Does Insurance Cover Therapy? How to Get the Support You Need

A concerned man on the phone wondering does insurance cover therapy.

Does Insurance Cover Therapy?

Quality mental healthcare is essential—but not always accessible. Before seeking professional help, it’s important to know what mental health services are available to you under your current health insurance plan.

 

So—is therapy insurable? The short answer? 

 

It depends! 

 

Most plans offer some level of coverage for mental healthcare, including therapy.

 

The long answer? Mental health benefits are determined by medical necessity, which requires a mental health diagnosis. Coverage may apply to pre-existing conditions or, if not yet formally diagnosed, a provisional diagnosis. 

 

If your condition is covered, coverage may be determined by federal parity law.

 

Under federal parity law, coverage for mental health services is comparable to medical care, including behavioral health and treatment for substance abuse. (For example, the copay for a therapy session may be equal to or less than an appointment with your general physician, or another comparable service.)

 

To help you find the best route to therapy, we’ll go over what to expect from insurance coverage and how to find out if therapy is covered under your current plan.

What to Know About Insurance Coverage for Therapy

Health insurance companies determine the type of mental healthcare deemed medically necessary under your current plan. This may include, but is not limited to behavioral health treatment, substance abuse services, psychotherapy, and telemedicine such as Emote’s online therapy and counseling services.

 

The type of plan—be it private, state, or federally insured—also determines copayments and deductibles for services like therapy. 

 

Employee health insurance plans and government programs like Medicaid often cover therapy. They are also subject to parity law—with some limitations. 

 

To learn more about health insurance coverage, we’ve broken down types of coverage and what to expect from each.

 

Inherent issues with using insurance for therapy

As enacted by the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008, parity law removes restrictive pricing for mental health benefits. That said, insurers are not obligated to include mental health benefits, and for those that do, therapy may still be a limited option.

 

Many therapists do not accept insurance. This is due to low reimbursement rates, despite rising costs for practices and outpatient care.

 

If you can find a network therapist, waiting lists can stretch on for weeks. Furthermore, the number of sessions may be managed by your insurer. Though legal insurers cannot enforce an annual limit on sessions, they can evaluate what is “medically necessary” based on your condition.

 

Finally, with insurance, you will still have to manage copays. Copayments are out-of-pocket costs for services like hospital stays and office visits. This is predetermined by your coverage and may be financially non-viable for you. 

 

Health insurance market plans

Mental health treatment is listed as one of the 10 essential health benefits provided through the Affordable Care Act. All marketplace plans are part of the ACA. All plans also include treatment for behavioral health and substance abuse disorder services for individuals, families, and/or small businesses.

 

Coverage varies by state. To view plan options and how to apply for coverage, visit HealthCare.gov.

 

Employer-sponsored insurance for companies with 50+ employees

All companies with 50 or more employees are legally obligated to provide health insurance. However, employers are not legally obligated to provide mental health benefits. If mental health benefits are provided, they are subject to federal parity laws.

 

Non-federal government organizations, such as public schools and state universities, may be exempt from this law. If you are a state government employee, review your insurance plan to find out whether your benefits are subject to parity.

 

Employer-sponsored insurance for companies with less than 50 employees

Small businesses are not legally obligated to provide health insurance. However, if insured under the Affordable Care Act, mental health benefits must be provided.

 

Medicaid and Medicare

Both Medicaid and Medicare offer coverage for mental health conditions, such as addiction, mood, and behavioral disorders.

 

Most Medicaid programs are subject to parity law, with varying degrees of coverage from state to state.

 

Medicare is not subject to parity.

 

Under Medicare, mental health services are available through Part A, B, C, and D insurance plans. Part A covers inpatient care, including psychiatric hospital stays of up 190 days

 

Part B covers outpatient care, including therapy. Family counseling and couples therapy may be covered if deemed relevant to your treatment plan.

 

Coverage through Part C and D is privately insured. Part C provides a combination of Part A and B plans, while Part D provides coverage for medication.

 

Children’s Health Insurance Program (CHIP)

The Children’s Health Insurance Program, or CHIP, provides low-cost healthcare to children from low-income households. According to 2018 statistics, 9.6 million children have been enrolled in the program. As a federally funded program, CHIP is subject to parity laws and is legally mandated to provide mental health coverage for services like therapy and counseling.

How to Check if My Insurance Covers Therapy

Though it may appear overwhelming, you can easily find information on your plan and how to navigate things like insurance claims for therapy and other mental health services.

 

You can also find out whether your insurance is liable under parity or not, and the cost comparison between mental and physical health insurance. 

 

Here’s how:

 

Log in and check your online insurance account

 

All information on benefits and costs should be available online through your insurance provider’s website. Register for an online account if you haven’t already, and review your specific plan.

 

In addition to coverage specifics, information on network providers should also be available. If covered, this will include therapists, psychologists, and other mental health professionals insured by your provider.

 

Check with your company’s HR department

If you are insured through an employer-sponsored healthcare plan, contact an HR representative about insurance benefits. A representative will be able to answer any questions about mental health wellness and related programs available through or sponsored by your company’s insurer. 

 

Call or reach out to your insurance provider

You may also speak directly to an insurance representative. A phone number and email address should be located on the back of your insurance card or on their website. Any specific questions about your insurance policy will be easier to answer if you provide a diagnostic code.

 

Ask your therapist or therapy provider if they accept your insurance

Alternatively, your therapist or mental health provider will be able to answer any questions about insurance. Be aware that many mental health professionals, including therapists, do not accept insurance due to low reimbursement fees. Network therapists also often change insurance plans and you may have to find a new therapist if you cannot afford their rates thereafter.

Accessible and Affordable Online Therapy with Emote

Let’s face it: Filing insurance claims and juggling copayments is mentally and physically taxing.

 

But with Emote, you don’t have to worry about coverage—high-quality mental healthcare is just a click away.

 

Through virtual sessions, a certified therapist is ready and able to assist you at a moment’s notice. From depression and anxiety to addiction and bipolar disorder, our trained mental health professionals can provide you with tools to better manage mental illness and improve your mental well-being—all at an affordable rate!

 

Slash the cost of therapy and cut out months-long waitlists through our subscription plans. With Emote, your first week of therapy will only cost $35.

 

Whatever you need, with Emote, you’re not alone

 

Start today to gain exclusive access to our versatile therapy services and never worry about high out-of-pocket costs again.