Does Health Insurance Cover Therapy For Mental Health Services?

Therapy and mental health services have various costs. When looking for a mental health service that works for you, you might consider the overall treatment cost per hour, health insurance coverage, possible co-pays, and the types of mental health treatment.

Does health insurance cover therapy for mental health? 

Are there health insurance plans that cover therapy? 

Most providers have in-network therapists and other mental health professionals, allowing clients to reach providers who have experience providing counseling and treating mental illness covered by insurance. If you have a primary care physician, they may refer you to in-network providers. Working with an in-network therapist, instead of a provider not included in your plan, can help you save money. Still, you could face outside factors that affect how much you pay for therapy, depending on the deductible or plan you signed up with when you first obtained your policy. 

Some outside factors may include these:

• Therapy and insurance co-pays
• Added mental health therapy session costs that are not covered by insurance
• Online or in-person mental health professionals who charge upfront fees you may need to pay
• Online or in-person mental health professionals who require you to submit invoices for insurance reimbursement for therapy

If you have Medicaid or Medicare through the US government, it's possible that your therapy will be covered under your plan, depending on your established need for it and what the provider offers. Some providers offer a selective list of companies covered under their plans, so check with them before signing up for counseling. 

You may also learn more about the Mental Health Parity and Addiction Equity Act of 2008, a federal law preventing companies that offer insurance from restricting mental health more than physical health. Even though counseling can be expensive, the Mental Health Parity Act helps ensure that covered mental health benefits are as comprehensive as physical health benefits. Note, however, that parity law doesn’t mandate mental condition coverage. Instead, it requires that providers that offer mental health coverage must treat it the same way as other services. In the case of plans purchased through the Health Insurance Marketplace, substance use disorder services must be covered. 

In addition to the parity law, the Affordable Care Act is another reform law that deals with insurance for mental health services. It outlines government policies to provide equal access to coverage, including plans through Medicaid or Medicare. This act may ensure insurance covers some or all your treatments as a low-income individual. Some government plans will cover online therapy as well as in-person. 

Types of services that insurance may help with

Below are some of the most common mental health services sought by clients and information on whether they will be covered by providers. 

In-person counseling

Health insurance may cover your treatment for traditional in-person talk therapy. However, in personal practice, therapists often have the right to choose which plans to accept, and not every therapist will accept the same plans. Additionally, depending on your policy, you may be limited to seeing therapists in your state or county. 

Some health insurance plans may also limit your therapy sessions by:

• Setting a fixed cost for each in-person or online therapy session
• Covering a limited number of mental health therapy sessions
• Providing a specific list of mental health professionals whom your insurance provider will cover
• Requiring a mental health diagnosis before insurance covers any therapy sessions
• Lacking insurance coverage for alternative mental health therapy, such as online therapy or CAM therapy
• Including annual limits on mental health care (though parity law prevents unequal coverage between mental and physical health services) 

Many plans have mental health care, online therapy, or therapy as a coverage item. However, they might not cover the entire therapy session. In some cases, you might have to pay an upfront cost, such as the entire cost of the session, and your plan may reimburse you afterward (note, however, that reimbursement rates can vary). If you have not been diagnosed with a condition needing therapy, a policy could also require you to have a diagnosis and establish the underlying need before covering your therapy sessions. You might also require a medical doctor’s referral for any treatments.

If your budget is limited, you could consider alternative treatments such as CAM therapies, as they may be cheaper than traditional therapy, or you could utilize them as complementary therapy under the supervision of your doctor or therapist to pay less. The National Center for Complementary and Integrative Health offers materials if you wish to learn more about CAM therapies, also known as complementary and alternative medicine. It is important to discuss any changes to your treatment plan with a knowledgeable professional.

Online therapy

Many special practice therapists have moved to online therapy and online counseling to offer more services and convenience for clients experiencing mental illness concerns. However, not all internet practitioners offer therapy care through insurance plans. If you're searching for individual therapists or therapy companies that offer telehealth therapy, check the insurance page or section of their biography or website. You can also reach out by phone to ask if that therapist does offer online therapy. If the therapist is licensed in your state and can accept your insurance, you may be able to attend online therapy. 

If you attend therapy through an online platform, you may not be able to use insurance cover options due to the site's terms and conditions or policies. For example, someone in the UK may not be allowed to see a therapist in the United States due to differing laws about practice locations. However, many online platforms are hundreds of dollars cheaper than in-person therapy per month, which can benefit those with high co-pays, upfront costs, or barriers to traditional therapy.

Insurance and treatment centers

Companies, like Blue Cross Blue Shield, may cover treatment centers like substance use disorder rehabilitation centers, psychiatric hospital stays, eating disorder treatment and therapy centers, or outpatient therapy groups. These centers may be costly without insurance, however. Depending on your provider, you may be required to pay an upfront registration fee, and the rest will be paid through your insurance. For rehabilitation centers in the US, there is an average cost reaching upwards of $30,000. However, location can also have an impact on cost. Rehabilitation and counseling centers in the UK typically cost up to £14,000.

