Does Health Insurance Cover Therapy?
The situation: I want to start therapy. Will my health insurance pay for it, and how much will each session cost me?
Quick Answer
Usually, yes. Marketplace health plans must cover behavioral health treatment, such as psychotherapy and counseling, and federal parity rules generally stop plans from limiting mental health care more strictly than medical care. Your cost depends on your plan's copay or coinsurance, deductible and network, so check whether the therapist is in-network.
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What Happened
Leah, 29, has a marketplace plan and books weekly sessions with a licensed therapist in her plan's network. Her plan charges a $30 copay per visit, the same as a regular doctor's visit, so her first month costs $120. A friend chooses a therapist outside her own plan's network and pays the full $150 fee each time, then submits receipts for partial reimbursement under her plan's out-of-network benefit.
Likely Relevant Policies
- Marketplace (ACA) health plan
- Employer health plan
Potential Coverages
Behavioral health benefit High likelihood
Marketplace plans must cover behavioral health treatment, such as psychotherapy and counseling.
Out-of-network benefit Possible likelihood
Some plans pay part of an out-of-network therapist's fee; others pay nothing outside the network.
Employee assistance program (EAP) Possible likelihood
Some employers offer a few free counseling sessions through an EAP, separate from the health plan.
Possible Exclusions
- Therapists outside the plan's network, on plans without out-of-network benefits
- Services the plan doesn't consider medically necessary
- Couples counseling or coaching that isn't treatment of a diagnosed condition, on some plans
Questions That Determine Coverage
- Is the therapist in your plan's network?
- What is your copay or coinsurance for outpatient mental health visits?
- Have you met your deductible?
- Does the plan need a referral or prior authorization?
Recommended Immediate Actions
- Search your plan's provider directory for in-network therapists.
- Call the plan and ask about your outpatient mental health cost per visit.
- Ask the therapist's office to confirm they bill your plan.
Documents to Collect
- Insurance card
- Summary of benefits and coverage
- Receipts and superbills for out-of-network visits
Common Claim Process
In-network therapists usually bill the plan directly, and you pay your copay or coinsurance. For out-of-network care, you often pay up front and submit a superbill to the plan for any reimbursement.
Potential Outcomes
- In-network sessions cost your copay or coinsurance.
- Out-of-network sessions are partly reimbursed, or not at all.
- A denied claim can be appealed.
Risk Prevention Tips
- Confirm network status before the first session.
- Keep a record of each visit and payment.
Frequently Asked Questions
Do health plans have to cover mental health care?
Marketplace plans must cover behavioral health treatment, including psychotherapy and counseling, as an essential health benefit.
What are mental health parity protections?
They generally mean a plan's limits on mental health care can't be stricter than its limits on medical and surgical care, such as copays and visit limits.
Can a plan refuse coverage for a past mental health condition?
Marketplace plans can't deny you coverage or charge you more because of a pre-existing condition, including mental health conditions.
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The factual claims on this page were checked against these sources. Rules and figures change, so check the source itself if you need to confirm the current version.
- Mental health and substance abuse coverageHealthCare.gov (Centers for Medicare & Medicaid Services)
Educational information, not advice: This page describes how health coverage generally works, not how your plan will decide a claim. Check your plan's documents. This is educational, not medical or legal advice. If you're in crisis, call or text 988.