It’s not uncommon for people to be hesitant when it comes to seeking out mental health care.
Behavior
Does insurance cover therapy?
It’s not uncommon for people to be hesitant when it comes to seeking out mental health care.
This could be due to the common perception that these services are expensive or that physical health is often prioritized over mental health in today’s society. However, the reality is that you may find yourself able to afford more therapy than you thought. Many insurances offer coverage for mental health services, and even if your plan isn’t one of them, there are other options available to you.
Ultimately, when looking into whether or not your insurance policy covers therapy, do some research first to identify which services are provided and the associated costs.
Education resources
Can You See A Therapist On Your Insurance?
For many people, seeing a mental health professional or therapist is essential in maintaining their mental and emotional well-being. But can you see a therapist on your insurance? Let’s look at what you need to know about using insurance for mental health care.
Insurance Coverage For Therapy Varies
The coverage offered by insurance companies varies significantly depending on your specific plan. Generally speaking, most insurers provide some mental health coverage, but the details of that coverage can be difficult to decipher from your policy.
In addition, if you have an employer-sponsored plan, your benefits may be limited depending on your job role or other factors.
Out-of-Pocket Costs
Even if your insurance covers therapy or mental health services, out-of-pocket costs are usually associated with each visit. This could include co-pays for each session and additional fees for medication or tests administered by the therapist.
Diagnosis Is Required
For a therapist or mental health professional to file an insurance claim on behalf of a patient, they must first diagnose them with a specific condition, such as:
- Depression
- Anxiety
- PTSD
- Phobias
This diagnosis must be made officially for the insurer to approve coverage for therapy sessions for that patient; without this diagnosis, insurers typically won’t provide coverage for those services.
Does Your Insurance Provider Cover Therapy?
If you have an employer-provided health care plan, one of the first steps is to look over the details of your policy. Some employer plans cover therapy as part of their benefits package, so look at what’s available through your company’s healthcare plan.
Remember that some plans may require prior authorization before covering any treatment. It’s also important to note that while some policies provide coverage for mental health services, they may not pay the total cost of treatment. Make sure to check if there is any limit on the amount your insurance will pay for therapy costs.
Although, as we’ve established, does insurance cover therapy? is yes, this only applies to “necessary” therapy. For any medical service to be deemed “necessary” by an insurer, there must be an official diagnosis from a medical professional. For your insurance provider to cover therapy, you will likely need to obtain an official diagnosis from a psychiatrist or psychologist. This can feel intimidating for some people, but receiving the coverage you need may be necessary.
Relevant Legislation For Getting Therapy On Insurance
Getting the help, you need for mental health issues is becoming more accessible due to relevant legislation. These laws help ensure that individuals seeking therapy can access it at a reasonable cost. Although each insurance plan is different and may have restrictions, most insurance plans now provide some therapy and mental health services coverage.
The Mental Health Parity and Addiction Act (2008)
The passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) was a significant milestone for mental health reform. This federal law requires insurers to provide equal coverage for the treatment of both addiction and mental health conditions. By mandating equal coverage for all types of care, the MHPAEA has made it easier for individuals needing treatment services without fear of financial burden due to inadequate insurance coverage.
Since its passage, the MHPAEA has positively impacted access to mental health care and addiction treatment services across America. Before its passage, 49 million Americans were uninsured, 2% had no coverage for mental health, and 7% had no coverage for substance abuse treatments.
Affordable Care Act (ACA)
The Affordable Care Act, also known as the ACA or Obamacare, was enacted in 2010 to provide Americans with more accessible and affordable health insurance. In addition to expanding coverage for physical health services, the ACA requires mental health coverage for specific plans.
The ACA requires all qualified health plans (QHPs) offered through Health Insurance Marketplaces to cover 10 essential health benefits, including mental health and substance use disorder services. These plans are required to cover an array of services related to mental health care, such as psychotherapy and counseling sessions, treatment for substance abuse disorders, and medications used to treat mental illnesses. Additionally, QHPs must offer these benefits without imposing pre-existing condition exclusions or higher cost-sharing on individuals with mental illness diagnoses.
Health Insurance Marketplace plans must uphold the following concerning mental health:
- Cover mental health and behavioral health inpatient services. These include hospitalization, partial hospitalization, and outpatient programs.
- Cover pre-existing conditions without imposing any additional costs on individuals with those conditions. Even if someone has a history of mental illness or addiction disorder before purchasing a plan through the marketplace, they will still be able to receive coverage for their condition without paying more than someone without a pre-existing condition would have to pay.
- Provide coverage for behavioral health treatments such as counseling and psychotherapy. If you need therapy or counseling sessions with a qualified mental health professional, your plan must cover it. It’s important to note here that limits may be placed on how many sessions are covered each year—so be sure to check with your provider for more information about their coverage limits.
Ensure that parity protections are in place so that coinsurance, co-pays, and deductibles are equal or close to any medical and surgical benefits a plan offers.
