You’ve recognized that you need a mental health professional to help work through some concerns. You chose a counselor with the right credentials and are ready to make an appointment. Now you’re wondering if your health insurance will cover therapy. The answer is probably.
Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008 to ensure equal treatment coverage for mental illness and addiction. The law requires that insurance companies treat mental health and substance use disorder coverage equal to or better than medical coverage. It means that insurance companies must handle mental and physical health treatment the same.
But insurance companies still may determine “medical necessity” in mental health coverage. Also, the law doesn’t cover all insurance plans.
The bottom line is that if you have health insurance, it probably provides some coverage.
The questions then become things like:
- How much of my therapy will insurance cover?
- Will insurance cover the counselor I want to see?
- What will I be responsible for out-of-pocket?
- When does coverage start?
- What counseling services will it cover?
Types of Insurance Coverage
If you have insurance through your employer, it may include therapy coverage. Whether you have mental health coverage depends on the type of insurance you have. If your health insurance provides mental health coverages, deductibles, and copays also likely apply.
How much those costs and what you’re responsible for out of pocket, depends on your insurance plan. Copays typically are $10-$40, depending on your insurance. Therapists typically charge $75-$200 a session.
Types of health insurance coverage include:
- Employer Paid Insurance with 50+ Employees: Companies with 50 or more full-time employees must provide health insurance. While the mandate doesn’t include providing mental health services coverage, most coverage includes some counseling services.
- Employer Paid Insurance with Fewer Than 50 Employees: Smaller companies are not required to provide health insurance for employees. But if they do, they must include coverage for mental health services.
- Marketplace Plans: Health insurance purchased under the Affordable Care Act must include coverage for mental health services. The terms of that coverage vary.
- Children’s Health Insurance Program: CHIP federally-funded children’s health insurance provides mental health coverage. The terms of the coverage vary among states.
- Medicaid: All state-run Medicaid plans must cover mental health services. The terms of coverage vary among states.
- Medicare: Medicare coverage covers mental health services, but the amount of coverage and the amounts you must pay depend on your plan. It also doesn’t cover all types of therapy.
While almost all health insurance provides some coverage for mental health services, some people choose not to use it for their therapy. This decision is because insurance companies only pay for services they consider “medically necessary.” That means you must have an official diagnosis on file for them to pay claims. Some people are not comfortable having their diagnosis on file and their employer potentially becoming aware of it.
How Do You Know if Your Insurance Covers Therapy?
You don’t want to make an appointment with your therapist, only to find that your insurance doesn’t cover it and you can’t afford their services. You also don’t want to find out too late that the counselor you’ve bonded with doesn’t accept your insurance.
To know if your insurance covers therapy:
- Check with Your Insurance Provider: Your insurance provider will have a list of services they cover online. If you still aren’t sure or want to find a more straightforward answer, you can call your provider and ask if your plan covers counseling and all the details involved.
- Check with Human Resources: You likely aren’t the first person in your company to have a question about counseling coverage. Ask your company’s HR representative whether your insurance plan covers counseling and the details of that coverage.
- Ask the Counselor: When you call to set up an appointment with the counselor you choose, ask the person booking your appointment whether they accept your insurance. They may not know the details of the plan’s coverage, but they can at least tell you if they take your insurance.
Therapy Coverage by Major Insurance Company
Aetna
Nearly all Aetna Behavioral Health plans cover therapy for mental and behavioral health conditions.
The Affordable Care Act requires that health insurance offered through the health insurance marketplace or small employers cover mental health services. While not required by federal law, most large employers also cover mental health services.
While rare, your Aetna plan may not cover therapy services if:
- You work for a large employer that doesn’t include mental health benefits in its insurance coverage.
- Your health insurance plan was created before 2014 when the ACA enacted its mental health coverage requirement.
In other situations, your Aetna plan may not cover the specific type of therapy service you’re seeking, or your coverage may not apply until you spend a certain amount on medical services.
