One in three Americans has resolved to make 2025 the year they get therapy. If you’re one of them, brace yourself: Figuring out how to get your insurance benefits to cover therapy can take some legwork.
The drudgery of figuring out whether and how your insurance plan covers therapy — or choosing between plans in the hope of getting therapy covered — can feel overwhelming. In a recent poll, more than half of Americans surveyed said mental health treatment costs were a major barrier to care, while four in 10 people said the scarcity of providers was a big obstacle. A third of psychologists don’t take insurance at all, and even people who get health insurance through their jobs often have to go out of 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,” wrote Hannah Wesolowski, chief advocacy officer at the National Alliance on Mental Illness (NAMI), in an email to Vox. “We wait longer, we pay more, and we have less choice for providers.”
That 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 US has had a law — the Mental Health Parity and Addiction Equity Act — that requires most health insurance plans to provide mental health coverage that’s as good as their physical health coverage. In particular, the law forbids insurance companies from charging more for visits to a mental health care provider than for other visits, or from limiting the number of those visits its plans cover.
However, this regulation hasn’t exactly created a consumer utopia. Insurance companies often pay super low rates to mental health providers in their networks, so many therapists simply opt out of partnering with insurance plans. People seeking in-network care are also often faced with “ghost networks,” provider directories that seem robust at first before you find out that many of the providers aren’t actually taking new patients, says Wesolowski. That means many people often end up having to contact four or more providers before finding an in-network therapist. People who struggle to find a covered therapist often end up going without.
A new law passed in September takes aim at the sparse network problem, and may force health insurance companies to expand their provider networks in the next few years.
What do all these insurance terms mean?
People trying to get therapy covered by their insurance typically run into a few different types of charges that it’s helpful to understand:
- Co-pays and co-insurance. These are out-of-pocket payments you make when you visit a therapist or buy medication. Co-pays are a set amount — you might get 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 each visit’s cost. With co-insurance, the discounted price doesn’t usually apply until you’ve already spent a certain amount of money on your health care. That spending threshold is known as a…
- Deductible. This is the amount you have to pay out of pocket each year before your insurance plan starts kicking in its share of costs. For example, if your deductible is $2,000, you’ll pay the full cost of all of your physical and mental health care until you’ve hit that threshold; afterward, you’ll only pay a portion of the cost (e.g. co-insurance or your regular co-pays).
- Out-of-pocket maximum. This is the most you’d have to spend on all the services your insurance plan covers in a year, including your deductible and any co-pays or co-insurances.
If you’re evaluating a health plan to determine how it covers therapy, look at the section of the plan document on mental health, under the “outpatient” subsection. Look for language describing visits to a therapist: This might include language like “office visits,” “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 kick in some percentage of the visits’ cost until the end of the year. Alternately, you might have to pay a co-pay for every visit, while the plan covers the rest. Still other plans may fully cover a certain number of visits before you start paying out of pocket.
In most insurance plans, getting care from the plan’s network of providers will likely cost you less than care from out-of-network providers. Many plans will pay some percentage of the total cost for providers in their network, and a lower percentage (or nothing) for providers out of network. Read through the plan carefully and call your insurance company (the 800 number on your insurance card) if you have questions.
Lastly, the plan should also note the number of visits it will cover in one year, something like the “calendar year maximum.” Most plans are now required to cover unlimited visits, but there are a few exceptions.
Once you start therapy, many therapists will give you the bill directly, which you pay and then submit to your insurer for reimbursement.
Should you find a therapist first, or choose an insurance plan first?
One of the key predictors of how helpful therapy will be is whether you “click” with your therapist — so having a range of personality types and approaches to choose from is good for consumers. But, insurance companies limit the number of therapists you can access at a lower cost. If you want to start therapy, it can be challenging to figure out whether to choose a therapist first and then see if they fall under an insurance plan, or choose an insurance plan first, then find a therapist from the plan’s list of in-network providers.
There’s no wrong choice here — how you approach this really depends on what you value most and the resources you have at hand. If it’s most important to you to keep costs down, it makes sense to find an insurance plan with decent therapy coverage first, and steel yourself to do some digging for a therapist match once you’re covered. (We’ve got some tips on finding a provider that’s a good fit here.)
However, if you’re set on working with a particular mental health practitioner, it might make more sense to ask the provider which insurance plans they work with. (If you choose this route, make sure you know exactly which plans the provider accepts — it’s not enough to know the insurance company’s name.)
What if I don’t have insurance? Or can’t afford therapy?
If you’re uninsured, it’s worth checking whether you qualify for government-sponsored insurance programs like Medicaid or Medicare — or can afford to buy your own insurance, either through your job, from your state’s 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 full price out of pocket may be an option. It’s costly, typically ranging from $100 to $200 for a session. Some providers offer therapy on a sliding scale — which means lower costs for people with less ability to pay — so it’s worth asking.
Many online-only providers provide services to people paying out of pocket (some also accept certain insurance plans) and can be very effective. “The pandemic changed the way we thought about telehealth,” says Jeff Ashby, a psychologist and professor at Georgia State University who researches stress and trauma. “What we discovered — consistent with previous research — is that a whole lot of issues can be treated using telehealth.”
There are also low- and no-cost therapy options out there. Megan Rochford, who oversees NAMI’s national helpline, suggests looking for universities with graduate programs training people to provide psychotherapy; these often offer treatment for free.
Although many people may think of talk therapy and medications as the cornerstones of care, there are other ways to get help and support from other people. Group therapy is typically less expensive than individual therapy, and for some people, is just as effective. The American Group Psychotherapy Association has a website where you can search for certified group therapists near you.
Self-help and support groups can also be helpful in lots of situations; you can find a few lists of support groups here and here. Some people may also find peer support, healing circles, and other community care approaches very useful.
In addition, there are lots of free and confidential mental health “warmlines” that provide help over the phone: The National Alliance on Mental Illness (NAMI) runs a national helpline, and many states run their own warmlines. These are different from hotlines like 988 in that they’re geared less toward supporting people through a crisis and more toward connecting people with resources for future care.
NAMI and Mental Health America have websites with troves of resources for people seeking low-cost support for mental health concerns: Check out their page on community care, their directory of helplines, and other resources.
However you choose to get help, it’s worth remembering that you’re not walking alone.
