Will My Treatment Be Covered by Insurance?
Read on to learn more about common insurance coverage for therapy and what kinds of treatments that are covered.
Therapy and Health Insurance Coverage
Insurance coverage can be an essential consideration if you’re looking for therapy. Health insurance therapy coverage is available for many health insurance providers and plans. Still, the amount of therapy and health insurance coverage varies from plan to plan. Is cognitive-behavioral therapy covered by insurance? Can you even get therapy through insurance? Here is some helpful information about health insurance therapy coverage.1
It might be surprising to learn that most policies cover insurance for therapy. Of course, it depends on the policy, but patients pay much less out-of-pocket when therapists accept insurance than when therapy isn’t covered.
Coverage Details to Consider
An individual may still have to pay a copay or deductible, but having even a little bit of insurance coverage can make a huge difference. It allows for the patient to attend therapy and get the help they need without having to worry about saving up money, or even going into debt, to cover necessary therapy bills. It is essential to know precisely the extent of insurance coverage your policy gives you. Most policies cover psychotherapy (counseling or talk therapy) and diagnostic assessments.2
What to Know About Common Insurance Coverage for Therapy
Employer-Sponsored Insurance in Companies of Fifty+ Employees
Employer-Sponsored Insurance in Companies Under Fifty Employees
Health Insurance Marketplace Plans
CHIP (Children's Health Insurance Program)
Medicaid is a federally funded health insurance program that covers mental health and substance use disorder services for individuals and families who receive Supplemental Security Income (SSI), meet financial criteria, or are pregnant. Medicaid doesn’t cover all types of therapy, so it’s essential to check with the provider to see what is covered on your plan and what therapy you can get through insurance.6
Medicare only has some forms of therapy covered by insurance. They provide coverage for psychological or neuropsychological testing but do not cover most forms of talk therapy. Those with a Medicare plan are advised to check their policy to see if it covers therapy. People with a Medigap plan can’t use it for mental health services unless they are also getting Medicare-covered skilled nursing care at the same time.
What Kinds of Treatments Are Typically Covered?
Different kinds of insurance policies cover different types of treatments. You’ll want to read up on what specifically your insurance coverage allows, but the following are some common types of therapy covered by insurance:
Services Usually Not Covered
- Cosmetic procedures (plastic surgery)
- Treatments for fertility issues
- Off-label prescriptions
- New technology used for products or services
How Do You Know If Your Insurance Covers Therapy?
We know it can be stressful to investigate insurance coverage, but we’re here to help! Here are some steps you can take to make sure you’re covered:
- Register and log on to your insurance account online
- Call your insurance provider
- Check with your company’s HR department
- Ask the therapist if they accept your insurance
When Does Insurance Start for Mental Health Services?
If you’re going to see a therapist or counselor, the good news is that most health insurance plans cover at least some of your therapy. If they don’t, you might still be able to get help paying for it through services provided through the state.
After Prior Authorization
Generally, health insurance therapy will kick in after prior authorization if the plan covers therapy insurance. Before patients can use insurance coverage, there needs to be permission from the insurance company, usually through approval from a doctor).
After Meeting a Deductible
After meeting your deductible, your insurance company will cover, or partially cover, the cost of your visits. The amount covered is based on a “coinsurance” percentage and whether or not the therapist is in-network. If they are in-network, they’ve agreed to accept a specific reimbursement rate from your insurance company beforehand through a therapist insurance.7
After Spending a Minimum
Below are some common questions people ask when considering counseling.
Does Health Insurance Cover Counseling?
The answer depends on your provider. Some insurance companies cover mental health treatment, while others do not. In addition to these differences, you may find that your provider may only allow you to choose between a few types of therapists and psychotherapy treatment plans.
What Is Medical Therapy Coverage?
Medical therapy coverage helps cover the cost of physical and occupational therapies and speech-language pathology services. These are services provided by healthcare professionals who specialize in the treatment of movement or cognitive functions.