To determine your copay:
- Log in to your member account
- Select “Find Care & Pricing”
- Type “Behavioral Health” to find providers in your network
You don’t need a referral when you visit any doctor in the Aetna network.
Learn more about Aetna mental health coverage.
Anthem
Anthem covers mental health services. But Anthem Blue Cross won’t cover any therapies that aren’t evidence-based or based. Treatment also needs to be based upon a specific mental health diagnosis. For these reasons, Anthem Blue Cross will not cover career counseling, life coaching, holistic therapies, or reiki healing
Therapy costs with Anthem Blue Cross vary based on the specific plan. A copayment of $50-$65 or a 20-50% coinsurance per session with your in-network therapist is typical.
Anthem Blue Cross offers both HMO and PPO plans. If you have an HMO health insurance plan, you need a referral from your primary care physician before you begin searching for a therapist. If you have a PPO plan, you can start working with a therapist as soon as you’re ready.
To check if your Anthem Blue Cross health insurance plan covers therapy services, review your summary and benefits document. You’ll find this document through your online Anthem Blue Cross account. Within this document, you’ll find the different rates of coverage — including copayment or coinsurance amounts — for each type of service available. Look for “outpatient mental health services” to see your coverage for therapy.
Learn more about Anthem behavioral health coverage.
Beacon Health Options
Beacon Health Options covers mental health services. Beacon often covers different kinds of psychotherapy depending on your specific insurance plan. Therapy options usually include coverage for mental health conditions and substance use issues.
Your therapist may use various techniques, but some common types of individual therapy that Beacon Health Options usually covers include Cognitive Behavioral Therapy (CBT) and Psychodynamic Therapy. You may also be covered for family or group therapy under your Beacon Health Options plan, depending on your specific coverage details.
Before starting therapy, double-check that your therapist accepts your Beacon Health Options insurance plan. You can also contact Beacon Health Options directly to find out more about what therapies your plan covers. To contact Beacon, call the number on your insurance card or use the online client portal.
Like most insurance, Beacon Health Options don’t usually covert:
- Couples counseling
- Life coaching
- Career coaching
- Therapy sessions outside the therapy office.
Contact the company directly if you’re not sure whether your plan covers a particular therapy.
The cost of therapy with Beacon Health Options changes, depending mostly on two key factors:
- Your specific plan’s benefits
- Whether you’re seeing a therapist who’s in-network with Beacon Health Options
Your deductible is the total amount you need to pay for medical costs each year before your insurance coverage begins. All your medical costs contribute to this, not just therapy costs. If you haven’t met your deductible for the year, your insurance usually will not cover therapy sessions, and you will be responsible for the total cost.
After you meet your deductible, your coinsurance is a set fee you pay at every therapy session. It typically ranges from $15 to $50 per session.
Depending on what kind of plan you have, you may need to get a referral from your primary care physician to see a therapist through Beacon Health Options. Here are the requirements:
- HMO – Yes, you’re typically required to see your primary care physician for a referral before your insurance company will provide outpatient therapy coverage.
- POS – Yes, you’re typically required to see your primary care physician for a referral to therapy before your insurance company will provide outpatient coverage.
- PPO – No, you typically don’t need to see your primary care physician for a referral before accessing outpatient mental health services.
- EPO – No, you typically don’t need to see your primary care physician for a referral before accessing outpatient mental health services.
Learn more about Beacon mental health coverage.
Blue Cross and Blue Shield
The majority of Blue Cross Blue Shield plans cover therapy. You may have coverage if you work for a large employer that doesn’t include mental health benefits in its insurance coverage, or your health insurance plan was created before 2014, when the ACA enacted the mental health coverage requirement.
There also are other situations when your Blue Cross Blue Shield plan may not cover the specific type of therapy service, or your coverage may not apply until you spend a certain amount on medical services first.
