardless of your income.
Does Insurance Cover Online Therapy?
Online therapy is an attractive alternative for individuals who prefer to conduct psychotherapy sessions from the comfort of their own homes, or for individuals who are limited in the therapists they can access in-person due to a rural location or other factors.
Some insurance plans cover online therapy sessions in the same way they do in-person sessions, but others don’t. Ask your insurance company directly to receive clarification.
Does Public Health Insurance Cover Therapy?
Public health insurance refers to insurance plans that are subsidized by the federal government. The three most common types of public health insurance plans are CHIP, Medicaid, and Medicare.
Children’s Health Insurance Program (CHIP)
CHIP offers discounted health insurance plans to children in families that earn too much to qualify for Medicaid, but too little to afford traditional private healthcare.
Virtually all mental health services are covered under CHIP, including therapy.
Medicaid plans are run by the state, which means they differ by state. However, Medicaid plans are subject to MHPAEA requirements, which means substance use services and mental health services such as therapy are likely covered. As with private health insurance plans, you may need an official medical diagnosis to be covered for therapy under Medicaid.
Medicare part B is similar to a traditional private health insurance plan and will cover some mental health services, such as yearly depression screenings. However, to get coverage for regular visits to your therapist, you may be required to have met your deductible and take care of a copay.
How Does My Therapist Bill My Health Insurance?
Although it varies based on location and plan, the differences between how your therapist bills you and/or your health insurance company depends on whether you are using a therapist within your approved medical provider network.
If your therapist is within your plan’s approved medical provider network, you will usually pay the copay to the therapist when you go in for your appointment, then the rest of the bill will be handled between the therapist and your insurance company, without any extra work from you.
If your therapist is not within your plan’s approved medical provider network, or you do not have an approved medical provider network for your plan (such as if you have a Health Savings Account, a popular type of small business health insurance plan), you will receive the bill yourself. From there, you will need to contact your insurance company, either to have them pay the bill, or to receive reimbursement after you have paid the bill.
As you can imagine, it’s important to verify beforehand that you’re covered for out-of-network therapy services. The last thing you want is to be holding the full bill from an out-of-network therapist and learn that your insurance company isn’t going to help out with it.
When Is the Soonest I Can See a Therapist?
Depending on the status of your mental health, you might want to see a therapist as soon as possible. There are a few different options available to you, with varying costs and wait times.
How Long Does It Take to See a Therapist Online?
The fastest way to see a therapist is by booking an appointment online. Certain apps like Talkspace, along with online therapist search engines, give you instant access to thousands of qualified and licensed therapists.
A good thing about seeing a therapist online is, as covered, the speed in which you can book an appointment. You can schedule one for tomorrow, or even later today. And if you find a therapist you like, remote appointments are a breeze to schedule and find time for in the future.
That being said, a purely remote therapy experience does lack true face-to-face interaction, which some may find important. If you’d prefer to find a local therapist quickly, you still have options.
How Long Does It Take to Get an Appointment With a Local Therapist?
It could be this week, or it could be weeks or months in the future. In general, rural communities are more likely to be underserved by therapists, leading to longer wait times. Individuals living in major cities may experience shorter wait times.
If you have a long wait to see a local therapist but you need help now, one option is using an online therapist as a temporary solution until you begin your scheduled sessions with your local therapist.
Where Can I Go to See a Therapist for Free Without Insurance?
Especially if you’re in a major city, you may be able to find mental health clinics near you that can provide some sort of free mental health care. SAMSA from the U.S. Department of Health & Human Services is a free online resource that you can use to locate and access mental health resources in your area.
Do I Need to Wait to Buy Insurance?
Unfortunately, it’s not always possible to buy insurance, then go start seeing a therapist immediately and have your insurance company take care of the bill.
For one thing, you usually need to cover your deductible before your health insurance kicks in. And, new Marketplace plans can only be purchased during the Open Enrollment Period, unless you have a qualifying life event that lets you enroll during a Special Enrollment Period.
The exception is if you are starting a new job. In that case, some companies will allow you to start receiving coverage immediately, though they technically have up to 90 days before they need to extend the option for you to buy insurance through the group health insurance plan.
Does Insurance Cover Couples’ Counseling?
As stated above, the ACA and MHPAEA require Marketplace health insurance plans to provide coverage for mental health services such as therapy.
Couples’ counseling is a form of group therapy, which leads some to think it’s covered under the ACA and MHPAEA. However, couples’ counseling is almost never covered by barebones plans that aim to be affordable rather than comprehensive.
Despite the fact that couples’ counseling isn’t covered in many health insurance plans, some plans, particularly workplace-sponsored plans, do cover couples’ counseling.
As with many healthcare services, it makes sense to ask your health insurance company directly whether or not you’re covered, as they’ll be able to give you a completely accurate answer and let you know about any rules or restrictions associated with receiving coverage for couples’ counseling in particular.
Does my insurance cover therapy? Usually, the answer is yes, so long as you have paid your annual deductible.
Be sure to understand your health insurance plan to ensure you’re covered for the particular therapist you want to see. If your plan has restrictions on who you can see, ask your insurance company for a list of in-network therapists and be sure to visit one of them. Otherwise, you could be on the hook for the full bill, even if your insurance covers therapy.
In the future, be sure to work with a health insurance company that provides this information to customers in a digital-centric and convenient way. The sooner you know which healthcare professionals you can visit while maintaining coverage, the sooner you can get the important mental health care you need.