Updated 3/20/24
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Navigating mental health care can often seem daunting, particularly when it comes to understanding the costs involved. A common barrier to seeking much-needed therapy is the misconception that it is expensive. However, the reality might be more encouraging than you expect.
The good news is that therapy may be more accessible and affordable than it appears with the help of insurance coverage. Many people are unaware that their insurance plans might cover a significant portion, if not all, oftherapy costs. And for those without health insurance, there are still numerous avenues to explore for obtaining the mental health care you need.
Health insurance usually offers some level of mental health support thanks to laws promoting equal treatment for mental and physical health. With that said, insurance coverage for therapy is dependent on whether or not you have a diagnosed mental health condition.
Additionally, coverage for therapy will depend on your specific plan. Some plans cover a range of therapies and therapists, while others have more restrictions or may require you to pay some of the cost.
The Mental Health Parity Act of 2008
TheMental 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 mental health conditions and addiction.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.
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:
Individual insurance plans
Some considerations may include:
Insurance through employer
Employer-provided health insurance, also known as group insurance, often includes coverage for mental health services, including therapy. However, the extent and nature of this coverage can vary, especially between small businesses and large corporations.
Larger employers don’t have to comply with ACA like small businesses do, but typically, they provide more comprehensive health plans. These plans often feature a broader network of therapists, offering more options for employees to find suitable mental health care.
Additionally, large corporations may have more resources to negotiate favorable terms with insurance providers, resulting in better coverage for therapy sessions. Employees in these settings should explore the specific mental health benefits offered, which may include various therapy options ranging from traditional in-person sessions to newer telehealth services like Talkspace.
EAP benefits
Some companies further support employee mental health through Employee Assistance Programs (EAPs). These programs are particularly beneficial as they often provide immediate, short-term counseling at no cost to the employee. EAP services are usually separate from the standard health insurance benefits, allowing you to access therapy without using your regular health insurance coverage.
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:
Medicaid
Medicaid, a joint federal and state program, assists individuals and families with low-income and limited resources. Coverage for therapy under Medicaid can vary significantly depending on the state, as each state has its own program rules and coverage limits. Generally, Medicaid must cover anything deemed as anessential health benefit. This includes mental health services and substance abuse services. Like CHIP, Medicaid plans will differ from state to state, but they are subject to MHPAEA requirements, too.
Medicare
Medicare, primarily serving individuals who are 65 or older, as well as some younger individuals with disabilities, offers mental health coverage through several parts of its program:
Average Cost of Therapy With vs. Without Insurance Coverage
The average cost of therapy with insurance typically ranges from $20 to $50 per session, depending on your insurance coverage plan. Without insurance, therapy sessions can cost significantly more, often between$100 and $200per session. These costs can vary based on the therapist’s location and expertise. For uninsured individuals, options likesliding scale therapy fees, community health centers, or online therapy platforms can offer more affordable therapy services.
Some of the mental health treatments that are most often covered include:
How to Find Out if Your Insurance Covers Therapy
To find outif your health insurance covers therapyin your specific health insurance plan, follow a few simple steps.
1. Check your insurance account online
If you haven’t already done so, register your online account. Most insurance plans have websites with information about coverage and any related costs you should be aware of. Because there are dozens, if not hundreds of plans out there, it’s important to make sure that you’re looking at your exact insurance plan.
Take note of whether you should be looking for a therapist or provider who is in your plan’s network, or if there are additional fees if you go out of network.
Pro tip:Call the licensed therapist or doctor you’re considering seeing and ask them for the Tax ID number that they bill with. This will help your insurance provider find them in their system so you can makeabsolutely surethey’re in-network.
2. Call your insurance provider
You can also call the provider directly. If you need any further information or if you can’t find what you’re looking for on the website, there should be a toll-free number on the back of every insurance card. Look for the number that’s noted for members, and you can ask any specific question you have about the types of therapeutic coverage your plan offers. If you didn’t get the information from the website, you should also ask about out-of-pocket costs to be aware of.
Pro tip:Ask your therapist or doctor about the specific diagnostic code(s) they’ll use when they file your claim. Giving this code to your insurance companies ahead of time can help you determine how much of your therapy services will be covered and how much (if any) you’ll owe out of pocket.
3. Ask your employer’s HR
If you have insurance through your company, your Human Resources (HR) department should be well-equipped to answer any questions you have.
Pro tip:You don’t need to go into the specifics about the types of services you want to receive unless you’re comfortable doing so.
4. Ask the therapist
You’re always free to ask a therapist before you seek mental health treatment if they accept your insurance. It’s smart to do so before your first therapy session, even if you find them listed on your insurance company’s website, as providers can opt-out of plans at any time.
Pro tip:You should verify with both the therapist and your insurance company to be certain they are in network.
“Finding a good licensed therapist can take time, depending on your preferences and needs. Doing your homework on reimbursement rates and therapy session limits can ease the search for the right clinician for you. Talkspace offers accessibility to licensed therapists and prescribers, with options for self-pay and plans through your employer or school.”
Online Therapy Health Insurance Coverage
Online therapy can be a great option for people who are nervous about getting mental health help, or for those who are busy and lead such hectic lives they simply can’t fathom fitting one more thing onto their plate. Online therapy offers more than just convenience though. It’s also an incredibly private experience that many people thrive in. Most plans are covering telehealth and online services now, which makes getting therapy as simple as logging onto a platform or app.
Sources:1. American Psychological Association (APA). https://www.apa.org.https://www.apa.org/. Published 2021. Accessed November 8, 20212. The Mental Health Parity and Addiction Equity Act (MHPAEA) | CMS. Cms.gov.https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet. Published 2021. Accessed November 8, 2021.3. Frank R, Beronio K, Glied S. Behavioral Health Parity and the Affordable Care Act. J Soc Work Disabil Rehabil. 2014;13(1-2):31-43. doi:10.1080/1536710x.2013.870512.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334111/. Accessed November 8, 20214. Murray C. The Average Cost of Therapy in 2022. Bankrate. Published May 5, 2023.https://www.bankrate.com/finance/credit-cards/average-cost-of-therapy/
Sources:
American Psychological Association (APA). https://www.apa.org.https://www.apa.org/. Published 2021. Accessed November 8, 2021
The Mental Health Parity and Addiction Equity Act (MHPAEA) | CMS. Cms.gov.https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet. Published 2021. Accessed November 8, 2021.
Frank R, Beronio K, Glied S. Behavioral Health Parity and the Affordable Care Act. J Soc Work Disabil Rehabil. 2014;13(1-2):31-43. doi:10.1080/1536710x.2013.870512.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334111/. Accessed November 8, 2021
Murray C. The Average Cost of Therapy in 2022. Bankrate. Published May 5, 2023.https://www.bankrate.com/finance/credit-cards/average-cost-of-therapy/
Our goal at Talkspace is to provide the most up-to-date, valuable, and objective information on mental health-related topics in order to help readers make informed decisions.
Articles contain trusted third-party sources that are either directly linked to in the text or listed at the bottom to take readers directly to the source.
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