If you choose a therapist in-network with Blue Cross Blue Shield, your therapy sessions likely cost $15 to $50 per session after meeting your deductible. The amount is your copay or the fixed amount you owe at each therapy visit. The deductible is the total amount you need to spend on medical costs in any given year before your health insurance begins to cover the cost of services. Here are examples of what you may see on your summary of benefits and what they mean:
- $15 copay, after $5,000 deductible – After you spend $5,000 in medical costs this year, your therapy sessions will cost $15 per session.
- $15 copay, after $1,000 deductible – After you spend $1,000 in medical costs this year, your therapy sessions will cost $15 per session.
- $15 copay, deductible does not apply – Your therapy sessions will cost $15 per session regardless of your deductible amount.
If you choose a therapist who is not in-network with Blue Cross Blue Shield and have a Blue Cross Blue Shield PPO Plan, your therapy session will likely cost between $50-$100 per session or 20%-50% of the total amount that your therapist charges per session. This percentage is called coinsurance. You pay the therapist’s full fee at the session, send a claim to your health insurance company, and receive a check or direct deposit for the remaining percentage that your plan covers.
PPO plans typically only cover out-of-network services after you meet your deductible. Here are examples you may see on your summary of benefits and what they mean:
- 20% coinsurance, after $5,000 deductible, therapist charges $100/session – After you spend $5,000 in medical costs this year, your plan will reimburse you $80 of your therapy session fee. Your therapy cost is $20 per session.
- 20% coinsurance, after $1,000 deductible, therapist charges $150/session – After you spend $1,000 in medical costs this year, your plan will reimburse you $120 of your therapy fee each time you submit a claim. Your therapy cost is $24/session.
If you choose a therapist who is not in-network with Blue Cross Blue Shield and you have a Blue Cross Blue Shield HMO or EPO plan, your plan will likely not reimburse you for sessions. You would owe the therapist’s full fee at the time of the session and not receive reimbursement.
If cost is a barrier to seeking therapy, you can look for a therapist who offers a sliding scale or lower session fees based on financial need.
Whether you need to see your primary care doctor before visiting a Blue Cross Blue Shield therapist depends on your insurance plan type:
- HMO or POS plan – Yes, you are typically required to see your primary care physician for a referral to therapy before Blue Cross Blue Shield will pay for services.
- PPO or EPO plan – No, you typically don’t need to see your primary care physician for a referral to therapy before Blue Cross Blue Shield will pay for services.
To check whether your Blue Cross Blue Shield plan covers therapy, look for the “Outpatient Mental Health” line item on your summary of benefits. You can find your summary of benefits by logging into your Blue Cross Blue Shield Member Services portal (find your local Blue Cross Blue Shield company here), calling member services, or checking your employer’s benefits portal.
Learn more about Blue Cross Blue Shield behavioral health coverage.
CareFirst
CareFirst covers mental health services. To determine your copay, log in to your member account, select “Find Care & Pricing” and type “Behavioral Health” to find providers in your network.
No referral is required, and you can visit any doctor in network.
Learn more about CareFirst mental health coverage.
CareSource
CareSource offers behavioral health as part of your core benefits, so you can receive counseling and addiction services from your CareSource health plan. To determine your copay, you have to view your plan.
If you want to see a mental health professional, you can go to any provider in the CareSource network. You don’t need a doctor’s referral or prior approval for most outpatient treatment.
CareSource can help you find a provider close to you. For help finding a provider or more information, call member services at 833-674-6437.
Centene Corporation
Centene Corporation covers behavioral health services, including substance use treatment. If you see a participating adviser, you will pay:
- $65 copay per visit, deductible does not apply
- Other than office visit – No charge or 40% coinsurance
- Out of network – Not covered
Centene also can refer you to a behavioral health provider in your area.
Learn more about Centene Corporation’s mental health coverage.
