Is Therapy Covered by Insurance? | Mira Health
Is Therapy Covered by Insurance?
The Affordable Care Act requires plans offered through the health insurance exchanges to cover services for mental health and substance use disorders.
The Affordable Care Act requires plans offered through the health insurance exchanges to cover services for mental health and substance use disorders. Most health insurance plans cover at least some forms of mental health care, including therapy, but few health insurance plans are not required to provide any mental health benefits. In general, usually only treatments considered “medically necessary” by a mental health provider are covered by insurance.
If you are without health insurance, there are still affordable therapy options available to you. Our team at Mira can help you find low-cost therapists in addition to discounts off your prescriptions and flat fee doctor’s visits.
Is Therapy Covered by Insurance?
If you have health insurance, it is likely that your policy provides some level of coverage. However, your coverage will depend on the type of insurance you have.
Mental Health Parity Law
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (also known as the mental health parity law or federal parity law) requires insurance companies to charge the same copay for therapy as other medical offices visits. It doesn’t require coverage of mental health services; it prevents insurance companies from inflating the cost of seeing a mental health practitioner. The parity law also eliminated annual mental healthcare coverage limits.
The Mental Health Parity Law applies to Employer-sponsored health insurance plans; coverage purchased through the ACA health insurance exchanges, Children’s Health Insurance Program (CHIP), and most Medicaid programs.
Therapy Coverage Through Different Health Insurance Plans
Depending on your health insurance plan, the cost of therapy will vary. Below, we outline coverage through each option.
Employer-Sponsored Health Insurance
Employer-sponsored health insurance plans usually cover therapy, but the level of coverage varies. It could be comprehensive coverage of all therapy services or only the minimum. If your company has more than 50 employees, your employer must provide health insurance.
Obamacare Marketplace Plans
According to healthcare.gov, all health insurance plans bought on the marketplace must cover:
- Behavioral health treatment, including counseling and psychotherapy.
- Mental and behavioral health inpatient services.
- Substance use disorder or substance abuse treatment.
This means catastrophic bronze, silver, gold, and platinum plans will cover these services, even for preexisting conditions. The specific benefits may vary, so be sure to compare plans on the marketplace before enrolling.
Outpatient Mental Health Therapy Benefits by Plan Metal Level: UnitedHealthcare, New York
| Metal Level | In-Network Cost Share |
|---|---|
| Catastrophic | No Charge after deductible |
| Bronze | 50% Coinsurance after deductible |
| Silver | $40.00 |
| Gold | $25 Copay after deductible |
| Platinum | $15.00 |
Outpatient Mental Health Therapy Benefits by Plan Metal Level: Oscar, New York
| Metal Level | In-Network Cost Share |
|---|---|
| Catastrophic | No Charge after deductible |
| Bronze | $50 Coinsurance after deductible |
| Silver | 30% |
| Gold | 20% |
| Platinum | $15.00 |
The law also states marketplace health plans cannot deny you coverage or charge you more just because your mental health issue existed before you bought a plan, and they can’t place yearly or lifetime dollar limits on this type of coverage. Therapy coverage still varies from state to state and policy to policy.
CHIP (Children’s Health Insurance Program)
CHIP is subject to the Mental Health Parity Law and is required to provide parity protections for mental health and substance use disorder services. Most CHIP plans provide complete coverage of mental health services, including:
- Counseling
- Therapy
- Medication management
- Social work services
- Peer supports
- Substance use disorder treatments
Medicaid
Like CHIP, Medicaid is subject to the Mental Health Parity Law. While Medicaid plans vary from state to state, all state-run Medicaid plans must cover essential health benefits, including mental health and substance use services.
Medicare
Medicare Part B is an optional medical insurance plan that helps cover medical services like doctors’ services, outpatient care, and other medical services that Part A doesn’t cover. Part B helps pay for these outpatient mental health services:
- One depression screening per year.
- Individual and group psychotherapy with doctors or certain other licensed professionals are allowed by the state where you get the services.
- Family counseling, if the primary purpose is to help with your treatment.
- Testing to find out if you’re getting the services you need and if your current treatment is helping you.
- Psychiatric evaluation.
- Medication management.
- Certain prescription drugs that aren’t usually “self-administered” (drugs you would normally take on your own), like some injections.
- Diagnostic tests.
- Partial hospitalization.
- A one-time “Welcome to Medicare” preventive visit.
- A yearly “Wellness” visit.
- Part B also covers outpatient mental health services for the treatment of inappropriate alcohol and drug use.
Best Insurance Companies For Mental Health
| Insurance | Pros | Cons |
|---|---|---|
| Best Overall: UnitedHealthcare | - Emotional support line available 24/7 - Telehealth available - TalkSpace online therapy - Online quotations - Superb reputation - Extensive provider network - A smartphone app that integrates with medical records - Available in all 50 states |
- May not be available in some counties - More expensive than some providers |
| Best for Customer Service: Kaiser | - Access to mental health services without referrals - Unparalleled customer service - Online quotations - Coordinated insurance and health care - Personalized treatment plans |
- Limited to eight states |
| Best for Telehealth Coverage: Cigna | - Access to 24/7 nurse hotline - Mental health virtual care - Online quotations - Large provider network - Rated A for financial stability with AM Best |
- Medical plans only available in 10 states - Some reports of poor customer service |
| Best for Additional Resources: Aetna | - Online mental health screening tools - Simple search to find therapists and psychiatrists - Helpful hotlines and resources - Phone and video counseling - Nationwide availability |
- No short-term health insurance options - No individual health plans |
Health Insurance Coverage for Therapy Frequently Asked Questions (FAQs)
Which mental health services are usually covered by health insurance?
When deemed “medically necessary” by a mental health professional, services that may be covered by insurance include:
- Psychiatric emergency services
- Co-occurring medical and behavioral health conditions, such as coexisting addiction and depression. This is often referred to as a dual diagnosis.
- Talking therapies, including psychotherapy and cognitive behavioral therapy
- Unlimited outpatient sessions with a psychiatrist, clinical social worker, or clinical psychologist.
- Telemedicine and online therapy
- Inpatient behavioral health services are received in a hospital or rehabilitative setting.
- Addiction treatment
- Medical detox services, including medications
How do I know if my health insurance covers therapy?
All ACA-compliant health insurance plans provide coverage for therapy but fall short of defining which type and how much therapy must be covered. To find out if your health insurance plan covers therapy, you have a few options:
- Check your description of plan benefits on your online insurance portal.
- Call your health insurance company directly.
- Ask your therapist’s office to check for you.
What’s the difference between in-network vs. out-of-network therapists?
Depending on your health insurance plan, you will have access to specified in-network therapists and out-of-network providers that accept your health insurance.
Why won’t my therapist accept my insurance, even though I have mental health coverage?
Mental health providers can choose whether or not to accept insurance. The reimbursement rate for mental health services is often low, so providers can make more money by only accepting patients who will pay out of pocket. This makes therapy unaffordable for many people, but before giving up on finding a therapist, ask if they charge on a sliding scale.
Bottom Line
Therapy is an important part of well-being, and thankfully most health insurance plans offer some level of coverage for these services.