Does Health Insurance Cover Therapy For Mental Health Or Do I Have To Pay?
By: Sarah Fader
Updated September 01, 2020
Medically Reviewed By: Dawn Brown
Using Health Insurance Plans To Cover Mental Health Therapy
"Does health insurance cover therapy"? One of the first things people usually think about when it comes to therapy is how much it costs with or without health insurance and how they will pay for it. You may be asking yourself, "Is therapy covered by health insurance?" The answer to whether therapy is covered by health insurance is often left up to the discretion of small health insurance plans. The good news is that mental health care is becoming common in marketplace plans, and just as affordable as life insurance, home insurance, and even car insurance (in some cases). The healthcare system and insurance marketplaces can be confusing, but people seek mental health treatment every day, and we’re here to walk you through mental health benefits.
There are lots of services to cover, and there has been legislation enacted to require that health insurance covers therapy and behavioral health treatments for mental illness. This legislation falls under the Mental Health Care and Parity Act (MHPA). Under the Mental Health Parity Act, larger health insurance companies and employers (that have more than 50 employees) are required to provide health insurance coverage where plans cover medical health and mental health services. Subject to the parity law, this health insurance coverage must also provide mental health and substance abuse coverage for around the same out-of-pocket costs. With an employee assistance program, there is a wide range of insurance marketplace options to help you receive mental health care, including substance use disorder services, and treatment for obsessive compulsive disorder, bipolar disorder, eating disorders, mood disorders, and stress.
In this article, we discuss a wide range of mental health care insurance, mental health services, where to find your mental health coverage in your health insurance policy, and how to get mental health care insurance coverage that is just as affordable as life insurance or car insurance.
Does Insurance Cover Therapy For Mental Health Care?
There are many options available to pay for mental health treatment. What's covered and what health insurance doesn't cover can be confusing at first. This is especially true in cases where insurance plans cover mental health care services like psychotherapy and counseling, or mental health and substance use disorder treatment. The Mental Health Parity Act is a component of the Affordable Care Act that requires large health insurance providers and health plans to provide equal coverage for mental illness (including substance abuse coverage and treatment). According to parity requirements, the benefits you receive will be similar to the medical and surgical benefits included in your plan. Health insurance for mental illness diagnosis may be included-contact your plan for details. Please keep in mind that you can always contact your health insurance provider directly if you have questions about what your health insurance plans cover. Call the plan to work with your health insurance provider directly and get information on health coverage for therapy and other mental health services. You can work with their secretarial staff directly to seek coverage of mental health services. They will be able to answer questions specific to their health insurance plans, whether you’re covered by one of the state agencies, or asking about your children’s health insurance program. The goal of this article is to help you figure out if you have mental health coverage under your health insurance plan.
How To Know If Your Insurance Does Cover Therapy?
Unfortunately, there are no fast and easy answers to whether your health insurance plan will cover your therapy sessions or mental health services. Your health insurance provider will tell you whether they cover therapy, what type of treatment is covered, and under what conditions they will cover it. The law doesn't require small health insurance companies with fewer than fifty employees to have health insurance cover the cost of therapy. A therapist's office can also help with these questions. Health insurers might be able to answer your questions, or you can see what state medicaid programs provide in terms of Medicaid and mental health services. Medicaid programs provide some mental health services and health benefits, and may cover substance use disorder treatment.
You can always contact your therapist in advance to see if they accept health coverage for mental health care services. Under the Affordable Care Act and Mental Health Parity Act, employers with more than fifty employees are required to provide members with equal access to health plans for medical care, mental illness and mental health care, substance abuse, and eating disorders. Parity requirements state that large and small group health insurance plans that provide mental health services or substance use disorder services cannot impose less favorable benefit limitations on those than on medical/surgical benefits. If you're an employee of a large employer who has more than fifty employees, check with your health insurance benefits department or insurance company to verify what level of mental health coverage you have.