Insurance Providers That Cover Therapy
Some key plans cover therapy, but this is not an exhaustive list. To get a definitive answer, does my insurance cover therapy? you should speak to your insurance provider.
CHIP (Children’s Health Insurance Program)
The Children’s Health Insurance Program (CHIP) provides federal funding to states that they can use to offer low-income households with children access to quality and affordable health insurance. Coverage varies from state to state, but most plans include a wide range of mental health services, such as:
- Counseling
- Therapy
- Medication management
- Substance use disorder treatments
- Peer support
- Social work services
CHIP helps bridge the gap between uninsured children and those whose families may not be able to afford private insurance or the cost of coverage through their employers’ plans.
Medicare
All three parts of Medicare offer some support for individuals seeking mental health treatment.
- Part A covers substance use services and inpatient behavioral health treatment, though you may be responsible for deductible and coinsurance costs.
- Part B covers many outpatient mental health services, such as yearly depression screening, but you may have to pay out-of-pocket expenses like deductibles, co-pays, or coinsurance.
- Part C often provides therapeutic services at the same level or better than your original Medicare plan. It’s essential to research your specific coverage as it can vary based on location, age, and other factors.
Medicaid
Medicaid plans are government-funded programs designed to provide comprehensive healthcare coverage for those with limited resources. These plans are available in all states and must adhere to the Mental Health Parity and Addiction Equity Act (MHPAEA), meaning they must include services such as substance use disorder treatment and mental health care.
Depending on the state, Medicaid plans can cover a wide range of treatments, including mental health services like individual counseling, group counseling, medication management, case management, emergency stabilization services, substance abuse treatment, crisis intervention services, family therapy, peer support services, and more. It’s important to note that each state will have specific rules regarding what is covered under a Medicaid plan. Therefore it’s wise to research your local plan before selecting a provider or seeking treatment.
Blue Cross Blue Shield
Blue Cross plans started after 2014 are covered under the Affordable Care Act (ACA). This means that therapy provided by a mental health professional is covered in most cases. However, only evidence-based services, such as psychotherapy and psychoanalytic treatments, may be covered by Blue Cross Blue Shield. Other services, such as life coaching or career coaching, are not covered.
Furthermore, plans taken out before 2014 may not cover mental health services. It is essential to check the specifics of your plan to ensure you get the coverage you need.
Kaiser Permanente
Kaiser Permanente provides mental health treatment tailored to each member’s individual needs. Members can often access therapy with a nurse practitioner or psychiatrist and potentially even group therapy through their treatment plans.
Additionally, Kaiser offers a variety of stress management and mental health classes that focus on helping people understand their mental health issues better and learning tools to cope with them. Also available are addiction counseling services that provide individuals struggling with substance abuse the support they need to overcome their challenges.
Find Out if Your Insurance Covers Therapy
You can follow a few easy steps to determine if your insurance covers therapy. Doing this research ahead of time can save you both time and money when seeking treatment.
Ask your HR department
If you have insurance through your employer, your Human Resources team is available to answer any questions, even if you don’t want to explain the specifics of the treatment you need.
Additionally, they can explain eligibility requirements for dependents and spouse coverage and provide information about supplemental plans that may be available.
Check the details of your insurance plan
Most insurance plans have a website with details about what services are covered and how much it will cost for those services. Alternatively, you can always call your provider and discuss your plan with them to find out if your insurance covers therapy.
It’s essential to understand the ins and outs of your particular insurance plan when seeking medical help, whether through a therapist or doctor’s office. Knowing which providers are accepted under your plan can save time and money when seeking medical treatment.
Ask the therapist
If you are considering therapy, you must check with the therapist and insurance company to ensure they accept your insurance plan. Even if a provider is listed as accepted by your insurance company on their website, this is not a guarantee that they currently accept it; providers can opt out of plans at any time.
To ensure you have the most up-to-date information, contact the therapist directly and ask if they are in network with your particular plan.
What Types of Therapy Are Covered by Insurance?
The specific mental health services and treatments covered by your insurance plan can vary. It is essential to understand what is covered by your particular insurance provider. The most common mental health treatments that tend to be covered are:
- Talk therapy like CBT (Cognitive Behavior Therapy) and psychotherapy
- Online therapy,
- Psychiatric emergency care,
- Outpatient therapy sessions,
- Addiction treatment.
Understanding what exactly is covered by your insurance plan will help ensure that you get the most effective and affordable treatment options available.
Online Therapy Health Insurance Coverage
With insurance companies offering more coverage for online therapy, it’s a growing option for those looking to access mental health care. It provides a tremendous level of convenience and privacy that allows people to better prioritize their mental health without making significant changes in their schedule.
Conclusion
If you’re wondering if your insurance covers therapy sessions, it’s essential to determine precisely what type of coverage is included in your plan. Some policies may include coverage for in-person visits with a licensed therapist and online video counseling or phone consultations with a mental health professional. It’s also worth noting that many insurance plans feature different levels of deductibles or co-pays, which can affect how much you’ll need to pay out-of-pocket for each session.
