For people looking for mental health services, cost can be a huge barrier to treatment — and a major reason why some people don’t get the help they need, whether they have a mental health condition or need a safe space to talk to a trusted professional. A number of therapists don’t accept insurance, charging upwards of $200 a session, making treatment inaccessible for many. Luckily, there are many amazing mental health professionals who do accept insurance, whether it’s private insurance or a government program like Medicaid. This can lower your costs and make mental health care much more attainable. Here’s how to check if your therapist is covered by insurance, as well as what the law states when it comes to treating mental illness and offering therapy.
How to Check Your Mental Health Benefits
You can learn about the mental health services your insurance covers by checking out your plan’s benefits, or the Summary of Benefits and Coverage (SBC). Your insurance provider may have mailed you a copy of your SBC when you first enrolled, but if you’ve lost it, you can find a digital version on their website. The SBC will outline the information you need to know about how much you have to pay for your plan and the cost of any services.
Some important health insurance terms related to your benefits that you should know are:
- Premium: Your premium is the amount you pay every month to keep your insurance. If your insurance is through your employer, they may cover some of the cost. If you have an individual private plan, you’re required to pay the whole premium. In some cases, depending on your income, you may qualify for tax credits to make your premium cost lower.
- Deductible: The deductible refers to how much money you have to pay before insurance kicks in. Once you meet the deductible, your insurance starts paying for services covered by your policy — including mental health services. Note: your deductible resets at the beginning of each plan year which often but not always coincides with January 1st.
- Copayments: Copayments, or copays, refer to set prices you have to pay for different types of services. These will be your costs after you meet your deductible. You’ll likely have different copay amounts for primary care, specialists, and mental health services.
- Coinsurance: Coinsurance is when your insurance covers a percentage of the cost of a service. Rather than a set copay across the board, your insurance might cover 80% of the cost of the visit, for example. Like copays, this will typically only be the case after you’ve met your deductible.
- Out-of-pocket costs: The out-of-pocket limit is the maximum amount of money you can spend within your coverage period. For example, if your limit is $8,000 and you spend this much on services throughout the year, your insurance will cover 100% of the costs after that.
- In-Network vs. Out-of-Network: In-network refers to healthcare providers that have contractually agreed to work with an insurance company to offer patients discounted rates. Whereas out-of-network healthcare facilities don’t have a contract with an insurance provider and therefore won’t offer you a discounted rate, so you’ll have to pay the full costs for any services you require.
Once you’re familiar with these terms, take a look at your benefits and find where it mentions mental health benefits. Here, your plan information will tell you how much your copayment or coinsurance is for mental health services. Don’t forget to take note of your deductible first if your mental health benefits are subject to it and work out how much you’ve already spent. Then you’ll know whether you will just pay your copay amount right off the bat, or more. You may also want to call up your insurance company to make sure that you’re clear on exactly what your plan covers and how much you’ll need to pay out of pocket. Checking with an insurance customer service agent will ensure that the policy information you have is accurate and up to date. Plus, they can answer any questions you have about the information printed on your health insurance card. Some clarifying questions you can ask your customer service agent are:
- What specific mental health services are covered by my plan?
- What is the copay or coinsurance for therapy?
- What’s my deductible, and how much of it have I already spent?
- Is reimbursement possible for healthcare providers outside the network?
Once you have this information and you’ve found a therapist who accepts your insurance, it’s still a good idea to call them to double-check that they accept your specific insurance plan. You can search for a therapist through the Grow Therapy marketplace and filter by your insurance company to get you started.
Mental Health Coverage Mandated by Law
It didn’t used to be as common for insurance to provide mental health benefits. Luckily, as mental health has come to be taken more seriously, legislation has been passed that requires insurance companies to cover mental health services. Some of these laws include:
Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
MHPAEA ensures that there isn’t a disparity between mental health and physical health benefits that an insurance provider offers. Basically, if insurance offers medical and surgical benefits, it can’t put “less favorable benefit limitations” on mental health or substance use disorder benefits. This is an effort to have the insured entitled to benefits across the board, from physical health to mental health.
The Affordable Care Act (ACA)
The Affordable Care Act (ACA) of 2010, sometimes called Obamacare, helped make insurance more affordable and more accessible to those who need it, including those with lower incomes. The ACA allows for subsidies, or premium tax credits, which help people pay less for their monthly premium depending on their yearly income. On top of making health insurance more accessible, the ACA requires that all plans available through the government’s Health Insurance Marketplace provide coverage for mental health services and treatment for substance use.
Children’s Health Insurance Program (CHIP)
CHIP is a government program that grants children low-cost health coverage. Even if a family makes too much money to qualify for Medicaid, they can still qualify for this program. CHIP covers essential mental and behavioral health services, providing children and teenagers with the mental health support they need. Specific benefits will vary based on the state you live in.
