Does Insurance Cover Therapy?

Does Insurance Cover Therapy?

Yes! Most major insurance plans (including the ones you get through your employee benefits) are now required to cover mental health therapy. 

Thanks to the 2008 Mental Health Parity and Addiction Equity Act, services to treat mental health and substance abuse disorders have to be covered the same as services that treat physical health concerns. 

This means that your insurance can’t cover a visit to a primary care provider but not to a mental health therapist. There are still nuances, so it’s important not to assume that the policy you use for your doctor also applies to your therapist. 

But in general, if you have a full insurance plan, it’s safe to say that you have some sort of mental health therapy coverage. 

How Much Is a Therapy Session with Insurance?

Therapy with insurance will cost anywhere between $0 to $60 per session. This is a big savings; therapy without insurance can cost anywhere between $100-$200 per session. 

Although $0 to $60 is a good estimate, it’s important to always check with your insurance provider first. Factors like deductibles and session limits may change how much your therapy costs. 

Things to Understand About Insurance Coverage for Therapy

How much therapy costs with insurance will depend on several factors, such as:

Deductible

A deductible is a monetary value you have to reach before your insurance benefits will kick in. On your insurance plan, it will usually say something like: “Mental Health Therapy: 80% after deductible.” 

This means that your insurance will cover 80% of your therapy session after you meet your deductible. Your deductible is always listed in your insurance policy. It can range from $0 to $8,000. 

Pro tip: When you’re deciding on what health insurance to choose, always check the deductible. Do insurance benefits kick in before or after the deductible is paid? Sometimes, it’s worth paying a higher monthly premium if your deductible is lower or if you get benefits before you meet your deductible. 

You pay towards your deductible whenever you use your insurance. For example, let’s say you have a $2,000 deductible. Your insurance says it’ll fully cover mental health therapy after you meet your deductible. In February, you have to go to urgent care for a broken arm and pay $2,000 for X-rays and a cast. That $2,000 will go towards your deductible. Now the deductible is met, and you can get mental health therapy for free. 

Deductibles will almost always reset in the New Year.

In-Network vs Out-Network

Just like with doctors, it’s important to find a therapist who is in-network with your insurance. This means that they accept your insurance, and your insurance will cover their services. 

Some insurances will still partially cover out-of-network providers, but it’s usually at a fraction of the coverage you would normally get. 

You can easily check if a therapist is in network with you by asking the therapist or using the search function of your insurance app.

Percent Covered

Outside of the deductible, insurance companies also vary on how much they’ll cover. Some insurance plans will fully cover mental health therapy, and others will expect you to pay some of it out of pocket. There are two ways this affects you:

• Copays: A copay is a set amount that you pay out of pocket. For example, a copay of $35 means that every time you see your therapist, you’ll pay $35. This won’t change throughout the year. 
• Coinsurance: A coinsurance is a percentage of the service fee that you pay. Unlike a copay, coinsurance will vary on the service you get. For example, if a therapy session is $100 and you have 20% coinsurance, that means you will pay $20 (20% of $100), and your insurance will cover 80%. If you were to go to a more expensive therapist, the amount you pay might be more, because you have coinsurance instead of a copay.

Some insurances will fully cover mental health therapy. 

Types of Therapy

Not every type of therapy will be covered the same. Usually, health insurance companies make distinctions with:

• Individual Therapy
• Family therapy
• Couples therapy
• Substance abuse therapy
•  In-patient vs out-patient
• Alternative Practices

“Alternative Practices" usually refer to therapy modalities that aren’t officially approved by major health researchers, and insurance therefore doesn’t cover them. These are typically things like Reiki, herbal medicine for mental health, or yoga for mental health.

How to Tell if Your Insurance Covers Therapy

Every insurance is different. Don’t rely on what your insurance plan was like last year or what your friend’s insurance plan is like to budget. Always check with your insurance company about prices. 

1. Call your insurance provider 

Often, the easiest and most straightforward answer will be to call your insurance provider’s customer support. Here are some questions you can ask to get a clear answer:

• Do you cover all types of therapy?
• Do you cover in-person and virtual visits the same?
• Do I need a medical diagnosis to be covered? If so, are there certain diagnostic codes I need?
• How many therapy sessions can I have annually?
• When does the policy year start and end? 
• Do I have to meet an annual deductible before insurance will pay for therapy services? 
• Do I have a copay or coinsurance? How much are they? 
• What’s the difference in coverage for in-network vs out of network providers?
• Can you provide a list of therapists that insurance will cover near me? 