Common Insurance Coverage Concerns
There are a lot of companies that aren't governed by the Affordable Care Act or the Mental Health Parity Act that choose to provide mental health coverage for their employees. Many health insurance plans do cover the cost of mental health and substance abuse services and treatment. Some might cover behavioral mental health treatment, visits to a psychiatrist or other doctor, or treatment for specific mental health and substance use disorders. If your group health insurance plan or insurance company provides coverage for mental and behavioral health services, it's up to you to find out your level of mental health coverage. Mental health benefits are not written in plain language, and can be arduous or confusing to cover, so we’ll outline a few things to look for.
Before seeing a therapist, it's important to see if the provider takes your health insurance. One way to find out is to give your provider the details shown on your insurance policy to learn if they accept your health insurance. Review your plan’s membership materials to see if visits with a psychiatrist, counseling, mental and behavioral therapies, mental health and substance use disorders, and other services are offered with coverage, or with reduced costs. Another easy way to find out mental health coverage you have (including in-network, and out-of-network providers) is to call your health insurance provider and ask if they provide health coverage for mental health and substance abuse related services.
For family members, it may be useful to look into a Children’s Health Insurance Program, CHIP. All marketplace plans must cover behavioral health treatment, which may include visits with a psychologist or clinical social worker, mental health and substance use disorder services, or medical and surgical services. People with diagnosed mental health problems, substance use disorder, or other mental illness can find their essential health benefits may seek more information with the Consumer Assistance Program.
Medicaid programs are a good option for family members, especially those with a diagnosable disorder, mental health conditions, pre-existing conditions, or those looking for a children’s health insurance program/CHIP. Some marketplace plans, including Medicaid, can provide you with essential health benefits, such as substance use disorder services. Some doctors or mental health professionals may require insurance. Learn more about these programs and a wide range of other mental illness, mental health and substance use disorder services at Healthcare.gov, part of the Department of Health (rights reserved). Using the website will allow you to skip long wait times, skip to main content, and get the information you need quickly.
If you're wondering about the health insurance plan you have and what it covers, you can contact your insurer and inquire on the phone, or check your plan’s membership details. If you’re interested in minimizing costs, you may seek in-office talk therapy for the sake of using insurance. However, many online therapy options (which may not be included in some marketplace plans) can be much cheaper than even in-network options. It’s important to understand your mental health benefits, pre-existing conditions, and your health care coverage-review your membership materials or call your provider to get the information you need. When you call, it will be helpful to have your medical record number handy, and be prepared, in case there are long wait times. Here are some questions to ask your health insurance company when you have them on the phone:
- Are there specific mental health services that my health insurance plan doesn't cover?
- Does my health insurance plan cover therapy?
- Am I covered for therapy if I have a pre existing condition?
- Does the therapist I want to see accept insurance and are they in the network covered by my health insurance plan?
- Which therapists do take my insurance for mental health related services?
- What are the costs for talk therapy or to treat a mental health issue like stress disorder, or compulsive disorder?
- Does my medical insurance cover mental health services like behavioral health treatment?
- Does my plan cover treatment for mental health and substance use disorders?
- Where can I find a list of therapists who accept my insurance for therapy and other mental health services under my health insurance plan?
- What is the number of sessions my health plan covers per year?
- Do I have a deductible to pay before my health plans cover services under my health insurance plan?
- Is there a copay required by individual or group health insurance plans?
- Do I need a referral from my primary care doctor under my health insurance plan?
- If I need a prescription drug, will I be paying out of pocket?
- Can I bundle my medical health insurance plans with other insurance options like -- mental health coverage, renters insurance, auto insurance, or pet insurance to receive a discount?
These are a few of the questions you can ask your health insurance provider.
If you are covered with Medicare, make sure you ask whether you have Medicare Part A Hospital Insurance or Medicare Part B insurance. Generally, Medicare Part A Hospital Insurance covers inpatient mental health stays, lab tests ordered by your doctor, and some home health benefits/services. Medicare Part B generally includes doctor office visits, preventative services, and mental health services. Even individual and small group plans may cover a range of mental health benefits, including mental health and substance abuse treatments, visits with a clinical psychologist or clinical social worker and lab tests. Medicare Part D/prescription drug coverage can be a helpful addition to a plan by your insurance company, as it covers drugs which may be necessary for those with pre-existing conditions, a mental illness, or a substance use disorder. You may need coverage for a mental illness, human services, stays at a hospital including visits (and room, meals, nursing care), a pre-existing condition, or substance use disorder services. According to parity requirements, some or all of these may be included.