Cigna
Cigna provides coverage to enable treatment of mental health conditions under employer-sponsored health plans. Your employer’s plan may include access to:
- A behavioral health network of licensed mental health providers
- Mental health services and follow up case management services
- Consultations, referral services, and outpatient services
- Referrals to local community support groups, behavioral coaches, and online resources
You pay your share of costs according to your Cigna plan. For plans with a deductible, you pay for care until you meet the plan deductible if it has one. When you meet the deductible, the plan covers some or all of your costs as outlined in your plan documents. There’s no separate deductible if mental health and substance use coverage is included under your employer’s medical plan.
A referral is required for Cigna to cover mental health services. Follow your employer’s medical plan requirements to make an appointment with a mental health professional. Your doctor, counselor, or therapist may also refer you and help you coordinate care or treatment.
Check your plan documents for information about treatments because you may need prior approval from Cigna before you get the service to receive coverage under your plan.
Learn more about Cigna mental health coverage.
HealthPartners
HealthPartners has 55 clinics across the Twin Cities and western Wisconsin. They see patients, including same day care at clinics or urgent care locations, and have a 24/7 nurse line.
The copay for a HealthPartners visit varies by plan. Behavioral health services don’t require a referral.
For more information call 952-883-5811 or 888-638-8787.
Humana
Humana covers behavioral health services, including for mental health and substance use.
Your summary and benefits document lists the coverage provided for each service type. When you find your summary and benefits document, which is generally found online through your Humana portal, look for the “mental health services” line. You’ll find the coverage rates for both in-network and out-of-network therapy visits there.
You may need to see your primary care physician before starting therapy if you have an HMO plan. If your plan is PPO or FFS, you won’t need to see your primary care physician before finding a therapist. You can start searching for the right therapist for you whenever you’re ready.
Learn more about Humana mental health coverage.
Kaiser Foundation
The Kaiser Foundation offers treatment and support for all mental, emotional, and substance use conditions.
Your summary of benefits and coverage documents summarize essential information about your plan’s health benefits and coverage.
Your first step in receiving benefits is to call the Kaiser Foundation office nearest you. You’ll talk to someone from the mental health care team or schedule an initial assessment for a later date.
During your assessment, you’ll talk about what you’re experiencing, why you’re seeking care, things you can do to support your mental health, and what you hope to achieve through treatment. Your answers will help the team figure out what type of care will be most helpful for you. Treatment will continue from there.
Learn more about Kaiser Foundation’s mental healthcare services.
Medicare
Medicare only covers mental health services you receive through a licensed psychiatrist, clinical psychologist, or other health professional who accepts Medicare assignments.
Medicare Part B (medical insurance) helps pay for the following outpatient mental health services:
- One depression screening per year from a primary care doctor or at a primary care clinic that can provide follow-up treatment and referrals
- Individual and group psychotherapy with doctors (or with certain other licensed professionals, as the state where you get the services allows)
- Family counseling, if the purpose is to help with your treatment.
- Testing to determine if you’re getting the services and help you need
- Psychiatric evaluation
- Medication management
- Diagnostic tests
- Partial hospitalization
- A one-time “Welcome to Medicare” preventive visit. This visit includes a review of your possible risk factors for depression.
- A yearly “wellness” visit. Talk to your doctor or other health care provider about changes in your mental health since your last visit.
Part B also covers outpatient mental health services to treat substance use.
You pay nothing for your annual depression screening if your doctor or health care provider accepts the assignment. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for visits to your doctor or other health care provider to diagnose or treat your condition. If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional copayment or coinsurance amount to the hospital.
Learn more about Medicare mental health coverage.
Magellan Health
Magellan Health specializes in behavioral health benefits and partners with other insurance companies to provide mental health coverage.
To check if your Magellan Health plan covers therapy, find your summary and benefits document. This document lists how much your Magellan Health plan covers and how much of the costs will be your responsibility. Look under “outpatient mental health” or “mental/behavioral health outpatient services” to find this item. You can find your summary and benefits document through your Magellan Health online portal.
While the cost for therapy depends on your Magellan Health plan, expect to pay a coinsurance of 20-40% per session with your in-network therapist. This cost increases if you choose to see an out-of-network therapist. Cost also varies based on your primary health insurance plan.
