Does Health Insurance Cover Therapy? Costs And Options

There can be various costs that go into counseling and mental health services. When looking for a service that works for you, you might consider the overall treatment cost per hour, insurance coverage, possible co-pays, and types of treatment needed.

Does Health Insurance Cover Therapy? 

Does insurance cover therapy? If you have a primary care physician, they may also help refer you to a therapist or specialist that takes your insurance plan. You could face co-pays, session costs, or upfront fees that affect your overall therapy cost, depending on the deductible or plan you signed up with when you first obtained your insurance policy. 

If you have Medicaid or Medicare through the US government, it's possible that your plan covers therapy, depending on your need for them and what the provider does cover. Some providers offer a selective list of companies they accept, so check with them before signing up for therapy. 

It is also important to understand the Mental Health Parity and Addiction Equity Act of 2008, which is a federal law that requires insurance companies to treat mental health and substance use disorders as they would any other medical condition. Even though therapy can be expensive, this mental health parity act helps ensure that all individuals have equal pass covered under their insurance plans for seeking help with their mental health needs.

In-Person Counseling 

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

Some insurance plans will also limit you by cost, the number of sessions, and the names of therapists you can see. If you have a limited list, it may be mailed to you, or you can reach out to your insurance provider through their website or email to ask. 

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

If your budget is limited, you can try alternative treatments such as CAM therapies or utilize them as complementary therapy under the supervision of your doctor or therapist. The National Center for Complementary and Integrative Health offers materials if you wish to learn more about CAM therapies or complementary and alternative medicine.

Online Counseling

Many special practice providers have moved to online therapy to offer more accessibility to clients experiencing mental health concerns. However, not all online practitioners offer 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 virtual counseling. If they are licensed in your state and can accept your insurance, you may be able to attend online counseling with insurance coverage. 

If you attend therapy through an online platform, you may not be able to use insurance due to the site's terms and conditions or policies. 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.

Treatment Centers

Insurance companies, like Blue Cross Blue Shield, may cover treatment centers like rehabilitation centers, psychiatric hospital stays, eating disorder treatment, or outpatient therapy groups. These centers may be costly without insurance, however. Depending on your insurance company, you may be required to pay an upfront registration fee and the rest through your insurance. For rehabilitation centers in the US, there is an average cost reaching upwards of $30,000.

Psychoanalysis Testing

If you are looking for a mental health 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 insurance companies do not offer coverage for official psychological evaluations. These tests may cost around $1,500-$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. 

Psychiatry 

Insurance does often cover psychiatry as a behavioral health 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 insurance plan is accepted and how much you might pay in co-pays for your medication if you are prescribed any. Psychiatrist visits can cost between $100-$400 per session. You may pay more for an initial consultation and mental health diagnosis. 

The Costs Of Therapy

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

For those covered by insurance, your co-pay or upfront service cost can depend on the overall deductible or premium you signed up for with your policy coverage. For example, if you have a high monthly payment on your insurance plan, 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-$45 in co-pays. If you are prescribed medication, that could add costs, depending on whether your insurance covers your medication. 

Understanding the Affordable Care ACT may also be very beneficial. The Affordable Care Act (ACA) is a comprehensive healthcare reform legislation that was created to ensure that everyone in the United States has access to quality and affordable healthcare. For individuals looking to receive mental health 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 Addiction Equity Act is also designed to help ensure individuals experiencing mental illness receive equal access to treatment provided through health insurance plans just as they would if they were suffering from any other medical condition. With improved access to 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.

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

Depending on the state, kids under the age of 19 may qualify for the free or low-cost mental health 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 Therapy

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

Utilize Sliding Scale Providers

Some therapists offer a sliding scale session fee option for those with a mental health 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-$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 can help provide access to mental health disorder services. You might also find sliding scale providers who offer mental health referrals, such as a primary care physician. 

Apply For A New Insurance Plan 

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

If you are low-income, are over 55, or have a disability, Medicaid or Medicare may be available to you and could offer more coverage for therapy, 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 health officials to learn more about these coverage plans and to see which health insurance marketplace plan could be right for 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 that does offer 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. 

Try Online Therapy

If you continue to face barriers to treatment or find that the cost of therapy doesn't fit within your budget in your area, you might consider online counseling. Online counseling often ranges from $65 to $90 a session instead of $100 to $200 or higher. Your first session will not cost more than your subsequent sessions. You can also receive some mental health benefits that you might not get from a traditional session, such as the option to attend therapy over the phone, via video chat, or through a live chat feature. If you feel most comfortable at home, online therapy can allow you to attend counseling through a method that feels safe to you.  

Studies on the efficacy and health benefits of online counseling found that it was more cost-effective and practical overall for conditions such as obsessive-compulsive disorder (OCD). The APA also labels telehealth therapy as a promising new treatment that offers several essential health benefits to clients with any symptoms or mental health conditions.

If you're interested in trying an internet-based treatment modality, you can do so through platforms like BetterHelp for individuals or Regain for couples. If you have questions about BetterHelp, you may reach out to contact@betterhelp.com. If you have questions about mental illness, you may contact helpline@nami.org.