Most individual and small group health insurance plans, including plans sold on the insurance marketplaces, are required to cover mental health and substance use disorder services. Remember, as a consumer, you have the right to know what your insurance plans cover. Knowing what your insurance covers can help you determine the course of your mental health treatment. Check to see if you are eligible for state medicaid, which may include meals or nursing care, coverage for pre-existing conditions, substance use disorder services, visits with a doctor, Medicare Part D, or mood disorder coverage.
Below are several more things to take into consideration when using health insurance for mental health coverage. Some of them may provide useful questions and answers as well.
Out-of-Network Providers For When Your Insurance Won't Cover Therapy
An out-of-network provider is a provider who accepts health insurance coverage as a form of payment. In this case, that health insurance partially covers mental health care. Although they may accept insurance for mental health coverage, an out-of-network provider is "outside" of your health plan’s network. When you choose an out-of-network provider, there's a limit to what your health insurance plans cover, so keep that in mind with which claims are filed through your insurance. Consider the added costs of managing your everyday insurance services like auto insurance and the cost of your other health plans when choosing your provider. Weigh the pros and cons of using an out-of-network provider before committing.
Sometimes you'll find a great therapist and ask them if they accept your health insurance. When you contact your insurer, they may say they don't take your insurance, but if you have out-of-network benefits, you can see them and get reimbursed by your insurance company. When finding a therapist, you shouldn’t be restricted to only in-network mental health services providers.
However, using out-of-network health insurance coverage also means that you have to pay a significant amount of money to your therapist upfront (in the form of a copay) before health plans will cover the remaining costs of therapy. Typical health plans pay for between 60 -80% of out-of-network fees. Health plans in the US require that you pay for the costs of your copay, and out-of-network costs, before your health insurance covers therapy.
Therapy insurance can be hard to find, and that's why people sometimes opt to see therapists who are out-of-network. If you have $200 to pay for a therapy session up front, then this option could work for you. But it can become expensive, and can take a while for your insurance to reimburse you for the sessions you paid upfront for, which is frustrating. If you’re looking to limit the number of upfront costs you face, out-of-network providers may not be the best option for you.
What About Health Insurance Coverage And Insurance Deductibles?
Finding out what your health insurance covers for mental health treatment can be overwhelming. You can compare the process of finding the best mental health care insurance, to finding the best renters’ insurance or the best life insurance. The process of finding the best mental health care insurance is just as important as shopping for the best deductible on your life insurance, renters insurance, or auto insurance policy. It is important to pay attention to what your mental health care health plans cover (before and after the deductible). If you're unable to choose between plans alone, weighing the pros and cons in insurance reviews can give you a better perspective on how people feel about your choice of mental health care insurance providers. When you figure out if your insurance covers behavioral health and mental health care, there's still more work to do.
Even though your therapist takes your insurance plan, you have to pay for each session out-of-pocket until your health plans reach a balance of $2,000 before the insurance company covers the cost of therapy. This could easily make therapy unaffordable. If you are not looking for a long-term therapy plan, you may have to pay thousands upfront because of your deductible. Treatment costs for mental illnesses can vary depending on the severity of symptoms. That's why many people prefer to pay for cheaper therapy (such as online therapy) upfront, since it costs less than the options you can get with insurance. Choosing this option also allows you to begin treatment for your mental illness sooner and long-term.
It's no wonder that some people are finding therapists who work on a sliding scale as an alternative to using health insurance to cover therapy. As mentioned above, if your health insurance has a high deductible, even if you find a therapist who takes your insurance, you have to pay them out of pocket until you reach your health plans deductible.
Some people find a therapist they like who doesn't take their insurance, but who will work with them and see them on a sliding scale. In many cases, the sliding-scale fee turns out to be less than the copay for the mental health care services health insurance covers. Sliding-scale therapists may charge a lower fee than another psychologist who has a private practice, and you’d bypass the deductible problem. The sliding scale offers lower rates to those with less financial flexibility. Health insurance for mental health benefits and substance use disorders is available.
