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, “Will my insurance 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?
We’ll answer all of those questions in this post.
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 cost 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 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.
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.