Health insurance can be confusing, and it can be difficult to know exactly what your plan covers. Even those with good insurance might be hesitant to seek health services when you are unsure what will or will not be covered.
Does health insurance cover the cost of therapy? The short answer is: it depends. Most plans in the United States cover mental health similarly to how they cover other medical costs, meaning that sessions could be billed with a co-pay or go toward your deductible.
So, what do you need to know about health insurance when it comes to paying for therapy?
What Kind of Insurance Plan Do You Have?
Most insurance plans either have a co-pay or deductible. A co-pay means you pay a set amount for each appointment, and your insurance covers the rest. A deductible plan means that you pay all your medical expenses up to a certain amount, at which time insurance starts covering a specific percent of your costs.
If your plan has a deductible, you will want to know how much each session will cost you before your insurance coverage starts. Most therapists post information about their rates on their website, but your insurance plan might have a negotiated rate with in-network providers. This means that your rate per session is discounted.
Options available to you depend on which company is your health insurer. Companies vary on what plans they offer and what services they cover. Since many people are insured through their employer, you might not get to choose which insurance company covers you and your family. Still, if you own your own business or purchase privately, you want to research your options before committing to a plan.
The cost of therapy varies significantly, with many providers in the United States charging between $65 to $200 per session. The cost depends on your location, the therapist’s training, and any specialized care you might need.
Usually, your insurance card lists which type of plan you have, but you can get this information from their website or by calling the customer service phone number on your card.
What If I Can’t Afford My Deductible?
Some insurance plans have very high deductibles, and paying this amount may be a challenge. Your therapist might offer affordable payment plans to allow you to pay over a longer time period. Communicate with your therapist, and ask for information about these options.
Maybe you cannot afford your deductible even with a flexible payment plan. In this case, you might choose not to use your insurance and instead find a therapist who offers sliding scale fees based on your income and ability to pay. Since your therapist will not bill your insurance, these payments will not go towards your deductible for the year, but they can make therapy services more affordable.
Sliding scales are also an excellent resource for individuals who do not have health insurance. Many universities will have mental health clinics staffed by graduate student therapists under the supervision of a licensed mental health professional, which also offer a sliding scale fee structure.
Does Insurance Cover Online Therapy?
Many people prefer online therapy (referred to as telehealth or telemental health) to traditional in-person therapy for a number of reasons, including:
- People save time not having to commute to and from the therapist’s office
- Those without vehicles or reliable vehicles do not need to find transportation for appointments
- People have additional privacy when seen from home due to not encountering other clients in the waiting room
- Those with young children do not need to find childcare while they travel to and from their session
- People with mobility issues might have difficulty coming to the office in person
- People who are immunocompromised might feel safer being seen from home
- People living in rural areas might not have the ability to travel for in-person sessions
Historically, insurance has not always covered telehealth services for therapy. However, since March 2020, many insurers are covering this service for in-network providers. Typically, insurance does not cover therapy costs through companies like Talk Space and Better Help.
Telehealth is an excellent option for many people, but some might prefer in-person services. Although many people benefit from telehealth services, you can decide which type of service best fits your needs.
How Do I Find an In-Network Therapist?
Many therapists list on their website which insurances they accept. Directory websites list providers by location and allow you to filter by your presenting concern to help you find a therapist who takes your insurance and is trained to help you with your unique challenges.
You can also call your insurance company or visit the company’s website and ask for the names of therapists in their network. Although the company typically will not have information on the therapist’s specialization, this is a good starting point.
Is the therapist that specializes in your issue out-of-network? Sometimes, insurance companies limit how many therapists they will accept on their panel at a time, and therapists who want to accept your plan are unable to. You can call the company and ask them to panel more therapists.
How Does My Therapist Bill My Health Insurance?
Prior to starting therapy, you can call your insurance company to ask about coverage for therapy. Since “therapy” is a broad term, it helps to ask if specific billing codes are covered. When it comes to therapy services, the most commonly used billing codes are:
- 90791 (Intake Interview): This is the first session, when your therapist gathers information about your history and your symptoms, and you discuss what you would like to get out of treatment. This appointment is typically one hour in length.
