Does Insurance Cover Therapy? What To Know About Mental Health Coverage

Yes, many insurance plans cover therapy for mental health concerns. However, navigating the details of your coverage can feel overwhelming, particularly when you are already thinking about taking the step to seek support. The specifics of what is covered, which providers you can see, and what you will pay out of pocket can vary widely depending on your plan type and insurance company. Below, explore the types of plans and their coverage, how to verify your benefits, what affects your costs, and alternatives if your coverage is limited. Understanding your options can help you feel more confident as you move toward getting the care you need.

Does insurance cover therapy for mental health?

Insurance benefits can cover therapy in many cases. For example, many small-group plans, Marketplace plans, and employer-sponsored plans include mental health and substance use disorder services as essential health benefits. Federal legislation has expanded access to mental health coverage over the years, which may make it more likely that your plan includes some level of support for therapy.

However, the specifics, like in-network providers, treatment requirements, cost-sharing arrangements, and session caps, can vary depending on the plan. Check with your insurance company to learn about what your specific plan may cover.

Understanding parity vs. coverage

The Mental Health Parity and Addiction Equity Act (MHPAEA) is designed to ensure parity between medical and mental health/substance use disorder coverage in applicable plans that offer both. For example, an insurance plan that MHPAEA applies to cannot charge more or cover fewer visits for mental health care than for medical care.

However, this does not mean that all health insurance plans have to cover mental health services. In general, the only way to find out whether your health insurance plan might cover mental health therapy is to contact your insurance company.

What the Mental Health Parity Act means for your coverage

If your insurance plan offers mental health benefits, the Mental Health Parity Act generally means it should not impose stricter limits on those benefits than it does for medical or surgical care. This includes limits on the number of visits, higher copays, or more restrictive preauthorization requirements. Understanding this can help you advocate for yourself if you feel your mental health coverage is being treated differently compared to other medical benefits.

Coverage by insurance plan type

Different types of insurance plans may offer different levels of mental health coverage. Knowing what to expect from your specific plan type can help you better understand your options and prepare for any out-of-pocket costs.

Employer-sponsored insurance

Employer-sponsored insurance is one of the most common ways people access health coverage. Many of these plans include mental health benefits, particularly those that are subject to ACA requirements or have 50 or more employees. Coverage details can vary by employer and plan, so it is important to review your specific benefits or contact your HR department for clarification.

Marketplace and ACA plans

Plans purchased through the Health Insurance Marketplace are generally required to cover mental health services as one of the ten essential health benefits under the Affordable Care Act. This generally means therapy and other mental health treatments should be included. However, your out-of-pocket costs may differ depending on whether you choose a Bronze, Silver, Gold, or Platinum plan, with higher-tier plans typically offering lower cost-sharing.

Medicaid coverage

Medicaid covers mental health services for eligible individuals, though the specific benefits can vary by state. Some states have expanded Medicaid under the ACA, which may provide broader access to mental health care. Contact your state Medicaid office to learn what services are available to you.

Medicare coverage

Medicare Part B covers outpatient mental health services, including individual and group therapy with qualified providers. If you have a Medicare Advantage plan, your network and costs may differ from original Medicare, so it can be helpful to review your plan details or contact your plan directly.

CHIP (Children's Health Insurance Program)

CHIP provides mental health coverage for children in families that earn too much to qualify for Medicaid but may not be able to afford insurance. Benefits can vary by state, so checking with your state CHIP program can help you understand what is covered for your child.

Factors that can affect your therapy cost with insurance

For insurance plans that do cover mental health therapy, coverage and out-of-pocket costs can vary widely depending on several factors. Understanding these can help you anticipate what you might pay and make informed decisions about your care.

• Provider qualifications (e.g., psychologist vs. counselor vs. psychiatrist)
• Whether you have a diagnosable mental health condition
• Where treatment takes place (e.g., outpatient vs. inpatient)
• Your plan's deductible, copay, coinsurance, visit limits, and preauthorization requirements

For those who are facing high out-of-pocket costs for therapy, online therapy through BetterHelp may be an affordable alternative as well. BetterHelp subscriptions for non-insurance users offer flexibility and transparent pricing: $70 to $100 per week (depending on location, referral source, discounts, preferences, and therapist availability), billed weekly or monthly. Financial aid is also available to those who qualify.

Therapy cost comparison by payment option

How to verify your insurance coverage for therapy

Figuring out whether your insurance plan covers therapy and what restrictions there are can take time. The following steps may help you move through the process and feel more prepared.

Step 1: Check your benefits

To verify your benefits, call the number on your health insurance card or examine your plan's benefits through your online insurance portal. Here are some things to look for:

• Covered mental and behavioral health benefits
• In-network requirements
• Copays and coinsurance
• Deductibles
• Session caps
• Whether prior authorization is required
• Whether a mental health diagnosis is required
• Whether telehealth services are covered

Step 2: Understand what may not be covered

Managing your expectations for what may and may not be covered can be helpful. For example, finding marriage counseling that accepts insurance can be difficult, as plans typically do not cover couples counseling unless it is required to treat a diagnosable condition for the covered partner. Other common exclusions may include experimental treatments or services from certain provider types not recognized by your plan.

Step 3: Learn the difference between in-network and out-of-network providers

Most insurance plans that cover mental health services have a list of in-network providers, with all others being "out-of-network." Understanding the difference can be important for managing your costs:

• In-network providers may offer lower contracted rates and simpler billing. Your insurance company has already negotiated fees with these providers, so your out-of-pocket costs are often lower.
• Out-of-network providers may involve higher costs. Services may not be covered at all, or you may need to pay upfront and submit claims for partial reimbursement. Some plans offer out-of-network benefits, but the reimbursement rate is often lower than for in-network care.

