One in three Americans They decided to make 2025 the year of receiving the therapy. If you’re one of them, brace yourself: Figuring out how to get your insurance benefits to cover therapy can take some work.
The daunting task of finding out if and how your insurance plan covers therapy — or choosing between plans in hopes of covering therapy — can feel overwhelming. In a recent survey, More than half Among Americans surveyed, the cost of mental health treatment is a major barrier to care, while four in 10 say lack of providers is a major barrier. A third of psychologists Don’t take insurance at allAnd even those who get health insurance through their jobs often have to Go outside the network For their mental health care.
As complicated as it is for Americans to get physical health care covered by insurance, “people with mental health conditions get the short end of the stick,” writes Hannah Wesolowskichief advocacy officer for the National Alliance on Mental Illness (NAMI), in an email to Vox. “We wait longer, we pay more and we have fewer choices for suppliers.”
This makes it especially important to understand how to navigate the mental health benefits insurance plans offer. Here’s what you need to know.
Do most insurance plans cover therapy?
For more than 15 years, the United States has had a law – the Mental Health Parity and Addiction Equity Act – which requires most health insurance plans to provide mental health coverage that is as good as their physical health coverage. Specifically, the law prohibits insurance companies from charging more for visits to a mental health care provider than for other visits, or from limiting the number of visits that the plan covers.
However, this regulation did not exactly create a consumer utopia. Insurance companies often pay mental health providers in their networks at very low rates, so many therapists simply opt out of partnerships with insurance plans. Wesolowski says people looking for in-network care often encounter “ghost networks,” which are provider directories that appear strong at first, only to find out that many providers aren’t actually taking new patients. That means many people end up having to communicate more often Four or more providers Before finding an in-network therapist. Those who struggle to find a covered therapist often end up going without.
A new law Passed in September take aim Sparse networks are problematic, and may force health insurance companies to expand their provider networks in the next few years.
What do all these insurance terms mean?
There are usually a few different types of people who are trying to get therapy covered by their insurance Type of charge It is helpful to understand that:
- Co-payments and co-insurance. These are your out-of-pocket payments when you visit a therapist or buy medicine. Co-payments are a fixed amount — you may be charged a $30 co-pay for each therapy visit — while co-insurance payments charge you a proportion of the price tag; For example, 30 percent of the cost of each visit. with Co-insuranceThe discounted price usually doesn’t apply until you’ve already spent a certain amount on your health care. That cost threshold is known as a…
- deductible You have to pay this amount out of pocket each year before your insurance plan starts kicking in the cost share. For example, if your deductible is $2,000, you will pay the full cost of all your physical and mental health care until you reach that threshold; Then, you’ll only pay a portion of the cost (such as co-insurance or your regular co-pay).
- Out of pocket max. This is the most you’ll pay for all the services your insurance plan covers in a year, including your deductible and any co-pays or co-insurance.
If you are evaluating a health plan to determine how it covers therapy, see the plan document’s section on mental health under the “Outpatient” subsection. Look for language describing seeing a therapist: This may include language such as “office visit,” “individual, family or group psychotherapy,” “medication management,” and “virtual care” or “telehealth.”
Some plans may require you to pay full price for therapy visits until you reach your deductible, then cover a percentage of the visit until the end of the year. Alternatively, you may have to pay a co-pay for each visit, while the plan covers the rest. Still other plans may cover a certain number of visits in full before you start paying out of pocket.
In most insurance plans, care from the plan’s network of providers will cost you less than care from out-of-network providers. Many plans will pay a percentage of the total cost to providers in their network and a lower percentage (or nothing) to providers outside the network. Read the plan carefully and call your insurance company (800 number on your insurance card) if you have questions.
Finally, the plan should also note how many visits a year will cover, something like “calendar year maximum.” Most plans now require unlimited visitation coverage, but there are a few exception.
Once you begin therapy, many therapists will bill you directly, which you will pay and then submit to your insurer for reimbursement.
Should you find a therapist first, or choose an insurance plan first?
One of the main predictors of how helpful therapy will be Whether you “click” with your therapist — so it’s good for consumers to have a range of preferred personality types and styles. However, insurance companies limit the number of therapists you can access at low cost. If you want to start therapy, whether to choose a therapist first and then see if they are covered by an insurance plan, or choose an insurance plan first, then finding a therapist from the plan’s in-network list can be difficult. provider
There’s no wrong choice — how you approach it depends on what you value most and the resources you have at your disposal. If keeping costs down is most important to you, it makes sense to find an insurance plan with decent therapy coverage first, and prepare yourself to do some digging for a therapist match once you’re covered. (We’ve got some tips on finding a suitable provider here.)
However, if you are set on working with a specific mental health practitioner, it may make more sense to ask the provider what insurance plan they work with. (If you choose this route, make sure you know right The plan provider accepts — knowing the name of the insurance company is not enough.)
What if I don’t have insurance? Or can’t afford therapy?
If you are uninsured, you should check to see if you qualify for government-sponsored insurance programs Medicaid or Medicare — or through your job from your state, you may be able to afford to buy your own insurance Affordable Care Act Exchange (also known as the ACA, or Obamacare), or from an insurance broker.
If you can’t get health insurance, you still have options. If you want therapy, paying the full price out of pocket may be an option. It is expensive, usually starting from $100 to $200 Some providers offer therapy on a sliding scale for a session – meaning lower costs for people who can afford to pay less – so it’s worth asking.
a lot Online providers only Services are offered to people paying out of pocket (some take certain insurance plans) and can be very effective. “The pandemic has changed the way we think about telehealth,” said Jeff Ashbyis a psychologist and professor at Georgia State University who studies stress and trauma. “What we discovered—consistent with previous research—is that many problems can be treated using telehealth.”
There are also low- and no-cost therapy options. Megan Rochford, who oversees NAMI’s national affairs HelplineAdvises people to look for universities with graduate programs training to provide psychotherapy; They often offer free treatment.
Although many people may think of talk therapy and medication as the mainstay of care, there are other ways to get help and support from other people. group therapy It is usually less expensive than individual therapy and is for some people Just as effective. The American Group Psychotherapy Association has one website Where you can search for certified group therapists near you.
Self-help and support groups can also be helpful in many situations; You can find several lists of support groups here And here. Some may even find it Peer supportHealing circle, and Other Community care methods are very useful.
In addition, there are many free and confidential mental health “hot lines” that offer phone support: The National Alliance on Mental Illness (NAMI) operates a national HelplineAnd many states run their own hot line. They differ from hotlines like 988 in that they are geared less toward supporting people in a crisis and more toward connecting people with resources for future care.
NAMI And Mental Health America There are websites with resources Relief for people seeking low-cost help with mental health concerns: visit their page Community caretheir Directory of helplinesAnd other assets.
However you choose to get help, it’s worth remembering that you’re not walking alone.
