It’s not uncommon for people to put off or avoid getting the mental health care they need. Sometimes, this can be due to a fear of the cost of treatment. There’s a perception that therapy cost can be quite expensive, and unfortunately mental health always doesn’t have the same priority in our society as physical health does.
The truth is though, you might be able to afford more therapy than you think. In fact, your insurance may even cover some (or all) of it — and even if you don’t have health insurance coverage, there are several options available to get the mental health care you need.
If you’ve been asking the question is therapy covered by insurance, keep reading to learn more. We’re covering all you need to know about in-person and online therapy covered by insurance so that you’re informed and aware of your rights and ability to get mental health coverage.
“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
Can You See a Therapist on Insurance?
The simple and broad answer is typically yes, you can see a therapist through your insurance. Unfortunately, there’s more to it. The more thorough and often complex answer is what type and how much coverage you have sometimes depends. There are significant and varying differences surrounding what types of insurance benefits insurers provide. There are also out-of-pocket costs you should be aware of.
There can be one single overarching determiner about what access you have to therapy covered by insurance. It’s whether a specific mental health condition diagnosis has been made. Mental health conditions can include:
Insufficient sleep syndromeAcute stressPhobiasAnxietyDepression
Laws have been enacted to protect those who are diagnosed with a mental health condition to ensure they can get the health coverage and mental health help they need.
Does Your Insurance Provider Cover Therapy?
You might be able to get therapy covered by insurance through your employer’s healthcare plan, but you’ll have to do your due diligence to find out what type of coverage you have through a company plan.
Even if the answer to the question is therapy covered by insurance is yes, some people still choose not to use it. This may in part be because insurance companies will only pay for medical services that are deemed necessary. To achieve that status, you need an official diagnosis. Some people feel uncomfortable with having this on record, but it’s a personal choice.
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 servicesBehavioral health treatments (including counseling and psychotherapy)Coverage for pre-existing conditionsParity protections that ensure coinsurance, co-pays, and deductibles are either the same or close to any medical and surgical benefits that are offered
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 both addiction and mental health conditions. 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.
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:
TherapyCounselingMedication managementPeer supportSocial work servicesSubstance use disorder treatments
Medicaid
Medicaid plans are state-run and required to cover anything deemed as an essential health benefit. This includes both substance use services and mental health services. Like CHIP, Medicaid plans will differ from state to state, but they too are subject to MHPAEA requirements.
Medicare
Part A of Medicare will cover substance use services and inpatient behavioral healthcare. You may be responsible for deductible and coinsurance costs if you’re hospitalized.
In terms of outpatient mental health services, Part B covers many services, including yearly depression screening. Out-of-pocket costs may be required to cover the cost of therapeutic services and any Part B deductible, co-pays, or coinsurance.
Medicare Advantage (known as Part C) will typically cover therapeutic services at least at the level of your original Medicare plan or better.
Blue Cross Blue Shield
Today, thanks to the Affordable Care Act (ACA), most Blue Cross Blue Shield insurance plans will cover therapy. If you have a plan that started before 2014 — when the ACA was enacted — your plan may not cover mental health services. There are some additional caveats to this as well. Blue Cross Blue Shield only covers evidence-based services like psychoanalysis. Sessions with a life coach, career coach, etc. are not covered.
Kaiser Permanente
Kaiser Permanente offers mental health treatment plans that are personalized to each member. They’ll generally cover therapy with a nurse practitioner or psychiatrist, and they often cover group therapy as well. Kaiser goes a step further and offers stress management and mental health classes and addiction counseling.
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.
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 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.
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 company ahead of time can help you determine how much of services will be covered and how much (if any) you’ll owe out of pocket.
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.
Ask the therapist
You’re always free to ask a therapist before you seek treatment if they accept your insurance. It’s smart to do so, 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 therapist can take time, depending on your preferences and needs. Doing your homework on reimbursement rates and 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 therapist in your area. There are specific filters that allow you to tailor your search to exactly what you’re looking for in your therapist.
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 plan. Just asking ‘does insurance cover therapy’ is probably not enough for you to feel confident about what types of services you can expect to be covered.
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 careTalk therapy — cognitive behavioral therapy and psychotherapyTelemedicine or online therapyOutpatient therapy sessionsAddiction treatmentDetox services
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 providers. To see if your employer or health plan will cover your therapy, check out our full partner list. 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
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