Does insurance cover therapy?

Yes — therapy is often covered by insurance, but the amount of coverage varies by plan. Navigating health insurance can be confusing. And this includes figuring out your coverage for mental health services like therapy. It can be even more confusing if you recently changed your health plan or just got insurance for the first time. To make the most of your mental health benefits, you need to know how they work.

So whether you’re looking to meet with a therapist in person or find online therapy that takes your insurance, it’s important to clarify your coverage and the financial obligations associated with your care.

How to check if your insurance covers therapy

For a long time, health insurance companies treated coverage for mental health and physical concerns differently. Visible health conditions, like a broken arm or heart disease, have historically received higher coverage rates than mental health conditions, like depression or anxiety. So if you’re confused about whether your health insurance plan covers therapy, you’re not alone.

Fortunately, more health plans are beginning to offer mental and behavioral health benefits. However, your insurance may not guarantee coverage for therapy, depending on your policy.

It’s important to understand how your health plan handles mental healthcare before making an appointment with a therapist.

Here’s how to determine your health insurance coverage for mental healthcare:

• Review your plan’s summary of benefits. This is a document that your insurer provides when you sign up for coverage. They may provide a hard copy, or it might be accessible via your online account. It details the ins and outs of your coverage and should describe your mental and behavioral health benefits.

• If you have trouble finding this information, talk to someone who can help. There should be an 800 number on the back of your insurance card that you can use to contact your insurer to ask questions. You might also be able to email your insurance company using the contact information listed on their website.

• When you talk to your insurer, let them know that you want to verify your mental health benefits. Ask about coverage for therapy and other types of inpatient or outpatient care. Be sure to ask:

  • How many therapy sessions your plan covers per year

  • Whether there are any session limits or visit caps

  • How much your plan pays per session

  • Whether you’ll owe a copay or coinsurance

  • If these payments count toward your annual deductible

Determining the cost of therapy with insurance

Once you’ve reviewed your health plan’s summary of benefits or confirmed your mental healthcare coverage with your insurance company, it’s time to estimate the cost of care.

Having health insurance doesn’t mean you’ll pay nothing out of pocket for therapy. Each health plan is unique, and there are many different models for financial reimbursement and coverage.

So to avoid the stress that comes from unexpected bills, be sure you have a clear understanding of the following terms before making an appointment with a therapist.

Copay

This is a fixed charge that you’ll need to pay out of pocket for a therapy session. This fee is on top of what your health insurance plan pays your therapist. Copays can vary widely depending on your benefits, so talk to your insurance provider to verify the amount. Find out whether your copay counts toward your deductible and/or out-of-pocket maximum.

Deductible

When you have a health plan with a deductible, you are responsible for paying for all of your healthcare expenses before reaching that amount. If your plan doesn’t include a copay for mental healthcare, you’ll need to pay the full cost of therapy sessions before your insurance begins covering a portion of your therapist’s rate. Sometimes, payments for care only count toward your deductible if you see an in-network therapist.

Coinsurance

After you meet your deductible, your health plan may implement a co-insurance agreement. At this time, you’ll pay for a predetermined percentage of covered expenses, and your health plan will pay for the rest. Sometimes, coinsurance payments and copays count toward your out-of-pocket maximum.

In network versus out of network

If your therapist is in network with your health plan, the plan and provider have negotiated a reduced rate for services. This means that your health plan will cover a portion of the cost of your therapy bill.

But keep in mind that this coverage may only kick in once you’ve reached your deductible. So you may still be responsible for a copay or coinsurance payment for your sessions. If a therapist is out of network, they are not able to bill your insurance company for the cost of your care. But some therapists offer sliding scale fees that make it easier to access affordable therapy without insurance.

Out-of-pocket maximum

Many insurance plans place a limit on what an individual or family has to pay out of pocket for healthcare during a single year. Once you hit your out-of-pocket maximum (typically via your deductible, copay, coinsurance, and/or other medical bills), your insurance company will pay the remaining balance for any covered medical bills from that year. Double-check with your insurer to determine which of your medical bills will count toward your out-of-pocket maximum.

Once you understand the specifics of your coverage and the costs associated with therapy, it’s time to find a therapist who’s right for you. Your insurance company can provide you with a list of in-network providers.

Before you make your first appointment, be sure to double-check the date your insurance coverage goes into effect. And keep in mind that if your plan changes in the future, your coverage for therapy might change too.

Dig deeper:

• Learn more about the cost of autism management

• Managing psychiatry costs without insurance

Clinician’s take

Insurance can feel confusing, especially when you’re already stressed and just want help. The good news is that many plans do cover therapy — you just need to understand the details so there aren’t surprises. Once you know your benefits, getting care usually becomes a lot less intimidating.

Brandy Chalmers, LPC

Clinical reviewer

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