Does Insurance Cover Therapy? Insurers, Services, Costs – Verywell Health

If you’re seeking treatment for your mental health, chances are you’re already feeling overwhelmed. Navigating insurance benefits can be confusing. For many, this complicates or even delays pursuing therapy. 

Research shows that lack of insurance is a significant barrier to seeking mental health care. The truth is most insurance plans offer mental health coverage, but it may be difficult to tell what is covered and how much you’ll have to pay.

This article discusses health insurance for mental health and substance use services, what may be covered, and how to find a provider.

Pornpak Khunatorn / Getty Images

The Need for Therapy

At least half of the U.S. population will receive a mental health diagnosis in their lifetime. This makes access to care and transparency about cost incredibly important. Many adults with mental health conditions don’t receive the services they need, and cost can be a significant factor. 

One study noted that 72% of adults with mental health conditions experience at least one barrier to getting care, with many reporting lack of insurance as that barrier.

Do Therapists Take Insurance?

Some therapists take insurance, although some do not, as healthcare providers who are on insurance panels often receive much less than their typical rates by going through insurance. However, since many people have health insurance privately or through an employer, this can open up a wide pool of potential clients.

If you have a specific therapist in mind you’d like to work with, you can check with them to see if they accept your insurance. Therapists can apply for an insurance panel, but the approval process may take some time. So, if you’re looking to work with someone out of network, it may be faster to talk to them directly about their rates.

Typical Costs

Therapy can cost anywhere between $50 and over $200 per session, depending on the type of provider and their location. So, going through insurance may feel like a reasonable option to lower costs. With insurance, you’re likely to have a copay and pay a specific amount toward sessions while your carrier covers the rest, or you may pay full price until you meet your deductible before insurance starts to cover services.

What the Law Says

The laws around mental health coverage have changed over time.

The Mental Health Parity Act passed in the 1990s, which kept insurance companies from minimizing their contribution to mental health benefits. However, this did not require coverage for mental health and substance use concerns. That didn’t come until the Mental Health Parity and Addiction Equity Act passed in 2008.

In addition to covering more services, this law keeps insurance carriers from charging high copays. Insurance companies are required to keep the cost of mental health and substance use services similar to medical services.

Since 2016, Medicaid and the Children’s Health Insurance Program (CHIP) have followed these parity rules.

Types of Insurance for Mental Health

From an Employer

If you have insurance through an employer, you may have mental health services offered under your health coverage or through an Employee Assistance Program (EAP) if they provide it. Through an EAP, you may get access to a certain number of counseling sessions per year per condition.

The Health Insurance Marketplace

The Marketplace provides access to many healthcare plans from different insurance carriers. Plans offered in the Marketplace are required to cover mental health and substance use services and keep costs comparable to other medical services.

The specific behavioral health benefits will depend on your state and the particular health plan.

CHIP

The Children’s Health Insurance Program (CHIP) provides low-cost insurance options for individuals with lower incomes.

Covered services by this federally funded program vary by location, but the following may be included:

Therapy sessions
Substance use treatment
Services through a social worker
Peer support services
Medication

Medicaid

Medicaid is required by law to provide coverage for some substance use and mental health services. Because they can limit how many sessions you receive, calling your state-run agency is the best way to get informed.

Medicaid offerings may not be standard and may vary by state or plan. 

Medicare

Medicare (federally-funded health care for people over age 65) covers the cost of some mental health services. However, it’s essential to note that certain parts of Medicare contribute to certain services. 

Part A covers some inpatient behavioral health and substance use services.Parts B and C may help pay for hospitalizations and outpatient office visits.You’ll need to call to find out what costs, like individual or group therapy, parts B and C may cover.Part D may provide coverage for some medications. 

How to Determine If Insurance Covers Therapy

There are a few steps you can take to find out if your insurance plan covers therapy. These include:

Call your insurance carrier: Contact information is on the back of your insurance card. The customer service phone number is a good place to start. You can ask for a list of providers and detailed information about services.Look online through your insurer’s website or app: Generally, you can log in to your patient portal and see what services are offered, in-network providers, and some information about the cost to you.Talk to your human resources representative: They may have guidance about how to contact and navigate employee-sponsored programs or can provide phone numbers for your insurance company. 

Questions to Ask

Questions you may want to ask when reaching out to your insurance company are:

What mental health, behavioral health, and substance use services are provided under my plan?How many sessions are covered for each type of service?Can you provide me with a list of in-network providers?What is my copay?What is my out-of-pocket cost?What will be covered after I reach my deductible?What happens if I want to see a therapist who is out of network?