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If you’ve been diagnosed with a mental illness, you know that finding mental health and substance use disorder coverage can be difficult or costly. Another option for finding affordable mental health care is to find a low-cost clinic. Under the Affordable Care Act, some mental health care facilities are designed for people who have lower incomes (where you can pay a sliding scale fee for therapy sessions and mental health benefits). If you need to extend the number of times you’re planning to seek mental health and substance use disorder services, a low-cost clinic cna help. There are also universities that have programs where graduate students are training in psychology under the American Psychological Association (APA) guidelines, and provide low-cost services under the Affordable Care Act. Students participating in these programs are governed by the standards of the American Psychological Association and see clients as a part of their clinical training. This means that in many cases, you can get therapy at a college or university for a meager cost, if not free. This can be particularly helpful for students with pre-existing conditions, medical necessity, or a need for mental health and substance use disorder services.
Wondering If Your Insurance Coverage May Include Flexible Spending of Health Savings?
Another option to pay for therapy is a health savings account or flexible spending account. A health savings account is a savings account that allows users to save money tax-free to pay medical expenses ONLY. Needing counseling or therapy sessions is a good reason to dip into this account, and you get to use it at your own discretion. You can learn more about flexible spending at Healthcare.gov (rights reserved).
What Are Parity Laws?
The parity laws have some effect on the benefits for therapy and provide special requirements for what health insurance plans must cover. Mental health parity laws don't always require insurance companies to cover therapy in all situations. The parity laws require health insurance to cover mental health conditions on equal terms as physical health. Parity laws stipulate that large group health insurance covers mental health care services and medical health care services equally. What this means is that there can be no differing amounts in what your medical and mental health plans cover.
The Affordable Care Act (ACA) and the Mental Health Parity Act have the same goals when it comes to deciding what your health plan covers. The goal of both programs is to make sure that plans cover (and health insurance covers) people in need of affordable mental health care insurance. Services for mental health care, including treatment for mental health and substance issues, are now as affordable as those that cover people for life insurance, renters insurance, home insurance, and car insurance. If you have questions about what your health insurance or mental health insurance plan covers under the Affordable Care Act, or MHPA review the terms outlined in your insurance policy, or contact your insurance provider directly.
Online Therapy Can Help
BetterHelp is an option to consider. It is online therapy, or a network of licensed counselors available to you anywhere you have an internet connection. BetterHelp might not be the best option, but for many people it is. Prices are billed at affordable out-of-pocket rates, so it is cheaper for people who do not have insurance, or for people who have insurance but also have a high deductible. BetterHelp counselors can be given access to your permanent medical record, allowing them to treat mental health and substance use disorder services.
BetterHelp is convenient and secure as well. It is completely anonymous if you wish, and can be accessed from the privacy of your home. We encourage you to do your research on financing therapy, and we hope that BetterHelp is part of your research. Below are two counselor reviews for you to help your search, from people experiencing a range of life's challenges.
"I've always struggled with going to appointments. Although I don't have to pay in Germany for mental health care, I choose to use BetterHelp because it's easier for me to have counseling sessions and I can be in the comfort of my own home! I am very happy with Daniel Merchant's help so far, I feel very understood, and for the first time in my life I don't feel like i'm incurable. I don't get treated as if something is wrong with me [but like] I have challenges I face that can get solved with methods that I am comfortable with. I can totally recommend it, it's totally worth the money!"
"I had some trauma when I was younger that was severely affecting my life and my relationships in a negative way. I also didn't have even the kind of money to afford this service for a long period of time. But Danny took the time and discussed treatment options for PTSD that I did not know much about before. I had tried different forms of therapy with limited success, but being able to write out my feelings, thoughts, and experiences allowed me to express myself in a way that I would not feel comfortable doing while sitting one on one with someone in the same room with me. Maybe that's a sign of me being on the older side of the texting/dm/instant message generation, but the messenger discussion was a game changer for me. Danny and BetterHelp helped me so much in a short amount of time, and they didn't dismiss me or treat me as less important just because of my adverse financial situation. Because of Danny, I found a local EMDR therapist that I can see, and it has been so helpful. Thank you so much."