Medicaid
Medicaid is a government program that primarily provides insurance for those with low incomes. You have to make under a certain amount of money and meet other requirements to qualify, depending on your state. Medicaid plans are required to provide “essential health benefits,” which include mental health services.
Medicare
Medicare is a government program that primarily provides federal health insurance to senior citizens over 65 years old. It also covers some younger people who have disabilities, and people with end-stage renal disease. A specific form of Medicare, Medicare Part B, helps cover outpatient mental health treatment costs. “Laws such as the ACA and MHPAEA have helped ensure more health plans have a wider set of mental health benefits than prior to them being enacted,” says Derek Lee, Grow Therapy’s Vice President of Insurance Operations. He continues, “However, there is very little awareness, especially of the Mental Health Parity Act. Most people may not realize that their health insurance likely has mental health coverage which prevents them from seeking care.”
Private Insurances with Mental Health Benefits
There are many private insurances that offer mental health coverage. Some of the largest and most popular ones include:
Even within one insurance company, there can be significant differences among insurance plans when it comes to deductibles, out-of-pocket limits, and copayment amounts. Speaking to an insurance agent can help you navigate the different plans and understand their benefits. Often, insurance offers mental health benefits and will cover therapy in some capacity. However, the costs and extent of benefits will still vary based on your specific plan. The best way to determine if your insurance covers therapy is to check out your plan benefits and call your insurance’s customer service department to get the most accurate and up-to-date information.
Does Insurance Cover Online Therapy?
Telehealth refers to therapy sessions that are conducted over the phone or online. According to the American Psychological Association’s 2021 survey, 96% of psychologists agreed or strongly agreed that telehealth was an effective therapeutic tool during the COVID-19 pandemic.
Of those psychologists, 93% agreed or strongly agreed that they planned to continue providing telehealth after the pandemic. Nowadays, most insurance companies cover online therapy services, meaning not only can patients save time and money, but they can also benefit from a wider choice of therapists and don’t need to limit themselves to professionals who operate in their area only. Medicare also covers certain telehealth services.
If you’re interested in online therapy, check your health insurance plan’s SBC or contact a customer service agent to see if it’s included in your plan.
How to Find a Therapist Who Takes Your Insurance
Kristian Wilson, a Licensed Mental Health Counselor (LMHC) with Grow Therapy, points out that your insurance provider’s directory is a great place to start when looking for a therapist who accepts your insurance.
You can also search for a therapist on Grow Therapy and filter by insurance company to see who is available to you and in-network. “It’s also a good idea to find out whether your plan limits the number of sessions you can attend each year and whether using an out-of-network therapist will affect your out-of-pocket costs. You can still see a therapist that’s outside of your health insurance, but it may be more expensive. However, sliding scales exist, and if you develop a strong connection with a mental health professional that isn’t covered by your network, you can see if your insurance will reimburse you for appointment costs.”
Not sure what a sliding scale is? It’s when a therapist agrees to charge fees based on your income.
Sliding-scale fees are especially helpful for individuals with lower incomes because they may be eligible for lower rates.
Once you’ve clarified whether your insurance plan covers therapy, online or in-person, start looking for potential therapists.
While finding a therapist who matches your financial situation is important, so is selecting someone who is the right fit for you and your mental health needs.
The Cost of Therapy with Insurance
If you make use of your insurance plan benefits, you can expect to pay between $20-$50 per therapy session on average.
However, because insurance providers and plans can vary widely, we recommend connecting with your health insurance company directly before booking a session with a therapist, just to be sure you’re covered.
The cost of therapy without insurance also varies, even from state to state. You may need to consider that if it turns out that your current or favored therapist doesn’t accept your plan.
Will I Have to Pay Out of Pocket for Therapy if I Have Health Insurance?
How much money you save on therapy sessions and how much you pay out of pocket depends on the coverage of your plan. If you’ve met your deductible, your plan may fully cover the cost of therapy.
If you have a high deductible to meet, continually paying for sessions might eventually bring your costs for them down later in the year once your deductible is met.
Or, you may need to use a copay for therapy if your chosen therapist is in-network. Your copayments will be a flat rate per session and you can inquire about these with your insurance company.
Takeaways
As you can see, there are some simple ways to check whether your chosen therapist accepts insurance, and there are many that do.
While it’s easy to feel discouraged and like you can’t get the help you need at a price you can afford, there are options available to you, including a variety of health insurance plans.
However, if talking to a customer service agent doesn’t appeal to you, and calling around for in-network providers sounds like too much, why not ask a trusted friend or family member for help?
You may already know someone who is a whizz at understanding health insurance, and if they’re someone you can trust, they may be able to help you find the right therapist who also accepts your policy.
And if you don’t want to share that information with them, simply ask if they can help you understand your plan’s benefits and health insurance coverage.
Or try using the Grow Therapy Cost Estimator to get an idea of what a therapy session might cost for you. Then browse our network of providers who accept your insurance.
