Jeffrey Wade
The cost of therapy can be a significant barrier for many people, and insurance coverage can help reduce this financial burden. Most individual health insurance plans offer some level of mental health support, including therapy services, thanks to laws promoting equal treatment for mental and physical health. However, the extent of coverage varies depending on the specific plan and insurance provider, with some plans having more restrictions or requiring partial payment. It is important to understand the specifics of your insurance plan to determine if therapy is covered and to what degree. Factors such as deductibles, copays, and coverage limits can influence the final cost. Additionally, certain types of therapy, such as hypnotherapy or niche methodologies, may not be covered by insurance. Seeking therapy can be a challenging journey, and understanding your insurance coverage is an important step in making it more accessible and affordable.
| Characteristics | Values |
|---|---|
| Cost without insurance | $100 to $200 per session |
| Cost with insurance | $20 to $50 per session |
| Factors determining coverage | Type of insurance provider, type of therapy, reason for therapy, specific health plan, insurance plan |
| Benefits of insurance | Lower costs, no surprises, less research, improved consistency in care, helps meet deductible |
| Cons of insurance | Loss of total confidentiality, ethical conundrum for therapists |
| Additional options | Medicaid, federal grants, nonprofits, clinical trials, online therapy, sliding scale payment options, transportation support, pro bono therapy, employee assistance programs |
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What You'll Learn
Individual insurance plans
The type of individual insurance plan you choose (HMO, PPO, or EPO) can affect your access to mental health services. Each plan type has its own network of providers and rules for coverage. For example, HMO plans may require you to see a primary care physician before visiting a therapist, while PPO plans offer more flexibility but potentially higher out-of-pocket costs.
Some mental health services that may be covered by individual insurance plans include:
- Co-occurring medical and behavioral health conditions, such as addiction and depression (dual diagnosis)
- Talk therapies, including psychotherapy and cognitive-behavioral therapy (CBT)
- Unlimited outpatient sessions with a psychiatrist, clinical social worker, or clinical psychologist. However, your insurer may cap the number of visits unless medically necessary.
- Inpatient behavioral health services received in a hospital or rehabilitative setting, though your insurer may limit the length of your stay or the amount they pay.
It is important to note that insurance companies may put restrictions on the diagnostic codes they will pay for, which can create an ethical dilemma for therapists and limit the care that is covered. Additionally, using insurance for therapy may result in a loss of total confidentiality as a mental health diagnosis will be on your record. This information may be accessed by insurance companies or government agencies in certain situations, such as security clearance for work or background checks.
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Employer insurance plans
If you have employer-provided health insurance, your plan may include coverage for therapy and mental health services. This is also known as group insurance. However, the specifics of what is covered and to what extent can vary depending on the employer's chosen plan.
In the United States, the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, also known as the federal parity law, requires insurers that provide mental health coverage to treat these services the same way they would other types of services. This means your insurance provider cannot charge you higher copays for therapy than for other specialists. This law ensures that coinsurance, co-pays, and deductibles are either the same or similar to any medical and surgical benefits offered.
According to this law, companies with over fifty employees are required to offer health insurance that includes mental health services. Employers may provide coverage from large companies, such as Anthem Blue Cross Blue Shield, Kaiser Permanente, Cigna, Aetna, or United Healthcare. Many smaller companies also offer good coverage.
If you are insured through your employer and need help understanding your coverage, you can refer to your plan documents or contact your employer or the insurance company for more information. If you feel comfortable, you can also reach out to your company's human resources (HR) department for assistance. If your company doesn't currently offer insurance that covers mental health services, you may wish to discuss your need for such a plan with them.
It is important to note that some insurance plans have high deductibles, which can make it challenging to access therapy services. In such cases, you may choose to find a therapist who offers sliding scale fees based on your income or a flexible payment plan. Additionally, some non-traditional therapeutic options, such as hypnotherapy, are typically not covered by insurance, and personal growth topics and niche methodologies might also not be covered.
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Medicaid and Medicare
Medicaid
Medicaid provides essential physical and mental health coverage to eligible low-income adults, pregnant women, elderly adults, children, and people living with disabilities. It covers mental health, behavioral health, and substance use disorder services, including individual and group therapy. Medicaid may also cover individual counselling and group therapy services. However, certain alternative therapies may not be covered.
Medicaid coverage varies from state to state, and each state has its own rules and limitations. Some states offer comprehensive benefits that cover an extensive number of sessions annually, while others cap benefits after a certain number of visits. To understand the specific benefits and limitations of your state's Medicaid program, it is recommended to contact your state's Medicaid office or visit their website.
