Does Health Insurance Cover Therapy?

Finally, mental health as a whole is gaining focus, and for a good reason. Therapy has the ability to turn a person's life around. For some, it could even mean managing anxiety, navigating grief, or any form of self discovery.

One of the biggest questions that many people have is whether health insurance actually covers therapy. Well, the good news is that, yes, it does, but how and to what extent it covers depends on the individual's health plan.

Employer-Sponsored Health Plans: A Common Source of Coverage

If you have a 9 to 5 job, most of them provide a health insurance plan which has some mental health benefits. These are called employer-sponsored health plans and are guided by laws like the Mental Health Parity and Addiction Equity Act. These laws ensure that mental and behavioural health services are covered on par with medical services. In simple terms, and in even more simplified terms, the therapy will be as accessible as a primary care visit.

coverage does vary from plan to plan, and by and large, most participating patients under a plan will be required to conform to a therapy network to maintain affordability. There are plans that are very restrictive and insist upon a referral or pre-authorization pre-treatment and others with session-limiting curtailments, or a co-pay, or a deductible limit.

Some companies go the extra mile by offering Employee Assistance Programs (EAPs). These often include a few free therapy sessions and can be a great starting point if you're not ready to dive into long-term care.

ACA Marketplace Plans: Mental Health Matters

Due to the Affordable Care Act, all ACA Marketplace medical insurance plans have to include mental health and substance use disorder services. That means therapy for one-on-one, group, and even family therapy sessions. These services are "essential health benefits," meaning that they are integrated into the structure of all ACA plans.

If you are self-employed, unemployed, or between careers, these plans are a godsend. You can also qualify for income-based financial help, making therapy more affordable than ever. Many plans also have telehealth benefits, allowing you the flexibility to participate from home.

Prior to signing up, ensure that your desired therapist is in-network and check if the plan has limits on sessions or demands co-pays. These things can save you from surprises in the future.

Public Options: Medicaid and Medicare

If you are eligible for Medicaid or Medicare, you do not lack access to therapy but the process is slightly different.

Medicaid, which is state-administered, includes therapy as one of its basic benefits. How many sessions and from whom are covered, as well as the type of providers, is determined by each state, though minimum counselling and mental health services must be provided. Teletherapy is also covered by many states under Medicaid, which is convenient.

Medicare, intended for seniors and individuals with disabilities, includes therapy under Part B. This entails annual screenings for depression, individual and group therapy sessions, and psychiatric assessments. If you're a Medicare Advantage (Part C) beneficiary, you may even have more providers and services available to you.

It's crucial to check that your therapist takes Medicaid or Medicare, though, because they don't all do. Out-of-pocket expenses are lower with these government programs, so they're a boon for people on a budget.

What Mental Health Services Are Typically Covered?

Individual therapy is covered by most insurance policies, including face-to-face sessions with a licensed therapist. These typically last between 45 and 60 minutes and address a variety of matters such as depression, trauma, anxiety, or relationship problems. Group therapy is also well covered and provides a good value for receiving treatment, particularly for ailments such as addiction, PTSD, or social anxiety.

Aside from talk therapy, most plans have coverage for psychiatric exams and medication management. These are important services for making a mental illness diagnosis and writing prescriptions when necessary. Although psychiatrists generally are more expensive because of their medical training, insurance usually will cover them especially if they are in-network.

Teletherapy has experienced a significant surge in popularity. The ease of logging in from your living room can't be exaggerated, and to their credit, most insurance plans have kept up. The majority now cover virtual visits the same way they cover in-office sessions, and some even drop co-pays for online appointments.

What Are the Common Roadblocks in Coverage?

Even with solid coverage, there are limitations to be aware of. Some plans impose caps on the number of therapy sessions they’ll cover annually. If your therapist believes continued treatment is necessary, they may need to submit documentation proving medical necessity to extend coverage.

Another possible challenge would be pre-authorization. Some insurance providers require you to seek permission first before starting therapy, especially if it's your first time doing so or if there's a change in the therapist or more sessions. It is always very important to contact the insurance provider prior to starting therapy.

Want to see a therapist who isn't in your insurance network? You can do that, but it will be more expensive. Out-of-network therapy usually requires paying upfront and filing a reimbursement claim afterwards if your plan covers it. Some insurance plans cover a share of the cost, while others don't cover out-of-network therapy at all. So double-check your plan's details.

How to Find a Covered Therapist

The quickest method to discover an in-network counsellor is by using your insurance carrier's online directory. Most of these will allow you to filter by specialty, language, gender, and availability. However, since these listings can be old, it's a good idea to call 

the therapist's office to double-check that they still welcome your plan and are accepting new patients.

Aside from your insurer's website, sites such as Psychology Today, Zocdoc, and TherapyDen have strong search capabilities and allow filtering by type of insurance. Some of these lists provide therapist bios, modality of treatment, and even online bookability.

If you don't have insurance or are underinsured, look into options such as Open Path Collective, which provides affordable therapy, or government-funded clinics on SAMHSA's treatment locator.

Final Thoughts

So, is therapy covered by health insurance? In most instances, yes and more fully than ever. Yet, there are some fine points to understand. Having an idea of what your policy pays for, if you must pre-approve, and how much you'll pay out-of-pocket can be important.

Ready for Expert Guidance?

Not sure where to start? Speak with a Savvital advisor today for personalized help navigating your options and choosing a plan that fits your needs and your budget.