Therapy is often an important part of a mental health treatment plan, but insurance coverage for mental health services isn't the same for every policy. While most insurance plans now cover medically necessary therapy, plans outside the Marketplace don’t have to comply with Affordable Care Act (ACA) standards.
ACA-compliant plans must cover mental and behavioral services as part of the essential health benefits. But even if your policy covers these services, there may be some limitations that could prevent you from getting as much help as you need.
It can be difficult to figure out whether insurance covers therapy, especially if you’re already feeling stressed or anxious while you’re trying to look up your coverage options. To help, here’s more information about how health insurance may cover therapy.
- The Mental Health Parity and Addiction Equity Act (MHPAEA) improved the coverage for therapy under insurance. With the addition of the Affordable Care Act, all ACA-compliant insurance plans must provide mental and behavioral services as part of the essential health benefits coverage.
- Your insurance company only pays for therapies that are deemed medically necessary. There may also be other limits, such as requiring you to try less expensive treatment plans first.
- Other options may also help you afford the mental health treatment you need, such as assistance programs.
How Much Does Therapy Cost?
Therapy isn't cheap, but it can be an affordable treatment option for mental health issues. Many factors influence the cost of therapy, including:
- The type of provider you see and their qualifications
- What type of therapy you’re seeking
- Your insurance policy terms
- Where you live
- How long each session lasts
You can typically expect to pay at least $100 for a therapy session, with many therapists charging $200 a session or more. You may also find therapists who offer a sliding scale, which adjusts the price you pay based on your household’s income.
Therapy Billing Practices
If your therapist accepts insurance, they’ll use certain mental health CPT codes to bill your insurance company. These include details about the type of therapy you received and how long it lasted, so the insurance company knows what services were rendered.
A few common codes include:
|Code||What It Means|
|90832||Psychotherapy, 30 minutes|
|90837||Psychotherapy, 60 minutes|
|90846||Family psychotherapy without the patient|
|90847||Family psychotherapy with the patient|
You’ll be responsible for paying any copays, coinsurance, or deductibles before your insurance coverage kicks in.
Not all therapists accept insurance. If yours doesn’t, but your insurance company offers mental health benefits, you may be able to submit an out-of-network health insurance claim and seek reimbursement. Ask your insurance company for details.
Therapy Insurance Coverage
The Mental Health Parity and Addiction Equity Act prohibits any insurance company that offers mental health benefits (including ACA plans) to have more restrictive limits than its medical and surgical service. This means if your insurance company offers mental health coverage, it cannot place arbitrary dollar limits on your therapy.
However, insurers only pay for services that are deemed medically necessary, and not all therapy is. Without a mental health diagnosis, it’s likely that your insurance company won’t cover your therapy sessions, even if it offers mental health benefits.
In addition, insurance companies can also require you to try less expensive treatment options first, a practice known as step therapy. This means you may not be approved for the exact treatment your therapist prescribes until you’ve tried other options first.
Mental health diagnoses go onto your permanent medical record. And once there, it’s a preexisting condition that can disqualify you from life insurance down the road.
Limitations to Insurance Coverage For Therapy
In the past, insurance companies routinely placed annual caps on the amount of mental health benefits or severely limited your coverage in other ways. The Mental Health Parity and Addiction Equity Act helped with this. Now, any limits that exist can’t be more restrictive than limits placed on your physical health.
However, though ACA-compliant plans, Medicare, and Medicaid provide at least some mental health coverage, non-ACA compliant plans for sale outside the Marketplace aren’t required to do so. So, check with your insurer to see if any limitations exist. Your policy's summary plan description is a good starting point for researching limitations.
How To Check On Your Plan’s Coverage
If you want to use your insurance benefits to pay for therapy services, it’s important to see if these are covered. Begin by reading your plan documents and seeing what mental health services are listed.
Then you can call your insurance plan to ask clarifying questions to help you determine what is covered and what isn’t. Here are some questions you could ask:
- Does my plan include mental health benefits?
- How much is my deductible? How much have I met of this amount?
- How many therapy sessions does my policy cover per year?
- Is there a limit for how long each session can be?
- Which therapists are in-network?
- What are my out-of-pocket costs for therapy sessions?
- Do I need to pay more for an out-of-network therapist?
- Can I submit a claim for reimbursement from an out-of-network provider?