Psychoanalysis testing

If you are looking for an evaluation and official psychoanalysis testing from a licensed psychiatrist, you may have to pay the amount out of pocket, even if your insurance covers therapy. Many companies do not pay for official psychological evaluations. These tests may cost around $1,500 to $3,000 or more, depending on the area and the provider you select. You might be able to find cheaper testing if you go through a student program at your local university or contact local vocational rehabilitation services for financial support. 

Insurance and psychiatry

Insurance often covers psychiatry as a behavioral medical service, as psychiatrists are medical doctors. However, depending on your plan, your medications may or may not be covered. Talk to your local pharmacy to find out if your plan does accept it and how much you might pay in co-pays for your medication if you are prescribed any. Psychiatrist office visits can cost between $100 to $400 per session. You may pay more for an initial consultation and diagnosis. 

The BetterHelp platform does not intend to provide any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.

The costs of therapy with or without insurance

Out-of-pocket costs for therapy can vary depending on where you live. However, Forbes notes that the national average in the US is $100 to $200 per therapy session without insurance. This cost can be around $400 to $800 or more monthly.

For those with insurance, your co-pay or upfront service cost can depend on the overall plan’s deductible or premium you signed up for with your policy. For example, if your plan has a high monthly payment, your insurance policy might cover mental health services. 

You may have to pay more out of pocket for your sessions if you have a high deductible and lower monthly cost. For some, that amount might be around $100 per session. If you have a co-pay plan, you might pay $15 to $45 in co-pays. If you are prescribed medication, that could add costs, depending on whether your insurance covers your medication. 

Affordable Care Act

Understanding the Affordable Care Act (ACA) may also help you understand what is offered by your plan. The ACA is a comprehensive healthcare reform legislation created to ensure that everyone in the United States can get quality and affordable healthcare. For individuals looking to receive services through their insurance, the ACA requires all plans provided by employers with over 50 employees to cover essential medical and surgical benefits, including mental health services. The part of the ACA requiring equal employer-sponsored health coverage for mental and physical services is commonly called parity law (Mental Health Parity and Addiction Equity Act). 

Note: the parity law does not require mental health coverage. However, if a policy covers this, it must provide equal coverage for mental and physical health services. For example, among other things, a provider would not be allowed to charge higher copays for talk therapy than other types of specialist services. 

If you are insured through your employer and your company isn't offering plans with mental services, consider checking with your HR department for accommodations. 

Addiction Equity Act

The Addiction Equity Act is also designed to help ensure individuals experiencing mental illness receive covered treatment provided through insurance plans just as they would if they were experiencing any other medical condition. With improved options for quality providers as well as increased transparency into what is actually covered under an insurance policy, the Addiction Equity Act helps make it easier for those dealing with mental health difficulties to get affordable assistance. 

Children’s Health Insurance Program

Additionally, the Children's Health Insurance Program (CHIP) is a federal and state-supported insurance program that provides coverage to uninsured children in families that earn too much money to qualify for Medicaid programs but don't make enough to afford paid insurance. While Medicaid does cover some costs of therapeutic treatments, CHIP typically does not provide full coverage for therapy services, though CHIP programs are required to provide parity protections for substance use disorder and mental health services if covered. 

Depending on the state, children under 19 may qualify for free or low-cost mental care provided by local clinics through CHIP's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.

What to do when you can't afford mental health services

People sometimes cannot afford therapy due to insurance limits, co-pays, or other barriers. In these cases, there are a few options. 

Find sliding scale providers

Some therapists offer a sliding-scale session fee option for those with a mental condition. Sliding scale means the therapist may consider your case and offer a lower-end fee if you have a financial burden or cannot pay their regular fee. For example, a therapist might offer a sliding scale for sessions at $65 to $150 per hour. If you have a lower income and can't afford $150, your therapist might work with you to offer a $65 per hour rate. 

Although a therapist might not be covered for you and might not work for free, sliding scales may provide opportunities for mental health disorder services and treatment. You might also find sliding scale therapists who offer referrals, such as a primary care physician. 

Get a new insurance coverage plan

At times, insurance plans might not cover everything you need them to. In these cases, you can search for a new or better plan and create an insurance account online. If you do not have a pre-existing condition, they may offer coverage for counseling within a month or two after signing up. 

If you are low-income, are over 55, or have a disability, Medicaid or Medicare therapy coverage may be available to you and could offer more, depending on your state. Monthly costs for Medicaid can be under $50 or free in some locations, depending on your financial ability. Talk to your local government officials to learn more about these plans and see which health insurance marketplace plan could suit your needs.

Talk to your doctor

If you're unsure how to find low-cost medical services, talk to your primary care physician. They may be able to refer you to a mental health professional they know of who offers sliding scale or low-cost services under your insurance plan. They may also recommend outpatient mental health services with mental health classes, or health insurance marketplace plans as a more affordable option.

Some primary care physicians can prescribe certain mental health medications and offer general tips for well-being and care. If you have any mental health symptoms due to physical health concerns, they can also address physical symptoms to reduce stress.