While therapy covered by Medicaid is common for anyone with a diagnosed mental health condition, not all services are covered. It is important to choose a provider within your Medicaid network to ensure coverage. Your plan may require a copay or coinsurance, and there may be limits on the number of therapy sessions covered. Additionally, you may need a referral from your primary care physician before seeing a therapist.
Medicare
Medicare Part B (Medical Insurance) covers outpatient mental health services, including visits with various types of healthcare professionals, such as psychiatrists, clinical psychologists, clinical social workers, and mental health counselors. It covers preventive screenings, therapy, and counseling, psychiatric evaluations, and diagnostic assessments. Medicare typically covers a significant portion of the expense, but beneficiaries are generally responsible for a percentage of the cost, such as copayments and coinsurance.
Medicare Part B covers mental health services related to treatment, such as family counseling and grief and loss counseling for qualified hospice patients and their families. However, it is important to note that Medicare does not cover all types of therapy or counseling, including marital or relationship counseling. To be covered, services must be provided by a licensed mental health professional who accepts Medicare assignment.
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Online therapy
The coverage of online therapy by medical insurance depends on the insurance company and health plan. Some insurance policies cover online sessions, while others do not. Some insurance companies cover online therapy services, but many require video for therapy.
Talkspace, for example, is an online therapy platform that accepts insurance from Optum, Cigna, Aetna, Blue Cross Blue Shield, UnitedHealthcare, Premera, certain Medicare and Medicare Advantage plans, and many other insurance providers. It is also in-network with many other insurance plans and covered by Medicare in some states. Regence also covers Talkspace online therapy and psychiatry as an in-network service in select plans. However, Talkspace does not currently accept Medicaid.
Brightside is another online therapy platform that accepts more than 20 insurance plans, including major insurers like Aetna, Anthem, Blue Shield, UnitedHealthcare, and some Medicaid and Medicare plans. It also offers a crisis care program tailored for individuals experiencing heightened suicidal thoughts or behaviors.
Other online therapy platforms that accept insurance include Teladoc Health, Grow Therapy, and WellQor. Grow Therapy works with folks who have insurance coverage and is in-network with more than 60 major insurers, including Aetna, BlueCross Blue Shield, Cigna, and UnitedHealthcare. WellQor's services are covered by most commercial insurance (including Aetna, Anthem, Cigna, and Molina) plus Medicare, and Medicare Advantage plans.
It is important to note that coverage for online therapy may depend on your location and insurance provider, and it is always a good idea to confirm with your insurance company and the therapy provider to ensure that online therapy is covered under your specific plan.
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In-person therapy
To start, log into your insurance provider's website or call the number on your health insurance card to confirm whether your policy covers mental health treatment. If you receive your insurance through your employer, you can also reach out to your human resources department to clarify your mental health benefits. They can provide information about the specific plans offered by your company and how they relate to mental health services.
Once you know the details of your plan's mental health coverage, you can begin searching for in-network therapists. Your insurance company's website or portal should have a directory of in-network therapists that you can filter by specialty or location. It's important to double-check with the therapist's office to confirm their network status and that they are accepting new patients.
When considering in-person therapy, it's essential to keep in mind that insurers typically only cover treatment if it is to treat a diagnosed medical condition, such as depression or anxiety. The type of insurance plan you have may also impact your access to mental health services. For example, HMO plans may require you to see a primary care physician for a referral before visiting a therapist, while PPO plans offer more flexibility but potentially come with higher out-of-pocket costs.
Additionally, some insurance plans may have restrictions on the number of therapeutic visits allowed annually, so be sure to review the details of your coverage. If you are unable to find a therapist in your network or are facing long waitlists, telehealth or online therapy may be an alternative option to consider, as it can provide access to a wider range of potential providers.
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Frequently asked questions
It depends on your insurance provider, the type of therapy, and why you need it. Many insurance plans cover some amount of therapy. Individual insurance plans typically include coverage for therapy and mental health services.
Using your medical insurance plan can help reduce the cost of acute or ongoing mental health care. Insured patients may end up paying nothing out of pocket. Using therapy covered by insurance requires less research for the patient.
The cons of using medical insurance to cover therapy include loss of total confidentiality and access to other benefits. Having a mental health diagnosis on your record means that you will have a pre-existing condition that is accessible by insurance companies or government agencies.