- Do I need a referral from my primary care provider?
- Are there certain CPT codes my provider must bill to be approved?
Though it’ll take time to gather this information, this process is important. It’ll help you know what to expect when it comes to your insurance coverage.
Does Medicare Cover Therapy?
Yes, Medicare Part B coverage includes outpatient mental health services, including therapy or counseling. Diagnostic testing for mental health conditions is also covered.
With Medicare Part B, you’ll be responsible for part of the therapy costs. You’ll pay 20% coinsurance plus your deductible. You may also have copays or coinsurance for services in a hospital outpatient clinic or department.
Does Medicaid Cover Therapy?
Unlike Medicare, which is federally managed, Medicaid coverage varies from state to state. And while Medicaid covers therapy in some situations, states are not required to provide optional benefits such as psychological services.
This means therapy may not be covered by Medicaid where you live. You’ll want to read your policy carefully to see what your coverage options are.
Do Marketplace Plans Cover Therapy?
Yes, all Marketplace plans are required to cover therapy and counseling. However, the specific mental health benefits you qualify for vary from plan to plan.
How To Ensure Your Therapy Is Covered
You don’t want any surprise bills for your therapy sessions. That’s why it’s important to verify you’re covered before you begin treatment.
Once you know what services are covered, you need to find a provider who accepts your insurance. Here are some questions to ask:
- Are you an in-network provider for my insurance company?
- Do you bill the insurance, or do I need to submit a claim?
- What will my out-of-pocket costs be?
- What happens if the insurance company denies my treatment?
- Do you offer any sliding scales or reduced-cost therapy options if I need to pay out of pocket?
If one therapist doesn’t work with your insurance company, don’t be discouraged. You can often find in-network service providers in your area on your insurer’s website or by calling customer service.
How Many Sessions of Therapy Does Insurance Cover?
If your insurance plan provides mental health benefits, it must cover medically necessary treatments. The type of therapy you receive, the length of each session, and the amount of time your insurance covers sessions are all based on your medical needs.
How To Bill Insurance for Therapy
If you go to an in-network provider, your therapists’ office typically files the claims on your behalf.
However, you may need to pay for your therapy sessions out-of-pocket and then get reimbursed by your insurance company. In that scenario, you’ll likely have to file the claim yourself.
You may be able to fill out the claim form online. If not, you should have the option to mail or fax it to your insurer.
No matter how you file the claim, you’ll likely need the following information:
- A copy of your therapy bill and receipt
- Your provider’s name and address
- The tax ID number of your therapist
- Your diagnostic code
- The procedure or CPT code for the type of therapy you had
Your therapist’s office should be able to help you locate this information. Once you send everything in, your insurance company processes the claim and makes a decision on how it is covered.
What To Do When You Need Help Covering Therapy Bills
Insurance isn’t the only way to lower your out-of-pocket expenses for therapy. If you need help paying for therapy, here are some strategies you can try:
- Look for therapists who offer a sliding-scale discount.
- Try telehealth, which is often less expensive and can be done from the comfort of your home.
- Visit a federally funded health center for treatment instead of a private practice.
- Check to see if a local college offers inexpensive therapy services by their psychology students.
- Call different therapists to see if they offer low-cost sessions or if they can recommend an office that does.
- See if group therapy would meet your needs. It often costs less.
There are plenty of ways to support your mental health needs on a budget. Don’t give up until you find the services you need.
Find the closest federally funded health center is through the Heath Resources and Services Administration (HRSA).
Frequently Asked Questions (FAQs)
How does couples therapy work with insurance?
Since it’s not usually medically necessary, couples therapy isn’t covered by most health insurance policies. However, there are exceptions. For instance, if one person in the couple has a mental health diagnosis, the insurance company might approve family counseling that’s in support of that diagnosis.
What category of treatment does therapy fall under for insurance companies?
Therapy is a type of mental health treatment. All insurance companies, including Medicare and Medicaid, use the same CPT codes when billing for these services.
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Kaiser Family Foundation. “Can I Buy Health Insurance Outside of the Marketplace That Meets All ACA Standards?”
Anxiety and Depression Association of America. “Important Questions for Your Therapist and Insurance Carrier.”
Medicare. “Mental Health Care (Outpatient).”
APA.org. “Medicaid and Psychology.”
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