The process of looking for a therapist and juggling insurance can be complicated with the many factors involved. We hope that this article has given you the tools to reach out to your insurance provider. If you find that your insurance does not pay for therapy, or there is a deductible that's too high, try taking the first step with BetterHelp. You can cancel at any time, no hassle, no questions asked.
Frequently Asked Questions - The Mental Health Parity Act of 1996 -
MHPA - Mental Health Parity Act - Mental Health Parity and Addiction Equity Act (MHPAEA - Applies to employers with 50 or more employees, Large group health plans)
How much does therapy cost with insurance?
The national average cost of therapy in the United States starts at around $65.00 per hour and can go up to as much as $200.00 an hour (or more) depending on your location and other factors. Health insurance plans who cover services for mental health can help reduce your therapy cost. Since the Mental Health Parity Law took effect, health insurance companies are required to provide equally affordable options for physical health, mental health and addiction.
Do insurance companies cover therapy?
The Mental Health Parity law requires mental health parity and addiction equity for large insurance providers and companies with more than 50 employees. This means that large health insurance companies who offer medical coverage are required to offer equivalent cost options for medical care, mental health visits, and substance use or addiction. Call your insurance company to see what options are available and to find a provider who accepts your insurance.
How much does it cost to see a therapist?
It can cost from as little as a few dollars to over a few hundred dollars an hour to see a therapist. This cost is dependent on several factors. People whose insurance covers mental health treatment are only required to pay the reasonable and customary copay to see a therapist. The national average cost of therapy in the US is between $65.00 and up to $200.00 an hour. Low-cost online therapy options can start as low as $40.00 per week for unlimited messaging therapy.
Does Blue Shield cover therapy?
Yes. Some Blue Cross and Blue Shield employers and insurance providers offer mental health benefits. Blue Shield is one of the therapy providers whose plan covers in-office therapy and online therapy treatments. Blue Cross Blue Shield is a major employer whose insurance covers mental health.
How much is therapy out of pocket?
The cost of out-of-pocket therapy can vary depending on your circumstances. For example, if you belong to a large group insurance plan you'll have the benefit of therapy services covered under the Mental Health Parity and Addiction Equity Act. This act provides equal benefits for medical health, mental health, and substance use or addiction. People who use health insurance to cover their therapy costs pay the reasonable and customary copayment set for their area. Low-cost and sliding-fee scale options are available for people with lower incomes or no ability to pay for therapy costs out-of-pocket.
How much is a psychiatrist without insurance?
If you don't have mental health benefits, or behavioral health insurance covering mental health you're looking at paying the national average costs for therapy out-of-pocket. This cost ranges between $65.00 per hour to over $200.00 an hour in some cases. The benefit of having a health plan that covers your visits to a mental health provider (and a therapist who can accept your insurance) is that your health plan covers the majority of your therapy costs.
Do most insurance plans cover mental health?
Not all insurance plans cover visits to a mental health provider. This is true in the case of small insurance plans and others who are exempt from the Parity law. The Mental Health Parity and Addiction law requires that large health insurance providers with more than fifty employees are required to provide equal access to medical and mental health benefits. A recent update to the law requires that your insurance cover mental health, substance use, and addiction at the same rate of affordability as your medical health insurance program. The Federal Parity law applies to large insurance plans and large employers who have 50 or more employees (who offer mental health benefits). Large insurance plans run by state employers and agencies cover teachers, firefighters, and police for mental health care services.
Can health insurance refuse to pay?
If your health insurance provider is exempt from the MHPA regulations or if your health plan doesn't offer insurance benefits, yes, you may be denied coverage. It's important to note that not all providers can accept your insurance. Contact your health plan provider to learn if your health insurance covers mental health treatment, or contact your therapist’s office to see if he or she accepts insurance.
Do you need a doctor's referral to see a therapist?
In most cases, no. You don't need to have a referral to see a therapist, nor do you need a mental health diagnosis. People visit licensed therapists for a variety of reasons that don't require a referral. Find out if your insurance covers mental health services under your plan or requires a referral for services.
How long is a therapy session?
Traditional therapy sessions last for an hour per session. Therapy sessions and lengths are becoming more flexible with the advent of online therapy, which offers unlimited therapy sessions for always-on therapy. Contact your insurance provider to find out if your insurance covers mental health services online under the Mental Health Parity and Addiction Equity Act.
