Apr 9, 2024
Mental health is a significant (and often-overlooked) aspect of overall well-being. Yet, many of us may struggle to access the treatment we need due to financial constraints, geography, or lack of understanding coverage for mental healthcare, therapy, or counseling by our insurance plans.
So let's tackle that third aspect –
Is treatment for mental healthcare, therapy, and counseling covered by insurance?
How does mental health insurance coverage works?
Is therapy covered by Insurance?
Short answer: Yes. Most major insurance plans (including the ones you get through your employee benefits) are now required to cover mental health therapy.
This is a relatively new development. Before the recent legislature, therapy wasn’t always covered as well as doctors, surgeons, and other physical health practitioners. Now, however, if you have full coverage insurance, then you can see a therapist and your insurance will cover.
Laws that require mental health therapy to be covered
The Mental Health Parity Act of 2008
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 aimed to address disparities in insurance coverage for mental health and substance use disorder treatments. This act required that comprehensive standards be established for equitable coverage of mental health and substance use disorder treatments, ensuring that they were no more restrictive than coverage for other medical conditions. By enforcing these standards, the act sought to promote fair access to mental health and substance use disorder treatments, thereby reducing discrimination in insurance coverage based on the type of illness being treated.
Essentially, it made it required that insurance cover mental health
Affordable Care act of 2010
The Affordable Care Act (ACA) of 2010 was a landmark legislation that sought to expand access to affordable healthcare for all Americans. As a part of this act, mental health and substance use disorder services were classified as essential health benefits, like other medical/surgical treatments. This provision required that mental health services be covered by insurance plans at the same level as medical/surgical services, increasing access to mental health therapy for millions of Americans. The ACA also eliminated annual and lifetime limits on mental health benefits, ensuring that individuals could access treatments to adequately manage their mental health. This provision has been especially critical in promoting equitable access to mental health therapy, removing financial barriers for those in need of mental health services. Overall, the ACA has helped bridge the healthcare gap and provided hope for those who might not have been able to afford mental health therapy otherwise.
Does my insurance cover mental health therapy?
While the answer is most likely yes, your insurance covers mental health therapy, it can be a bit more complicated than that. Some insurances require you to meet a deductible first, while others will cover a percentage of your fees. Some pay more than others. Some will only pay for 12 sessions. The specifics depend on the type of therapy you have. Let’s examine a few options below:
Individual Insurance Plans
This is an insurance plan you picked out and are paying for by yourself. It is not through your employer or any other benefits organization. Individual Insurance Plans are by far the most varied form of health plans. How much you have to pay out of pocket will depend on factors such as:
- Types of Plan: HMO, PPO, and EPO are different types of health insurance plans with varying characteristics and levels of flexibility. An HMO (Health Maintenance Organization) typically requires members to choose a primary care physician (PCP) who acts as a gatekeeper for all healthcare needs. Referrals from the PCP are necessary to see specialists, and out-of-network care is generally not covered except in emergencies. On the other hand, a PPO (Preferred Provider Organization) offers more flexibility, allowing members to seek care from both in-network and out-of-network providers without a referral. However, using in-network providers usually results in lower out-of-pocket costs. An EPO (Exclusive Provider Organization) is a hybrid between HMO and PPO, where members don't typically need a referral to see specialists but must use in-network providers for coverage, except in emergencies. It's important to consider personal healthcare needs, choice of healthcare providers, and cost factors when selecting the most suitable insurance plan.
- In-Network vs Out-Network: Some insurances will have a much reduced cost for in-network providers. To find a therapist who is in-network with your insurance, go to your insurance webpage. They should have a “Search a provider” function that allows you to find a mental health therapist near you.
- Therapy Modalities: Some insurances cover individual therapy, family therapy, couples therapy, and substance abuse therapy differently. To know the rates for your therapy, contact your insurance provider.
What type of insurance you have will determine your deductible (how much you have to pay before your insurance pays) and your out-of-pocket cost, also known as a copay (how much you pay every time with insurance.
Insurance Through Employer
Many employers now offer insurance through their employee benefits. Usually, you have to be a full-time employee to get these benefits. The amount of coverage you get typically depends on the size of the organization.
Small businesses tend to offer less robust benefits, although they are still required by law to provide coverage for mental health.
If you want to learn more about what insurance benefits your company offers, reach out to your HR person.
EAP Benefits
EAPs, or Employee Assistance Programs, are additional health services an employer may offer. It is not required by law, so make sure you check with your HR if you qualify for this.
EAPs are usually short-term and immediate counseling services through a select group of providers. For example, if you just moved and relocated to a new branch, you might be eligible for stress management counseling through your EAP program. These are usually at no extra cost to you, or a smaller cost than outside counseling services, but they are limited to a small group of providers you can see.
Children's Health Insurance Program CHIP
The Children's Health Insurance Program (CHIP) is a vital program that provides affordable health insurance coverage to millions of children in need. It is designed to bridge the gap for families who earn too much to qualify for Medicaid but cannot afford private health insurance. CHIP covers a wide range of essential healthcare services, including doctor visits, immunizations, prescriptions, dental and vision care, and mental health services. This program ensures that children have access to the care they need to thrive and grow. By removing financial barriers and promoting preventive and comprehensive care, CHIP plays a crucial role in safeguarding the health and well-being of our nation's children.
How much does therapy cost with insurance?
As we’ve explored above, how much therapy costs with insurance varies widely. In some cases, it may be completely free. Usually, though, therapy covered by insurance costs around $20-$50 out of pocket every session.
Without insurance, that rate can skyrocket to between $100 and $200.
Sliding Scale Fees
Some mental health practices will offer a “sliding scale fee” for people without insurance based on their income. So lower income individuals who may not have insurance are still able to receive mental health services at a reduced rate.
What type of therapy is covered by insurance?
Insurances are required to cover mental health therapy, but does that include all mental health therapy? The specific type of therapy can influence your out-of-pocket costs.
Insurances do cover therapy for:
- 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.
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.
How to find out if your insurance covers therapy
Insurance can be confusing. The best ways to find out if your insurance covers mental health therapy include:
- Register your online insurance account: You should have access to an insurance portal. There you can find information about your coverage and search for in-network providers.
- Call your insurance provider: Talking to another human is sometimes the best way to deal with tricky insurance questions.
- Ask your HR: If your insurance is through your employer, HR may have the quickest answers.
- Ask a therapist: Your therapist will know what insurance they take and how much it is. At places like Lifebulb, a team of support staff handles insurance queries and will make sure your claims are handled promptly, resulting in more saved dollars for you.
Pros and Cons of Using Insurance for Therapy
While it is often a no-brainer to use insurance for therapy, 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 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 treat. 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 100 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.
