Will My Health Insurance Plan Cover Therapy?

Health insurance, including Medicare and Medicaid, may cover some or all of your therapy costs, although coverage can vary among insurance plans and therapists. Even if you don’t have access to health insurance or your benefits don’t make therapy affordable, there may be low-cost alternatives that can help you get the mental health assistance you need.

Learn when insurance covers therapy, what types of therapy are typically covered and alternatives to health insurance for getting therapy services.

Key Takeaways All ACA-compliant health care plans must cover therapy services for mental health care. You can check your mental health coverage by using your insurer’s online portal or calling your carrier directly. Health insurance may cover telehealth therapy, but coverage will vary among plans and therapists. Covered disorders may include — but are not limited to — major depressive disorder, autism, bipolar disorder, panic disorder, schizophrenia and obsessive-compulsive disorder. The average cost of therapy ranges from $100 to over $200 per session, but there may be affordable alternatives to finding therapy if you don’t have health insurance.

When Does Insurance Cover Therapy?

The Affordable Care Act (ACA) lists therapy as an essential health benefit in all ACA health plans purchased through your state’s health insurance marketplace. Coverage may extend to most mental health disorders, substance use disorders and the treatment for chemical and alcohol addiction. Covered treatments and coverage limits will depend on your insurance plan and company.^[1]

Many types of health insurance plans may cover therapy, including:

• Plans purchased through your state’s health insurance marketplace
• Employer-sponsored group health coverage
• Medicare (Part B covers depression screenings, individual and group psychotherapy, medication management, psychiatric evaluations and more)
• Medicaid
• Children’s Health Insurance Program (coverage for children whose families do not qualify for Medicaid)

However, keep in mind that private health care plans can vary in mental health and substance use benefits and may offer fewer services compared to Medicaid or public mental health programs.^[2]

Does Insurance Cover Therapist Visits?

Health insurance often covers therapist visits, including in-person sessions, telehealth and group therapy. However, your insurer may place an annual cap on the number of covered therapy sessions. If you need continued treatment, your therapist can submit a letter to your insurance provider requesting additional coverage for ongoing services.

During the initial therapy session, your therapist typically asks multiple questions so they can submit an accurate current procedural terminology (CPT) code for your treatment. These codes are submitted to health insurance companies as shorthand and let the insurer know how long the session was and whether it was an individual, group or telehealth session. Common CPT codes include:^[3]

• 90837: Psychotherapy, 60 minutes with the patient
• 90834: Psychotherapy, 45 minutes with the patient
• 90791: Psychiatric diagnostic evaluation
• 90847: Family psychotherapy (conjoint psychotherapy) with the patient present, 50 minutes
• 90834-95: Psychotherapy 45 minutes, telehealth
• 90853: Group psychotherapy (other than of a multiple-family group)
• 90832: Psychotherapy, 30 minutes with the patient
• 90837-95: Psychotherapy, 60 minutes, telehealth modifier
• 97803: Medical nutrition therapy; intervention and reassessment, individual, face-to-face with the patient, 15 minutes each
• 99214: Office or another outpatient visit for the evaluation and management of an established patient, requiring a medically appropriate history and/or examination and a moderate level of medical decision-making

Your therapist will submit this information to your insurer, including your diagnosis and recommendations for treatment. Your plan may cover the costs, but you might need to pay a copay or meet your plan’s deductible first.

Typically, you won’t need to file a claim — your therapist will send the necessary documentation to your insurance provider.

Does Insurance Cover Mental Health Services?

Federal law requires that essential health benefits include behavioral and mental health services, such as counseling, psychotherapy, substance use disorder treatment and inpatient mental and behavioral health services.^[1] These services must be managed the same way as physical medical services, but your insurer may limit the number of covered therapy sessions. Additionally, out-of-pocket costs, like deductibles and copays, can still apply.

Does Insurance Cover Online Therapy?

While not always covered by every insurer, health insurance companies are increasingly covering online therapy (telehealth). However, coverage may be limited to in-network providers.^[4]

Some companies offer telehealth services, but whether they accept insurance can vary. For example, the prominent online therapy company BetterHelp doesn’t accept health insurance.^[5] You’re best advised to check with your insurer to see if they cover telehealth services with your therapist.

How Do I Know if My Health Insurance Provider Covers Therapy?

The simplest way to find out if your health plan covers therapy services is to contact your insurer directly. The representative you speak with can explain what your plan includes and whether you’ll need to pay a copay or meet your deductible. They can also provide a list of therapists and mental health practitioners within your plan’s network.