Possible Covered Mental Health Services

Types of services that may be covered by insurance include:

Crisis services
Individual or group therapy sessions
Co-occurring conditions (such as depression and alcohol use disorder)
Sessions at an outpatient center
Telehealth services
Addiction and substance use treatment
Inpatient or partial hospitalization 
Medically supervised detoxification

Keep in mind that insurance companies will only pay for services they deem medically necessary. The best way to know what services are covered is by contacting your insurance carrier. They can share information about whether something is covered, how many sessions or days of treatment are allotted, and your personal responsibility for care.

Finding a Therapist: What to Look For

Finding not just a therapist but also the right one for you may require some work.

Here are some factors you may want to consider before choosing a mental health provider:

Level of education: Therapists and social workers typically have a master’s degree, while psychologists have a doctorate. Psychiatrists are medical doctors.Personal background: This can include gender identity, race, religion, and sexual orientation.Consultation: This is a good opportunity to ask questions and see how you get along.Payment: Options may include insurance, employee assistance program, self-pay, or sliding fee scale.Ways they offer services: In-person, telehealth, or other services may be available.Training and areas of specialtyLocation

Evaluating cost is just one factor to consider. Make sure to identify other factors that are important to you.

Alternative Ways to Get Therapy Without Insurance

Though there have been strides in the mental health field, therapy is not accessible to everyone. Research shows that people with mental health conditions are less likely to be insured, which creates issues with access to and coverage of care. 

If you are uninsured or are simply looking for other ideas about how to get mental health support, you can try:

Asking whether a therapist provides a sliding fee scale: This means they may offer services at a rate that accounts for your income and ability to pay.
Talking to a guidance counselor: Many schools and universities have counselors on staff. Depending on the organization and what’s offered, services may be free or low in cost. 
Signing up for a telehealth service: Some telehealth providers accept insurance, but a great deal do not and aim to offer services at a lower cost. While many of these services bill per month, the cost of sessions may be less than what you would pay without insurance in a different setting. There is also the added benefit of services being virtual. 
Using a therapist directory from a trusted source to find therapists who specialize in your needs: You can speak directly with them about your needs and payment. 
Exploring county or state programs: Mental health services and support may be available locally.
Working with a clinician who is seeking licensure: You may have seen the term “registered intern” when looking for a healthcare provider. This means a provider is working toward licensure and practicing under the supervision of a fully licensed professional. They may offer lower or reduced rates for sessions.
Talking with your primary healthcare provider about your mental health: While this may not be their area of expertise, many healthcare providers can discuss general mental health concerns. This may also give you the chance to ask about referrals for treatment. 
Talking to a trusted member of your community: This could include your religious community, if you practice religion. Some clergy members or religious leaders have training in basic counseling skills.
Connecting with a sponsor or peer support specialist: Again, although this is not a licensed mental health professional, this avenue allows you to get support from people with similar experiences. They may also have knowledge or information about resources. 

Summary

Lack of insurance or mental health coverage is a commonly noted barrier to accessing mental health care. While most insurers offer some level of mental health coverage, it can be challenging to determine your level of coverage and how to navigate benefits. There are also other avenues for getting coverage, including many government programs.

You can learn more about getting care by contacting your insurance carrier, inquiring about services a therapist covers, discussing payment options, and exploring other options for support.

A Word From Verywell

Navigating insurance for mental health services can be overwhelming. However, taking the time to thoroughly research your benefits and potential therapists can help you make an informed decision about your care and how to afford it. Fortunately, there are many avenues available to get the mental health services you need.

Frequently Asked Questions

Does insurance cover couples therapy?

It depends. Insurance companies will pay for what they deem medically necessary services. A documented diagnosis often helps you obtain coverage. For example, an insurance provider may be more likely to pay for couples therapy if at least one of the partners is diagnosed with a mental health condition. However, the best way to know if and how much of the cost insurance will cover is to reach out directly to the carrier.

Is therapy worth it?

Therapy can be a life-changing experience, and it is proven to be effective in treating mental illness. Getting started can seem like a hassle. Doing your research and finding a therapist who feels like a good fit, has training in your specific needs, and offers services at a rate you can afford can make it easier to start and stick with the process.

Should you favor in-network providers for mental health services?

Sticking with an in-network provider may seem like a great way to reduce the cost of treatment. However, it may be helpful to determine what factors are most important to you when seeking services. Other things you might consider include a therapist’s education, training, and specialties, and whether they deliver in-person or telehealth services. 

Are some insurers better than others for mental health coverage?

Most insurance companies have therapists in-network. It’s difficult to say which insurer is the best because the services they cover and the number of sessions allotted may vary. If you’re looking to determine which carrier is right for you, some research may be required. You can contact insurers to find out about services, costs, and in-network providers.