Can a therapist prescribe medication?
In most cases, no. Prescribing medication falls into the category of medical services. Medical services are provided by a licensed provider like a doctor, nurse practitioner, or psychiatrist who hold an MD or similar degree.
Does insurance cover online therapy?
Some large group insurance companies provide both physical health coverage and cover mental health treatment. A large group provider whose insurance covers mental health treatment can offer coverage for traditional in-office therapy and online therapy treatments. Under the Mental Health Parity Law, large health providers must cover mental health treatment for around the same out-of-pocket costs as medical services. Check with your provider directly to find out if they cover mental health treatment online, or speak with your therapist to see if they have a contract with an insurance provider.
What does out of network mean?
Out-of-network means that you've chosen to get medical services or behavioral health services from a provider that is not listed directly with your insurance network. The cost for using an out-of-network provider is often higher. When you make a claim to your insurance using an out-of-network provider, they may pay your claim reimburse you at the out-of-network rate. Some insurance doesn't cover out-of-network services, though some will cover services not in network. Some out-of-network fees can be reimbursed with a request to your insurance company for reimbursement.
Do you have to pay for counseling?
The answer to this question is maybe. Some counseling services are free while other therapeutic counseling services require payment. There are several factors that determine if you have to pay for counseling. Under the Mental Health Parity Law, if you work for a large employer that provides medical care insurance, the law requires that they offer insurance comparable to physical health insurance. State-based programs for insurance cover mental health care services in many cases. You can find the number for your provider using the health insurance exchange or on the back of your insurance card.
How do you get low-cost mental health care?
There are a few options for finding low-cost mental health care.
- Insurance covers mental health care.
- Online therapy offers low-cost options that are less expensive than the national average that can range from $65.00 to $200.00 per hour.
Contact your insurance provider directly to find out if your insurance falls into the parity requirements set forth by the Mental Health Parity and Addiction Equity Act.
Does Blue Cross Blue Shield cover mental health?
Yes, Blue Cross Blue Shield is one of the large group insurance providers (and employers) required to provide coverage under the Mental Health Parity and Addiction Equity Act. Parity requirements state that large employers' insurance cover mental health care and physical health care services equally. Check with your provider to see if they are governed under the Mental Health Parity and Addiction Equity Act.
What does Medicaid cover for mental health?
Medicaid is a state-based insurance plan that covers mental health services under the Mental Health Parity and Addiction Equity Act. Under the act, Medicaid is required to cover mental health care services that are comparable in quality and cost to physical health care services.
What can you do if your health insurance company won't pay?
The Federal Parity law applies to large employers and large group insurance plans. In some cases, employers are exempt and aren't required to provide coverage for mental health services. Contact your insurance company to find out if the Federal Parity law applies and if your plan covers mental health treatments under the Mental Health Parity and Addiction Equity Act.
If you have concerns about insurance coverage and therapy, you may wish to try these numbers:
- Call (800) 273-TALK to speak with a crisis volunteer 24/7 regardless of insurance coverage
- Call (866) 444-3272 to appeal your insurance coverage outside of their internal appeal process
- Call (866) 267-2323 if you have an insurance parity complaint on a self-insured plan
- Call (800) 950-NAMI to reach the NAMI helpline
Therapy Is Personal
- RAINN (Rape, Abuse, and Incest National Network) - 1-800-656-4673
- The National Suicide Prevention Lifeline - 1-800-273-8255
- National Domestic Violence Hotline - 1-800-799-7233
- NAMI Helpline (National Alliance on Mental Illness) - 1-800-950-6264
- SAMHSA (Substance Abuse and Mental Health Services Administration) SAMHSA Facebook, SAMHSA Twitter
- Mental Health America, MHA Twitter, MHA Facebook, MHA Instagram, MHA Pinterest
- WebMD, WebMD Facebook, WebMD Twitter, WebMD Pinterest
- NIMH (National Institute of Mental Health), NIMH Facebook, NIMH Twitter, NIMH YouTube
- APA (American Psychiatric Association), APA Twitter, APA Facebook, APA LinkedIN, APA Instagram