- 90837 (One hour therapy session): Hour-long therapy sessions are defined as a session lasting 53 minutes or longer. Certain treatments, such as EMDR, require longer sessions and might use this code. *Note: Some insurance plans will not cover sessions longer than 45 minutes. Ask your therapist the length of a typical session and which billing code they use.
- 90834 (45-minute therapy session): This is the traditional therapy “hour,” and it covers sessions lasting 38 to 52 minutes. If your therapist schedules on the hour, this session time gives them a chance to make notes about your session between appointments.
- 90832 (30-minute therapy session): Shorter sessions, lasting 16 to 37 minutes, are billed with this code. This might be used with young children who do not have the attention span for a 45-minute appointment.
Your therapist should be able to provide information on which billing codes they use in their sessions, and you can confirm with your insurance company what is covered and if there are any limits to the number of sessions allowed.
Insurance coverage is confusing, so knowing what questions to ask and how to navigate the system is helpful in accessing services.
Does Your Insurance Provider Cover Therapy?
You might be able to get therapy covered by insurance through your employer’s healthcare plan, but you’ll have to do your due diligence to find out what type of coverage you have through a company plan.
Even if the answer to the question is therapy covered by insurance is yes, some people still choose not to use it. This may in part be because insurance companies will only pay for medical services that are deemed necessary. To achieve that status, you need an official diagnosis. Some people feel uncomfortable with having this on record, but it’s a personal choice.
Affordable Care Act (ACA)
The Affordable Care Act (ACA) passed in 2010 was established to reduce the cost of health insurance for anyone who wanted it. It offers tax credits and cost-sharing reductions to make insurance affordable for low-income families.
Among other things, it also created a Health Insurance Marketplace and requires plans to cover specific essential health benefits. Any plan that’s purchased through the Health Insurance Marketplace must include mental health as well as substance use disorder services.
In terms of mental health, Health Insurance Marketplace plans must offer:
- Mental health and behavioral health inpatient services
- Behavioral health treatments (including counseling and psychotherapy)
- Coverage for pre-existing conditions
- Parity protections that ensure coinsurance, co-pays, and deductibles are either the same or close to any medical and surgical benefits that are offered
The Mental Health Parity Act of 2008
The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that keeps group plans from offering different (less) mental health benefits than they do medical or surgical benefits.
A major goal of MHPAEA and the ACA was to create a system that offers equal coverage for the treatment of both addiction and mental health conditions. Prior to the MHPAEA’s passage, 49 million Americans were without insurance, 2% had coverage that didn’t offer any type of mental health benefits, and 7% had no substance use benefits.
CHIP (Children’s Health Insurance Program)
The Children’s Health Insurance Program (CHIP) gives states federal funding so they can offer low-income households with children low-cost health insurance. Though actual coverage varies depending on which state you’re in, most plans cover virtually all mental health services, including:
- Therapy
- Counseling
- Medication management
- Peer support
- Social work services
- Substance use disorder treatments
Medicaid
Medicaid plans are state-run and required to cover anything deemed as an essential health benefit. This includes both substance use services and mental health services. Like CHIP, Medicaid plans will differ from state to state, but they too are subject to MHPAEA requirements.
Medicare
Part A of Medicare will cover substance use services and inpatient behavioral healthcare. You may be responsible for deductible and coinsurance costs if you’re hospitalized.
In terms of outpatient mental health services, Part B covers many services, including yearly depression screening. Out-of-pocket costs may be required to cover the cost of therapeutic services and any Part B deductible, co-pays, or coinsurance.
Medicare Advantage (known as Part C) will typically cover therapeutic services at least at the level of your original Medicare plan or better.
Blue Cross Blue Shield
Today, thanks to the Affordable Care Act (ACA), most Blue Cross Blue Shield insurance plans will cover therapy. If you have a plan that started before 2014 — when the ACA was enacted — your plan may not cover mental health services. There are some additional caveats to this as well. Blue Cross Blue Shield only covers evidence-based services like psychoanalysis. Sessions with a life coach, career coach, etc. are not covered.
Kaiser Permanente
Kaiser Permanente offers mental health treatment plans that are personalized to each member. They’ll generally cover therapy with a nurse practitioner or psychiatrist, and they often cover group therapy as well. Kaiser goes a step further and offers stress management and mental health classes and addiction counseling.