Most insurances will have a list of therapists they cover near you. Asking them will ensure your therapist takes your insurance and you get the most affordable therapy possible. 

2. Check your insurance portal: Most insurances will have some sort of client portal that will have an explanation of benefits that should clearly tell you how much your therapy will be. Remember to pay attention to whether the deductible applies and the copay and coinsurance amount. Insurance portals will also have a therapist search directory to find therapists who take your insurance near you. 
3. Ask your HR: If your insurance is through your employer, HR may be able to clear up any questions you have. 
4. Ask your therapist: Your therapist won’t be the expert on your insurance, but they can help you understand your insurance charges and direct you to whom to ask for more information. 

You can also call a therapy office directly. At places like Lifebulb Counseling, a team of dedicated support staff handles insurance queries and will make sure your claims are handled promptly, resulting in more saved dollars for you.

When Does Insurance Start for Mental Health Therapy?

Insurance often “resets” in the New Year, meaning you’ll have to meet your deductible again (if that applies to your plan) and your out-of-pocket max resets. 

The exact date will depend on your insurance, but it is usually in the first week of January. Check your insurance plan to make sure.

Is Marriage Counseling Covered by Insurance?

Sometimes. Marriage counseling isn’t always covered by insurance, although it is getting more common to be covered. 

If a doctor deems marriage or couples therapy medically necessary, you are more likely to get insurance to cover it. 

Check your insurance plan for details on whether they cover marriage counseling. 

Is Group Therapy Covered by Insurance?

Yes! Most of the time, insurance will cover group therapy. In fact, group therapy tends to be cheaper for you than individual therapy, because the cost is effectively “shared” by other members in the group.

Does insurance cover online therapy?

Yes! Most major health insurances will cover virtual therapy at the same rates they do in-person therapy, so long as the therapist is properly licensed and practicing within their state. 

Types of Therapy Covered by Insurance

Insurance will cover all treatments that are deemed medically necessary. This includes:

• Emergency psychiatry services
• Mental health conditions like anxiety, depression, OCD, Trauma, Grief, and more. 
• Psychiatric conditions like Bipolar, Schizophrenia, and more. 
• Co-Occurring or Co-morbid conditions, like when you have depression and anxiety, or ADHD and a substance use disorder. 
• Psychiatric inpatient stays
• Talk therapy like Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and more
• Addiction Services
• Online therapy 
• Child therapy 

Health insurances are not required to cover family therapy, couples therapy, or marriage therapy. Some insurances may offer some coverage for these services, but they will likely be less than others. 

When Should I Pay Out of Pocket for Therapy?

Sometimes, people choose to pay out of pocket, meaning they don’t use insurance to pay for their therapy. Although this will result in a more expensive session, there are a few reasons to do this:

• Your insurance won’t cover a type of therapy
• You can’t find a provider who takes your insurance
• It’s cheaper to pay out of pocket. Some therapists will offer a more affordable self-pay rate, which is useful if you have a high deductible you have to meet before your insurance will start paying for your therapy. 

After you talk with your insurance provider about how much therapy will be, determine for yourself if self-pay will be cheaper. It is possible to find therapists who offer sliding-scale therapy sessions to make sessions cheaper for those without insurance or who have to meet a high deductible before their insurance starts paying. 

Pros and Cons of Using Insurance for Therapy

While therapy is cheaper with insurance more often than not, there are a few cons we want to address. 

Pros: 

• Lower cost. This is the big one to most people. Lower costs mean you can go to therapy more often, resulting in greater long-term benefits. 
• Easy: Your insurance provider's portal likely has a therapist directory full of all the therapists they take. There’s less research on your end. 
• Safe: You know for sure how much every session will cost, and usually, you’re not the one dealing with the insurance; the therapist will. 

Cons:

• Limited choice for therapists: You may be stuck with only the in-network therapists. For example, not every therapist accepts Medicaid clients. 
• Limited choice for treatment: There are still some treatments that insurance doesn’t cover. If you’re looking for specialized or unique treatments like art therapy, music therapy, family therapy, or the like, you may have to pay out of pocket. 

Whether you choose to use insurance or not is up to your individual situation.

Does Lifebulb Accept Insurance?

Absolutely! Lifebulb employs over 200 therapists who all accept most major insurances. We also have a support team dedicated to dealing with all insurance, scheduling, and billing, so once you’re matched with a therapist, you can focus on therapy and less on the logistics. 

To learn if your insurance is in-network, or to find a therapist near you, reach out to our team. We will be happy to help.