Because Magellan Health contracts with various health insurance companies to provide behavioral health services, it depends on your health insurance plan whether you need a referral from your primary care physician before seeing a mental health professional. If you have an HMO health insurance plan, you will need to see your primary care physician first. But, if you have a PPO health insurance plan, you can start to look for a therapist that matches your needs as soon as you’re ready.
Learn more about Magellan Health mental health coverage.
Molina Healthcare
Molina Healthcare covers behavioral health services and treatment for substance use for providers in its network.
Members also can call Molina Healthcare’s Behavioral Health Crisis Line 24 hours a day, 365 days a year at 888-275-8750. The service connects you to a qualified nurse who can speak to you in your language.
Check your member handbook to determine if your plan includes a copay.
Call member services at 855-687-7861 if you need behavioral health or substance abuse services.
Learn more about Molina Healthcare mental health coverage.
Mutual of Omaha (Medicare Supplement)
In general, Mutual of Omaha covers substance use and mental health treatment costs. Some of the specific plans available through Mutual of Omaha include a Mutually Preferred PPO Plan and HMO/POS plans.
Original Medicare Part B (medical insurance) helps pay for covered outpatient services. Mutual of Omaha frequently includes behavioral health services.
Some plans require precertification, including possible authorization by another professional review organization. It is indicated on the member’s Mutually Preferred ID card if this is necessary. There are specific network procedures in these instances.
Most outpatient behavioral health services may not require precertification, but it’s important to check with the company before obtaining service.
Learn more about Mutual of Omaha mental health coverage.
TRICARE (Military Insurance)
TRICARE covers various services for mental health and substance use disorders. Copays for treatment vary by plan.
You don’t need a referral or pre-authorization for outpatient mental health or substance use disorder care.
Learn more about TRICARE mental health coverage.
United Healthcare
United Healthcare coverage of mental health services depends on your plan. You can sign in to your health plan or call the number on your member ID card to determine if you are eligible for services and, if so, what copays it requires.
Wellcare (Medicaid)
The WellCare Behavioral Health Integrated Program enables a holistic approach to care in which one integrated care management team is responsible for medical and behavioral health. Most Medicaid plans cover mental health services, but coverage varies by state.
Copays for mental health care services vary, but you don’t need approval or referral for coverage.
Learn more about Medicaid mental health coverage in your state.
WPS
WPS offers behavioral management services, including mental healthcare and substance use treatment.
The copay is $220 or less for behavioral health services.
The Behavioral Health Management program doesn’t require triage or prior authorization before contacting customer service or scheduling a behavioral health practitioner appointment. It requires prior approval for inpatient treatment and out-of-network practitioners or providers.
Learn more about WPS mental health coverage.
What Types of Therapy Does Insurance Cover?
You may find out that your health insurance plan covers mental health services but still have some questions about when the coverage kicks in and what types of therapies it covers.
The insurance provider and your company’s human resources representative can likely answer those questions.
To start your insurance coverage for therapy, you may need:
- Pre-Authorization: Some health insurance plans require that they authorize coverage before receiving healthcare services, including those for mental health.
- To Meet a Deductible: As mentioned previously, you may have to reach an out-of-pocket deductible before your insurance company starts covering therapy. That means you may need to pay for your initial appointments before you receive coverage. If this is the case, you’ll need to consider how much those appointments will cost and whether paying for them is feasible.
If your health insurance covers mental health services, it typically covers an array of services, as long as they’re “medically necessary.” Make sure your plan covers the services that you need.
Mental health coverage insurance typically includes services for:
- Mental health emergency services
- Co-occurring medical and mental health concerns
- Talk therapy (although your insurance may limit the number of sessions covered during a specific timeframe)
- Online therapy
- Addiction treatment
- Rehabilitation services
How All Counseling Can Help
All Counseling wants to make sure you receive the mental health support you deserve. Use our searchable counselor directory to find a counselor who fits your needs and accepts your insurance.