If you cannot find an in-network provider who meets your needs, contact your insurance company to ask about out-of-network reimbursement or exceptions. In some cases, insurers may offer a single-case agreement if no suitable in-network providers are available.

Step 4: Find the right therapist

Once you have gotten a list of in-network providers from your insurance company, if applicable, you can start looking for the right fit. For best results, you might search for a therapist who has the credentials or experience you are looking for and who you feel comfortable opening up to. Many insurance companies offer online provider directories where you can filter by specialty, location, and availability. It can be common to meet with a few therapists before finding the right provider for you.

Does insurance cover online therapy?

Many insurance plans now cover telehealth and online therapy, particularly following the expansion of telehealth services in recent years. Coverage depends on your specific plan and the online provider you choose. Some online therapy platforms, including BetterHelp, have providers who may be in-network with certain insurance plans in select states: Arkansas, Colorado, Connecticut, New Jersey, Florida, Illinois, Indiana, Kentucky, Maryland, Michigan, Ohio, Nevada, Missouri, Montana, North Carolina, New York, Oklahoma, Pennsylvania, Texas, Virginia, and Washington, DC. Other platforms operate on a subscription model and do not bill insurance directly. If you are interested in online therapy, it can be helpful to check with both your insurance company and the platform to understand your coverage options. BetterHelp also now offers psychiatry services through Uplift, which may be covered by insurance depending on your plan and provider availability.

Options if your insurance does not cover therapy

Therapy can still be unaffordable for some because of insurance coverage limits, high deductibles or copays, a lack of insurance coverage, or other barriers. If you find yourself in this situation, there are several alternatives that may help make care more accessible.

Using an HSA or FSA for therapy

Health savings accounts (HSA) and flexible spending accounts (FSA) are another way to pay for therapy. They allow people to save and use pre-tax dollars for eligible health-related expenses.

For many HSAs and FSAs, therapy can be considered an eligible expense. This often includes using an HSA or FSA for therapy through platforms like BetterHelp, which can accept these cards as a form of payment. Contact your HSA or FSA provider to find out more about covered expenses.

Sliding-scale and income-based therapy

If you need affordable therapy without insurance, some therapists offer income-based rates for those who qualify. For example, a therapy office might have a sliding-scale fee structure, which means the cost of therapy for a given client can vary depending on their income. Financial aid may also be available in some cases.

Community mental health centers and other low-cost options

Community mental health centers, nonprofit clinics, university training clinics, and employee assistance plans (EAPs) are other options to consider. Contact the relevant care provider for information on eligibility and wait lists.

Talking to your doctor for referrals

If you are unsure how to find low-cost services, talk to your primary care physician. They may be able to refer you to a mental health professional they know of who offers sliding-scale or low-cost services, or help connect you with other resources in your area.

Online therapy as an affordable alternative

Online therapy through a platform like BetterHelp can also be an affordable way to get care. A BetterHelp subscription for non-insurance users can range from $70 to $100 per week, billed weekly or every four weeks. Subscription costs vary by location, referral source, preferences, discounts, and therapist availability. Financial aid is available for those who qualify.

Some providers on BetterHelp may also be in-network with certain insurance plans in select states: Arkansas, Colorado, Connecticut, New Jersey, Florida, Illinois, Indiana, Kentucky, Maryland, Michigan, Ohio, Nevada, Missouri, Montana, North Carolina, New York, Oklahoma, Pennsylvania, Texas, Virginia, and Washington, DC. BetterHelp is continuing to work with insurance carriers to expand access. Coverage may vary by plan, provider, and therapist availability.

BetterHelp now also offers psychiatry services through Uplift as an additional care option alongside therapy. Psychiatry services may include medication management when clinically appropriate and based on evaluation by a licensed psychiatric provider. You can learn more or get started here:

Medication availability and coverage may vary by member location, clinical appropriateness, and individual pharmacy/insurance benefits. Prescribing decisions are made by the treating clinicians. We do not guarantee that any specific medication will be prescribed or covered by a member's insurance plan.

What to consider when choosing how to pay for therapy

Many factors can affect therapy costs. Below are some things to consider as you explore your options and decide what works best for your situation.

Clinical and practical factors

Several aspects of your chosen therapy type can influence its cost, such as:

• Session frequency
• Provider credentials (e.g., counselor, psychologist, therapist, etc.)
• Specialty (e.g., cognitive behavioral therapy, trauma-informed therapy, etc.)
• Care type (i.e., individual or specialty therapy)

It can be important to find a provider who meets your care needs, who you feel comfortable with, and who charges an amount that is affordable for you.

Online vs. in-person therapy formats

Whether your sessions take place online or in person can also affect what you pay. For example, some insurance plans may offer greater coverage for telehealth therapy sessions than they do for in-person sessions, though not all online therapy platforms accept insurance. Even without insurance, however, online therapy can still be more affordable than in-person sessions without insurance.

Benefits of online therapy

For those concerned about insurance coverage or affordability, exploring how online therapy can help may offer several advantages. Attending sessions from home eliminates the need to commute, which can save time and reduce stress. It may also be easier to fit therapy into a schedule when connecting with a therapist from anywhere with an internet connection. Online therapy through platforms like BetterHelp may also offer more predictable pricing compared to navigating insurance copays and deductibles, making it easier to plan for the cost of care.

How effective online therapy may be

Studies show that online therapy can be just as effective, if not more effective, than in-person therapy. BetterHelp reports similar platform-specific results, noting that 72% of BetterHelp users experienced a reduction in symptoms in 12 weeks. While each person's experience can differ, these findings suggest that online therapy may be a helpful option for many people seeking mental health support.