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 

Insurance Coverage

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.

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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 

Generally, initial appointments, usually an assessment or intake interview, will cost more than the follow-up visits. The first visit involves going over medical history and deciding on a psychotherapy treatment plan with the therapist, which takes longer and costs more than ongoing treatment sessions.3 

What to Know About Common Insurance Coverage for Therapy

There are many different types of insurance coverage for therapy, which all depend on what kind of plan you have and what the therapist’s office accepts.

Employer-Sponsored Insurance in Companies of Fifty+ Employees

Most employer-sponsored insurance plans will offer mental health coverage. In companies with fifty or more employees, federal law mandates that this type of coverage is included. This is called the Mental Health Parity and Addiction Equity Act (MHPAEA).4
With any other plan covered by an employer, it might be required to pay a monthly premium for therapy insurance, a copayment for each session, or an annual deductible before payment for therapy at a reduced rate can begin.

Employer-Sponsored Insurance in Companies Under Fifty Employees

The Fair Labor Standards Act (FLSA) makes it essential for employers to provide employees with health insurance only if the company employs fifty or more people. Many companies under fifty employees do not offer healthcare coverage to their employees, which means that each employee would be responsible for paying for therapy out of pocket. Suppose your company is under fifty employees and does not offer mental health insurance as one of its benefits. In that case, you will have to pay for therapy out of pocket. If cost is a concern, you can talk to your therapist about a sliding scale payment system.

Health Insurance Marketplace Plans

While most marketplace plans cover mental health and substance use disorder services, they don’t cover everything. Some programs have restrictions or higher cost-sharing. You can find out what mental health and substance use disorder services your plan covers by looking at your plan’s Summary of Benefits and Coverage (SBC).

CHIP (Children's Health Insurance Program)

CHIP insurance covers mental health treatment sufficiently. There have been recent cuts to spending on the program, but it still provides:

Medicaid

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

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

Not all therapy is covered by insurance. Some services that insurance companies consider unnecessary aren’t typically covered by mental health benefits. These include:
  • 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

Insurance typically starts after a minimum of $1,000 has been spent out of pocket. This is called the deductible. After that, a patient is responsible for 20% of the cost and should expect to pay a copayment at each visit. It’s good to check with your insurance company to know that your insurance covers therapy before starting.

FAQs

Below are some common questions people ask when considering counseling.

Insurance Coverage

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.

Does Insurance Cover Mental Health Problems?

You should check your insurance policy for details about if there are psychological treatments or psychotherapy covered by medical insurance and how much your insurance company will pay. Also, find out if there is a fee for each service, what percentage your insurance company will cover, and how much you have to pay out-of-pocket. You may also have to locate a psychiatrist covered by insurance.

REFERENCES

  1. https://www.medicalnewstoday.com/articles/323367
  2. https://www.healthline.com/health/mental-health/talk-therapy#:~:text=Talk%20therapy%2C%20which%20is%20also,issues%20that%20cause%20emotional%20distress.
  3. https://www.apa.org/topics/psychotherapy/understanding
  4. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet
  5. https://www.mentalhealth.gov/get-help/health-insurance
  6. https://www.medicaid.gov/medicaid/eligibility/index.html
  7. https://www.policygenius.com/health-insurance/out-of-pocket-maximum/