You can also search online for therapists in your area. Many list which insurance plans they accept, along with pricing. Additionally, you can log in to your patient portal through your health care provider’s website to view a list of your benefits.

Can I Get Therapy From an Out-of-Network Provider?

Don’t be discouraged from seeking therapy from an out-of-network provider. This may apply if you have particular therapeutic requirements that cannot be met by an in-network practitioner. If this fits your situation, ask your insurance carrier if any out-of-network benefits are available.

If the benefits outweigh the added costs, ask your therapist if they can issue a superbill — a detailed invoice of services — to submit to your insurer for possible reimbursement. Providers who may issue superbills include:^[6]

• Psychologists
• Counselors and psychotherapists (therapists)
• Clinical social workers
• Psychiatrists
• Psychiatric nurse practitioners
• Mental health or substance use clinics or facilities

Once the superbill is submitted, your insurance company will determine how much it will cover. For example, if your therapy bill is $200, your insurer may cover $150 and leave the remaining $50 as your responsibility, depending on your plan’s terms.

What Types of Therapy are Covered by Insurance?

Below are several types of mental health therapy services that are often covered by insurance:

• Adult treatment programs: Your health insurance may cover programs for adults experiencing depression, anxiety, suicidal ideation and other emotional or behavioral health concerns. Services may include partial hospitalization, inpatient care, outpatient specialty treatment and psychiatric home care.
• Child and adolescent programs: Your health care policy may include programs for children and teens dealing with anxiety, depression, bipolar disorder, substance use, aggressive behavior and self-harm.
• Cognitive treatment programs: Your health insurance may grant you access to programs that treat mood and anxiety disorders, including major depression, bipolar disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
• Dual recovery treatment programs: Your healthcare policy may provide treatment for substance use and behavioral health issues (co-occurring) that are designed to help patients understand the connection between mental health and addiction.
• Eating disorder treatment programs: Your health care coverage may include hospitalization and intensive outpatient treatment for those with bulimia, anorexia or binge eating disorders.
• Older adult service programs: Your health insurance provider may have mental health treatment programs tailored specifically to the elderly, including outpatient services for anxiety, depression and suicidal ideation.

You can typically log in to your health care provider’s online portal and search for specific therapy programs in your area that will be covered.

Do I Need Health Insurance To Get Therapy?

Health insurance is not necessary for receiving therapy. You can pay for therapy services out of pocket, but you may pay higher prices since you are not splitting the bill with your insurance company.

Despite costs, it’s still worth considering therapy even if you don’t have health insurance, as there are several ways you may be able to access low-cost mental health services and treatment.

What Options Are Available if I Have No Coverage for Mental Health Services?

If your financial situation makes you hesitant to seek mental health care, there are several options available. Review the resources below to find affordable support.

• The National Alliance on Mental Illness: The National Alliance on Mental Illness (NAMI) offers free 24/7 assistance by offering one-on-one emotional support and mental health information and resources through a helpline that can be reached by calling 1-800-950-6264. You can also text NAMI at 62640 for more information.^[7]
• University services: Some university hospitals offer low-cost mental health care through interns or residents. Costs may be on a sliding scale.
• Open Path Psychotherapy Collective: This nonprofit allows users to search their area for affordable therapists. In addition to a one-time membership fee of $65, costs generally range between $30 and $70 per session for individual, group, couple or family therapy.^[8]
• Employee Assistance Programs: Your employer may offer mental health benefits through their Employee Assistance Program (EAP), making these benefits free to you. Keep in mind there will likely be a limit on the number of free EAP benefits you can receive per year.^[9]
• Disability benefits: You can potentially receive financial aid through Part B of Medicare if you have a qualified diagnosis for a chronic mental health issue that inhibits your ability to work, allowing you access to Medicare before reaching the age of 65. Through Medicaid, individual states can also enact “medically needy programs” for those with significant health needs and an income too high to traditionally qualify.
• Negotiation: The therapist you see may adjust their pricing to accommodate your budget, as they often use a sliding scale based on your income when calculating what they charge for services. You can also ask whether there are discounts for paying in cash if you have the means.

How To Get Health Insurance To Cover Therapy

You’ll want to gather quotes from three to five different insurers offering therapy coverage to compare prices and understand your options. Each insurance company will need personal information, such as your age and whether you use tobacco. You’ll likely need to get these quotes from each insurer one at a time, which can become time-consuming and tedious.

Use an insurance marketplace like SmartFinancial to speed things up. After answering a brief questionnaire, we can connect you with a licensed insurance agent to help you get the coverage you need. Click here for a free health insurance quote today!