Does Insurance Cover Therapy?

Updated 3/20/24

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, of therapy costs. And for those without health insurance, there are still numerous avenues to explore for obtaining the mental health care you need.

Wondering whether therapy is covered by your insurance? We’ll guide you through the intricacies of getting in-person and online therapy covered by insurance. By understanding the potential for mental health coverage, you can take a crucial step toward prioritizing your well-being. 

Is Therapy Covered by Insurance?

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

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 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:

• 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

Options for Getting Therapy Covered by Insurance

Individual insurance plans

Individual insurance plans typically include coverage for therapy and mental health services, making them a vital resource for those seeking support. These plans, which are purchased independently rather than through an employer, offer varying degrees of mental health coverage, often dictated by the specifics of each policy. Understanding the nuances of your plan is essential for accessing and utilizing therapy services.

Some considerations may include:

• Plan types: The type of individual insurance plan you choose (like HMO, PPO, or EPO) can affect your access to mental health services. Each plan type has its own network of providers and rules for coverage. For instance, HMO plans might require seeing a primary care physician before visiting a therapist, while PPO plans offer more flexibility but potentially higher out-of-pocket costs.
• Coverage limits and restrictions: Individual plans may have specific limits on the number of therapy sessions covered per year or impose certain restrictions, such as requiring a referral for therapy services. These limits and conditions can vary widely between different insurance plans.
• Out-of-pocket costs: Understanding your plan’s deductible, copayments, and coinsurance is vital. These are the costs you’re responsible for when accessing therapy services. Some plans might have high deductibles that must be met before coverage kicks in, while others might have more manageable co-pays per therapy session.
• In-network vs. out-of-network providers: Plans typically have a network of therapists and mental health professionals who are considered “in-network.” Visiting these providers usually results in lower out-of-pocket costs. Going to an out-of-network therapist often means higher costs and less coverage, but it might be necessary if you need a specialist or if in-network options are limited.
• Coverage for different therapy modalities: Individual plans may cover various forms of therapy, such as individual, group, or family therapy. The coverage might differ based on the therapy type, so it’s important to check what your plan specifically covers.
• Telehealth options: Many individual insurance plans now include coverage for telehealth services, which can include online therapy. This can be a convenient and sometimes more affordable option for accessing mental health services.

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.

Small businesses (50 employees or less)

Companies with fewer employees might offer more limited plans with a smaller network of therapists. However, they are still required by law (Affordable Care Act) to provide mental health coverage if they offer health insurance.

Larger corporations (51 employees or more)

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:

• Therapy
• Counseling
• Medication management
• Peer support
• Social work services
• Substance use disorder treatments

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 an essential 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:

• Medicare Part A: Part A covers inpatient behavioral healthcare and substance use services. However, you may be responsible for deductible and coinsurance costs if you’re hospitalized.
• Medicare Part B: Provides coverage for outpatient services, including individual and group therapy sessions. It also covers psychiatric evaluations and preventive services, such as depression screenings.
• Medicare Advantage (Part C): Covers therapeutic services at least at the level of your original Medicare plan or better.
• Medicare Part D: Includes coverage for prescribed medications that may be necessary alongside therapy.

Talkspace therapy is also covered by Medicare in certain states, with more states being added soon. (Medicare Advantage does not cover Talkspace at this time.)

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 $200 per session. These costs can vary based on the therapist’s location and expertise. For uninsured individuals, options like sliding scale therapy fees, community health centers, or online therapy platforms can offer more affordable therapy services.

What Types of Therapy Are Covered by Insurance? 

Mental health services and treatments that are covered by insurance can vary depending on the insurance company and health plan.

Some of the mental health treatments that are most often covered include:

• Co-occurring behavioral health and medical conditions — for example, dual diagnoses like coexisting depression and addiction 
• Psychiatric emergency care
• Talk therapy — cognitive behavioral therapy and psychotherapy
• Telemedicine or online therapy
• Outpatient therapy sessions
• Addiction treatment
• Detox services

In general, marriage counseling and couples counseling are not covered by insurance, but you can still find affordable therapy for couples through online therapy platforms like Talkspace.

“Behavioral health therapy and support for substance abuse disorders are both covered by most insurance plans and should be comparable to medical care coverage, depending on your plan type. Familiarize yourself with the terms of your health insurance plan to better understand what providers and services are available to you.”

Talkspace therapist Elizabeth Keohan, LCSW-C

How to Find Out if Your Insurance Covers Therapy

To find out if your health insurance covers therapy in 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 make absolutely sure they’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.”

Talkspace therapist Elizabeth Keohan, LCSW-C

Psychology Today is another great resource for finding a licensed therapist or mental health professional covered by insurance in your area. There are specific filters that allow you to tailor your search to exactly what you’re looking for in your therapist.

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.

Looking for online therapy that takes insurance? Talkspace is covered by a number of mental healthcare providers and insurance companies, including Cigna, Anthem, Optum, TRICARE and more. To see if your employer or health plan will cover your therapy, check with your specific insurance provider and plan. If therapy is covered by your insurance, learn how to find a therapist online with us.

Sources:

1. American Psychological Association (APA). https://www.apa.org. https://www.apa.org/. Published 2021. Accessed November 8, 2021

2. 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, 2021

4. 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/